Anxiety & Worry

NICE recommends a whole-school approach: a supportive climate, trusted relationships, universal curriculum content on social and emotional skills, targeted support for those who need more, and trained staff. The DfE and Public Health England eight-principle framework covers the same ground and is the tool most schools already audit against.

Neither points primarily towards purchased provision. Both point towards the ordinary conditions of the school: predictability, how adults speak to children, how consistently expectations are applied, and whether staff have the confidence and time to respond well.

Anxiety-related absence is where policy, duty and compassion collide, usually under pressure. DfE guidance on mental health issues affecting a pupil's attendance, alongside the statutory 'Working together to improve school attendance', sets a support-first expectation where health or SEND is a factor — support and adjustment alongside the expectation of attending, not enforcement alone.

• Do attendance meetings routinely ask what is happening for the child, or only what the percentage is?
• Is there an agreed, written approach to partial and phased reintegration, or is each case improvised?
• Are absence patterns read at lesson and day level, not just as a total?
• Who holds the relationship with the family when attendance is falling — and is it someone the child trusts?
• Are part-time timetables tracked centrally, time-limited and reviewed?

Anxious children can present as refusal, walking out, or sudden anger. DfE behaviour advice expects clear, consistently applied expectations alongside reasonable adjustments for pupils with SEND. Schools run into difficulty at both extremes: rigid application that sanctions a child for the thing they need help with, and unpredictable discretion that leaves staff unsure and children unsafe.

The leadership question is whether staff know which adjustments are sanctioned, who decides, and how they are recorded — so that adjustment is policy rather than the disposition of an individual teacher.

NICE specifically recommends training so staff can support wellbeing. EEF implementation evidence suggests professional development that is sustained, modelled and followed up changes practice, while single training days largely do not.

• Can every adult describe what to do when a child is too anxious to come into class?
• Do staff know the difference between describing what they see and asserting a diagnosis?
• Is there somewhere to take a concern that is not yet a referral?
• Are staff supported after difficult incidents, and is workload part of the wellbeing plan rather than separate from it?

Know what exists locally — mental health support teams, educational psychology, school nursing, early help, voluntary sector counselling — who holds those relationships, and what happens to them when that person leaves. Waiting times mean school provision is often what the child actually gets, so it is worth being honest about its quality.

Relationships with families are provision, not communication overhead. Parents of anxious children frequently feel blamed, and they hold information the school cannot otherwise obtain. A first conversation that asks rather than tells changes what is possible afterwards.

1. NHSProfessional guidance
   Anxiety in children — advice for parents

   The plainest UK statement of the distinction this guide rests on: all children feel worried sometimes, and anxiety becomes a concern when it is out of proportion, persistent, and getting in the way of ordinary life.

2. NHSProfessional guidance
   Anxiety disorders in children

   Describes recognised anxiety difficulties and the routes to help — GP first, then local children and young people's mental health services. Diagnosis sits here, not with schools.

3. NHSProfessional guidance
   Children and young people's mental health — advice for parents

   The parent-facing hub, including what to do first and where support exists locally.

4. National Institute for Health and Care ExcellenceProfessional guidance
   Social, emotional and mental wellbeing in primary and secondary education (NG223) (2022)

   Recommends a whole-school approach: supportive climate, trusted relationships, universal curriculum content, targeted support for those who need more, and staff training to deliver it.

5. National Institute for Health and Care ExcellenceProfessional guidance
   Social anxiety disorder: recognition, assessment and treatment (CG159) (2013)

   Clinical guidance covering children and young people. Referenced here only to be clear where the clinical threshold and treatment decisions sit — with health services.

6. Department for EducationProfessional guidance
   Mental health and behaviour in schools (2018)

   Non-statutory advice on the line between what a school can reasonably provide and what needs a clinical service — the question most often at issue with anxiety.

7. Department for EducationProfessional guidance
   Mental health issues affecting a pupil's attendance: guidance for schools (2023)

   Directly addresses anxiety-related absence: attendance is usually improved by support and adjustment alongside expectation, rather than enforcement alone.

8. Department for EducationStatutory guidance
   Working together to improve school attendance (2022, statutory from 2024)

   Sets out the 'support first' expectation and the duties schools and local authorities hold where attendance is affected by health or SEND.

9. Department for EducationStatutory guidance
   SEND Code of Practice: 0 to 25 years (2015)

   Names anxiety as an example of a social, emotional and mental health need, and sets out the graduated approach — assess, plan, do, review.

10. Department for Education (research by University College London)Research evidence
    Identifying and supporting children and young people with social, emotional and mental health needs: a rapid evidence review (2025)

    Part of the DfE's SEND evidence programme. Published as research; the DfE states it does not endorse the approaches described.

11. Education Endowment FoundationResearch summary
    Improving Social and Emotional Learning in Primary Schools — guidance report (2019, updated 2021)

    Recommends teaching social and emotional skills explicitly and using them across the day. Rated by the EEF as moderate impact for very low cost, on moderate evidence.

12. Public Health England / Department for EducationProfessional guidance
    Promoting children and young people's mental health and wellbeing: a whole-school and whole-college approach (2021)

    The eight-principle framework most UK schools audit their wellbeing provision against.

13. Anna FreudProfessional guidance
    Mentally Healthy Schools

    Quality-assured UK resource bank for primary schools — useful when choosing classroom materials that are not simply commercial products.