Susan D. Swick, MD, MPH
In the exam room, pediatricians witness a wide range of fears in children, from fear of getting a shot to social shyness to performance anxiety before a big game or college applications. Anxiety in youth is universal and developmentally normal, although it may signal a disorder when it is impairing function or clearly disproportionate to the stressor.
It also always presents an opportunity: to nurture courage. Courage is not the absence of fear, but the ability to act in spite of it. Courage is also an essential skill for mental health across the lifespan. Courage empowers a child to explore a new interest or face a bully, fuels a teenager to ask someone on a date or to accept treatment for their drug abuse, and equips an adult to leave a bad relationship or to run for office. Cultivating courage builds self-knowledge, resilience, autonomy, and emotional maturity.
Pediatricians are uniquely positioned to counsel patients and their parents in practical strategies to foster courage across developmental stages. You can normalize discussions around anxiety, fear, and courage during well-child visits. Brief, open-ended questions — such as “What’s something that felt a little scary for your child recently?” — can open the door to valuable conversations. Reassure parents that their support is critical, even though progress may feel slow. With your encouragement, parents can nurture courage in their children.
Michael S. Jellinek, MD
What Is Courage?
Strength is a good paradigm, because courage is a set of skills — cognitive, emotional, and behavioral — that we build by facing challenges. Courage is built upon the ability to bear the discomfort of uncertainty and anxiety, to consider different choices available in the face of a challenge, and to move from thinking to taking action. The anxiety of a personal failure prevents some children from even trying or having the grit to persevere while in the learning phase of any activity. Courage is partially built on self-esteem.
Key Principles for Parents
Know Your Child
Different children have different temperaments and histories. They will experience anxiety in response to different challenges and in different ways. Parents are the experts on their children. They are uniquely equipped to stay connected to their child when they meet a moment of difficulty. With support, a child can face and manage that moment. That is courage. There will be discomfort, setbacks, and failures. But in trying, children are building the skills that are essential to their mental health. And they will be deepening their knowledge of themselves, their empathy, and their resilience in the process.
Build Emotional Vocabulary
Naming emotions gives children the power to learn how to manage them. When they can say, “I feel nervous,” they can bear it a little longer and learn what they need to do to handle big feelings while taking action.
Small Steps
Avoidance reinforces anxiety. Instead, help parents find opportunities to guide their children through small steps toward managing and eventually mastering what they fear. Talk about what makes each step doable and whether it gets easier with practice.
Reframe Success
Fear of failure is a major barrier to courage. Parents can remind children that mistakes are how we learn. There are no successes without many small failures first!
Model Courageous Behavior
Courage is contagious. Younger children emulate adult behavior and teenagers are watching what adults do more than listening to what they say. Parents model courage by trying new things, acknowledging when they’re anxious, and demonstrating tenacity in the face of uncertainty or setbacks. They should talk about what helps them be courageous and that each of us learns our own strategies.
Courage at Each Stage
Infancy to Toddlerhood (0-3 years)
Infants and toddlers have everything to learn about the world, but their most important education is through moment-to-moment interactions with their attuned caregivers. This is how they develop a secure base from which to explore. This secure attachment is the cornerstone of self-esteem and creates the foundation of their future mental health.
Tips for Parents:
- Respond to distress consistently and sensitively; showing calm concern helps them learn to bear discomfort as they calm themselves down.
- Encourage exploration in safe environments.
- Normalize stranger anxiety and separation anxiety — they are usually temporary. Bear them thoughtfully alongside your child with soothing words and physical reassurance without overreacting.
- Use simple affirmations (“You’re safe,” “You did it!”) to reinforce small acts of bravery.
Preschool (3-5 years)
Imagination flourishes — and so do fears. Monsters under the bed or fear of the dark are common during this phase of magical thinking.
Tips for Parents:
- Be curious about what your child is afraid of. Model calm curiosity.
- Avoid shaming or dismissing fears.
- Encourage pretend play to give children control over scary situations. Play with them and let them be the monster or the hero!
- Introduce books, games, or movies with courageous characters, and wonder with them what that character is feeling.
School Age (6-11 years)
Children have all the cognitive tools of adulthood but are still emotionally young. They have great capacity for empathy and prioritize fair play as they begin facing academic, social, and moral challenges. Peer comparisons and performance anxiety may rise.
Tips for Parents:
- Encourage effort over outcome and praise risk-taking in exploring and learning. Be curious about how it can feel (uneasy, uncomfortable, or stomach-turning), before, during, and after the effort.
- Pay attention to the smaller challenges where discomfort is easier to bear.
- Discuss examples of courage that they encounter, such as civil rights activism or a favorite athlete’s performance during a losing game.
- Promote autonomy — let them order their meal, ask a question, or walk to school when developmentally appropriate.
Adolescence (12-18 years)
Teens are establishing their identity, deeper relationships, independence, and impulse control. They are wired to tolerate higher levels of risk in the pursuit of novel experiences, especially in a social context. The need for courage in these years often arises when they face social stigma (facing a bully, resisting peer pressure, or managing embarrassment) or when they face letting go of something familiar to try something new.
Tips for Parents:
- Be a good listener: show up reliably and be calm and curious to encourage teens to talk without rushing to counsel them.
- Encourage responsible risk-taking (eg, trying out for a team, applying for a job).
- Remind them of what has helped them in the past when facing a challenge.
- Discuss current events, entertainment, or sports with a lens on courage.
- Emphasize self-compassion — help teens get comfortable with picking themselves up after a setback failure.
When to Ask for More Help
Whether they have an anxious temperament, a history of trauma, or an underlying anxiety disorder, some children will struggle with anxiety. They will need specialized skill building and support to develop courage. Perform a Screen for Child Anxiety Related Disorders (SCARED) for a child if:
- A child avoids most social situations or refuses to attend school.
- The fear is persistent, disproportionate, or not developmentally appropriate.
- There is disabling distress or physical symptoms (eg, stomachaches, headaches) with no clear medical cause that have led parents to accommodate a child’s avoidance.
- There is a persistent pattern of low self-esteem that inhibits trying.
If the screen is positive, work with the parents to locate a psychiatrist or a therapist who has experience treating anxiety disorders in children.
Final Thoughts
Helping children become courageous doesn’t require heroism — it requires small, consistent efforts by supportive adults. Pediatricians play an essential role by guiding parents to foster courage as an important developmental skill. When youth and their parents understand that courage is a critical part of a healthy and full life, a skill that is developed over time, they can face sources of anxiety not as things to be avoided but instead as precious opportunities to build courage. And those children will become adults who are equipped to meet life’s challenges with courage.
Pediatricians are uniquely positioned to counsel patients and their parents in practical strategies to foster courage across developmental stages.
