Anxiety, Night Terrors, Stick Out Your Tongue – PediaCast 468

Show Notes


  • We have a “news parents can use” edition of PediaCast for you this week as we explore childhood anxiety, night terrors and kids who stick out their tongue. We hope you can join us!


  • Childhood Anxiety
  • Night Terrors
  • Kids Who Stick Out Their Tongue



Announcer 1: This is PediaCast.


Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello, everyone. And welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We are in Columbus, Ohio.

It's Episode 468 for August 12, 2020. We're calling this one "Anxiety, Night Terrors, and Stick Out Your Tongue". I want to welcome all of you to the program.

So, you would have noticed that we did not have a PediaCast episode last week. And the reason is because we had a family vacation. Now, that family vacation was supposed to be a trip to San Antonio. We were going to enjoy river walk, explore the city, check out Sea World down in Texas and just have a little bit of family fun in the heat of a Texas summer. 


But, of course, like many, many things, the pandemic changed our plans. But we thought it was still important just to take some time off, do something different even though it was still at home. So we spent some time on the patio. Actually, lots of time back on the patio, which we have sort of turned into our own little resort over this past summer.

And we watched the birds. We watched movies. We really watched a lot of baseball and just overrelaxed. And I would encourage you, even if you're spending a ton of time at home, please still take a vacation, even if it just doing something different at home and relaxing, doing something fun with the kids.


Even though we're home a lot for many of us, especially those of you who are working from home, it's still important to take that mental break even if you don't change the physical location too much. So, I would definitely recommend it. 

All right, it has been a while since I flew solo on the podcast and simply brought you some news parents can use. That's what we're going to do this week as we consider, first, childhood anxiety, which is a very common problem and an important consideration as we head toward the beginning of a new school year, especially during a pandemic.

We'll also talk about night terrors. This typically affect younger kids especially toddlers. They're sort of scary to witness, with kids suddenly making loud noises and moving all around, sort of trashing about, sometimes loudly, while they appear to be sleeping. 

Night terrors are different than nightmares and we'll explain how they're different. We'll also look into their cause, let you know what to do during a night terror episode and suggest some ideas for preventing their occurrence. So that is coming up.


And then, we'll consider a question many parents have regarding their child's tongue. What does it mean when babies, toddlers, children, teenagers, even adults stick out our tongues, especially for those who seem to do it often? Is that a problem? When should you let your doctor know? 

Now, of course, to answer that question is whenever you're concerned, let your doctor know, even if it's something that ends up being nothing. It's a great idea to bounce your questions off your child's pediatric healthcare provider. That is always recommended.

Sticking out the tongue is particularly common while concentrating, so we'll explore some theories on why these occurs. And do you need to do anything about it? When should you worry? 

Again, if you're worried, fine, you're worried. But if you're kind of going back and forth, is this something to worry about, we'll talk about that.


Turns out there are times to definitely worry about it, especially in babies. If their tongue seems too big or their jaw seems too small, both possibilities can lead to a baby's tongue sticking out often and that could be caused by health condition. 

So lots of details coming your way regarding your child's tongue. See, we've got you covered from every angle on PediaCast. We leave no stone unturned including tongue problems.

I do want to remind you that every episode of PediaCast is available wherever podcasts are found. You'll find us in the Apple and Google Podcast apps, iHeart Radio, Spotify, SoundCloud, and most other podcast apps for iOS and Android.

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We also have a contact link at the website over at, so if you have a question or a comment for the program, you want to suggest the topic for future episode, we would love to hear from you. 

Also, I want to remind you the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your healthcare provider. Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at

So let's take a quick break and then we will be back to talk more about anxiety, night terrors, and sticking out the tongue. It's coming up right after this.



Dr. Mike Patrick: This News Parents Can Use edition of PediaCast is brought to you, in collaboration with Medical News Today. You'll find them at They curate terrific evidence-based content from all corners of the Internet and include topics for adults and children related to health and wellness. Be sure to visit their website for lots more medical news and information.

First stop is anxiety. Anxieties are normal response to stress and it happens in both adults and children. An anxiety disorder is a medical condition that involves regular, high levels of anxiety that are difficult to control. An anxiety disorder may interfere with the child's ability to engage in day-to-day activities such as going to school, socializing or maintaining relationships.


The Anxiety and Depression Association of America report that 25% of all young people between the ages of 13 and 18 have an anxiety disorder, so this is a very common condition. They also note that children living with untreated anxiety disorders are more likely to perform poorly in school, miss out on social experiences and engage in substance abuse.

So, what are the signs and symptoms of an anxiety disorder? Well, a child with anxiety may be reluctant to leave his or her parents. They may cry often or want to miss school. They may seem scared in situations such as social gatherings or they may refuse to speak to other people or engage in everyday activities. 

Of course, all of this is compounded by the COVID pandemic, so some of these responses are going to be normal with the uncertainties of today. But if these feelings and responses are prolonged, exhibited often, and interfering with the quality of your child's life and/or impacting your family's life, then an anxiety disorder maybe the problem.


Physical symptoms of anxiety are possible and these may include any of the following symptoms, shaking, shortness of breath, butterflies in the stomach, a hot face, clammy hands, dry mouth, a fast heartbeat. Sometimes, many of these symptoms are present together in an intense episode called a panic attack. 

Children may also find it hard to sleep, have bad dreams, struggle to concentrate, and be quick to become angry or annoyed. Some children want to use the toilet very often or say that they have frequent stomach aches. 

Of course, these symptoms and behaviors can also be caused by other medical conditions. So if they are occurring, be sure to touch base with your child's doctor to get the right diagnosis and treatment plan.

Anxiety disorders can be subdivided into some specific types. The first is a generalized anxiety disorder. Children with this may be very anxious about a range of issues and situations including schoolwork, grades, and exams, friends, family, relationships, and how well they perform in activities such as music or sports.


A child would generalized anxiety disorder is likely to be overcritical of their work and abilities and they may seek reassurance from others.

A panic disorder is another one. Children with this have multiple panic attacks which are often unexpected and without any clear trigger. They just happen, which can lead to child to worry about having another attack, with the worry sometimes lasting a month or more between episodes.

And then, there are separation anxiety disorder. This is common and, in fact, normal for young children between 18 months and about three years of age. However, it becomes a disorder when it lasts beyond age three, especially when the symptoms are severe and frequent. 

These older kids with separation anxiety disorder have feelings of worry when a parent or guardian leaves the room or is no longer visible. This condition is most common between seven and nine years of age and affects about 4% of children.


A child with separation anxiety disorder may refuse to go to school, camp, or a friend's house. They may ask for someone to stay with them while they sleep. Also, they might experience severe homesickness when they are not with their family.

Then, we have social anxiety disorder. Children with this worry excessively about interacting with other people or they are especially anxious about meeting new people or being called on in class. 

And then, selective mutism, this is a severe type of social anxiety. A child with selective mutism maybe too anxious to talk in specific situations. Although they may talk comfortably with people whom they know well. Sometimes parents or caregivers only find out that their child has selective mutism when teachers report that the child refuses to speak in class.


So, what can you do if your child is affected by one of these forms of anxiety? Well, first, recognize that you and your child are not alone. Anxiety disorders are very common, again, affecting up to 25% of older kids. And even more so given the current pandemic, very common to have anxiety and then again it becomes a disorder when it's really disrupting quality of life for the child and/or your family. 

So beyond recognizing that this is common and that you're not alone, the second thing to do is just to get some help from someone knowledgeable on the treatment of anxiety disorders. Of course, a great place to start your search for help is going to be your child's medical provider. They can assess the severity and urgency of the problem. They're going to be familiar with your local resources and will be able to point you in the right direction for that help. 

However, there are some things you can do at home while you are getting connected with that help. Now, it may seem on the surface simple matter of removing sources of anxiety from your child's life. However, sometimes, there is no obvious source. Anxiety just happens and some sources of anxiety are mostly good things, like school and activities and relationships.


Of course, there are some harmful sources of anxiety and removing those or minimizing their impact may be appropriate. But what is most helpful is guiding your child toward effective and productive ways to cope with situations and activities that make them anxious, which will lower their levels of anxiety over time and set them up for success when new anxieties come their way.

Now, when talking to a child about anxiety, it's important to ask open-ended questions. So instead of asking a yes or no question such as, "Are you feeling anxious?" ask how a particular question makes your child feel. Let them do the describing. 

Of course, there may not be a known situation. In this case, simply start with the feelings. What are they? When do they occur? And this may lead to the discovery of a related event or situation, if one exists.


This kind of conversations will help your child begin to see connections between feelings and life events. And it will help them begin to gain some control over their feelings. It will also prepare them for the sort of conversations they can expect when they talk to a counselor or psychologist

It may also help to teach your child to recognize signs of anxiety, including the physical symptoms. Stick to regular routines whenever possible, practice taking three deep slow breaths together with your child and encourage them to repeat this pattern when feelings of anxiety occur. 

For young children, distraction can help. For instance, if a child is anxious about going to stay with other family members, playing games such as I Spy can distract and help. You can make a worry box out of an empty shoe or tissue box. Have your child write down their worries and add them to the box as the worries come along. Then at the end of the day or the week, you can talk through the concerns with your child.


Ahead of a big change such as moving or changing schools, give your child time to adjust to the idea and talk about the reasons that the change is happening. To calm a child during a panic attack or a particularly anxious moment, give them an object and ask them to describe it in as much detail as possible, which is really another form of distraction.

Then, modeling good coping mechanisms toward our own anxiety as parents at home can also teach your child how to deal with anxiety in a healthy way, which means it is not necessary for parents or caregivers to hide all of their anxiety from a child. By managing stress and anxiety in healthy ways, we can lead by example.

If anxiety is mild and the strategies help, it might be all you need. However, as I mentioned before, if anxiety is severe or frequent or affecting school and relationships, be sure to check in with your child's doctors. They can connect you with a pediatric mental health specialist.


For more help on managing anxiety in kids, there is a great article from Medical News Today called What To Know About Anxiety in Children. We'll put a link to that in the Show Notes for this episode. And then we did a podcast, Episode 432, of PediaCast with Dr. Anna Kerlek, Anxiety in Children and Teenagers, where we really spent much more time and take a deeper dive into anxiety in children. So, I would encourage you to listen to that and again, we'll have a link to that in the Show Notes over at

Many toddlers experience night terrors. Now, they are different than nightmares and they do not have a lasting effect, but they can have a trigger, including excessive tiredness before going to bed, a fever or illness, needing to go to the bathroom, or a sudden noise, or there may be no trigger at all.


Night terrors are common and occur while a child is slow-wave sleep, which is the stage of deepest sleep during the first third of the night. This is not when dreams occur, so there is no dreaming during a night terror, which is why we say they are different than nightmares.

Now during a night terror, the sort of scared panic motion parts of the brain just fire. And we don't exactly know the mechanisms by which this happen but a child may seem panicky. They may scream, make sudden movements. They can shout unintelligible words, flail, or kick in bed, sit up in bed, make sudden movements, sometimes even jump out of the bed and seemed panic, distraught or afraid. 

They may even sweat or breathe heavily. So again, the brain is just telling the body to do this without there being any consciousness involved or a child doing it by will. It just happens.

Now, when night terrors occur, it's best to stay calm and not wake your child. Just make sure they're safe especially if they get out of bed. In fact, your child will be very difficult to wake during a night terror episode. Again, because they're in a very deep state of sleep when this happens. 


They may fight you or swing their arms or kick their feet, although not necessarily in an intentional way. Their eyes might even open, but keep in mind, this is all happening during, again, the deepest part of sleep. So if they do wake up, they're likely to be confused and that your child is unlikely to remember any of this the next day.

If night terrors occur often, you can try to eliminate any known trigger such as loud noises when they're sleeping. Make sure they use the restroom before going to bed and allow time for afternoon naps and create bedtime routines. 

Put your toddler to bed at the same time each night. Limit screen time well before bedtime. Dim the lights and read a book. All of these will prevent your child from being overly tired and help them get the recommended amount of sleep, which for toddler is going to be 10 to 14 hours in a 24-hour period. So we do include naps in that total time.


Worries and significant life change can also be associated with night terrors. So, prepare your child for upcoming change by talking about the change in advance and talk through worries with your children. Gauge how they're feeling and help them sort through their feelings. This will not only help the symptoms of anxiety, it can also prevent night terrors.

Now, in many cases, there is not a known trigger and nothing you do is really going to help. But there are still some good news, night terrors are typically short episodes lasting no more than about 15 minutes. And again they are not harmful. They generally go away on their own when your toddler gets a little bit older.

And so how exactly then are night terrors different than nightmares? Although both night terrors and nightmares disturb sleep and cause distress, as we've said, they're quite different. And they happen during different stages of sleep.


You'll recall there are two types of sleep, rapid eye movement sleep, also called REM sleep, and non-REM sleep. Non-REM sleep has three stages, falling asleep, light sleep, and deep sleep. And every person cycles through stages of REM and non-REM sleep throughout the night. 

Most dreams and nightmares happen during REM sleep. So a toddler may wake from a bad dream, remember what happen and be able to explain it. Causes of nightmares include worries and scary experiences like watching scary things on television.

In contrast, night terrors happen during non-REM sleep, most typically early in the night when parents are still awake and able to witness the occurrence. Your child, however, is sleeping deeply. Even though their eyes might be open, their body is moving and words or screams are coming out of their mouth, they're still sleeping. 

And if you wake them up, they will be confused. They'll wonder why in the world you're waking them up and there will be no dream to report. If you just let them be which you should, they'll have no memory of the event the next day.


So does your child need to see a doctor for night terrors? Generally speaking, no. However, if your child has whole body stiffening or jerking or drooling, especially if there's no talking or screaming with that, then you want to make sure these events are not seizures, simply describe what's going on to your child's doctor and take their advice from there. 

Again, as I mention frequently on this program, there's no concern too small. If you are concerned about what's going on and you're not sure are these night terrors or is it something else, it's always a good idea to talk to your child's doctor when concerns arise. Even if, at the end of the day, the events are simply night terrors which are not harmful and eventually go away on their own. The pediatricians are here to help and we always love hearing from parents with any concern about your child.


Great article from Miracle News Today on night terrors, Night terrors in toddlers: Symptoms, causes, and management. I'll put a link to that in the show notes for this episode. And then I actually wrote a blogpost on night terrors for the 700 Children's blog at Nationwide Children's Hospital. And I will put a link to that in the show notes.

Sticking out the tongue can have many meanings. Children may use it as a sign of silliness, while others might do it to express disgust. A person may also stick out their tongue when he or she concentrates. A baby who sticks out their tongue could just be learning about their body or it might indicate an underlying health issue. 

Indeed, some health conditions caused tongues to stick out. Although, when this is the case, there are usually other symptoms present which we will explore in a moment.

Our first consideration, however as we think about tongues sticking out, is body language. Sticking out the tongue is often a sign of silliness or playfulness and the meaning of a tongue sticking out may change depending on the culture and or situation.


For example, Maori warriors do it to demonstrate ferocity and defiance. Meanwhile in Tibet, sticking out the tongue is a sign of respect or a greeting. Sticking out the tongue is a rude gestures in some cultures. However, the context, situation and intent of this behavior may alter its meaning. 

Sticking out the tongue can indicate the person is being rude, mocking, disgusted, taunting, teasing, playful, cute or flirtatious. Again, the intent and context determine the meaning. For example, a person who sticks out their tongue during a photo is probably not being rude. It may be a sign of playfulness or an attempt to take a silly picture. 

So why do some people stick out their tongue compulsively, especially when they're concentrating on another task or lost in thought? One theory behind this is that it could stem from the evolution of human communication as a transition from a hand gestures to voice. Babies can further demonstrate this link between human gestures and speech.


Infants go through a stage of gesturing before they conform words, so language and gestures evolve together. The tongue plays a role in many other automatic processes involving the mouth such as forming words, swallowing and keeping itself from being bitten by teeth.

Nerve endings and taste buds cover the tongue and both send a steady stream of information to the brain. The tongue plays a key role in thinking and with language centers in the brain.

In addition to moving, when a speaker speaks, the tongue may also partially form words that a person nearly thinks. When someone sticks out their tongue as to concentrate, they temporary stop communication between the tongue and the brain with some scientist believe make it easier for other areas of the brain to communicate with each other, thus freeing up brain power for the task at hand.

Now, why do scientist think this? Well, because for many individuals, complex tasks involving the hands triggers the pathway which makes the persons stick out their tongue involuntarily. 


In any case, sticking out the tongue during a task is certainly not harmful and it is not a sign of an underlying issue.

All right, so what about babies? Why do they stick out their tongue? Well, there may be several reasons, although the exact reason for a particular baby sticking out his or her tongue at a particular time, that maybe difficult to know.

But there are many possibilities, the first being play and imitation. As a baby discovers their body, they can make many different gestures. It's common for infants to make motions with their mouth. They may open and close their mouth repeatedly, stick out the tongue, blow raspberries and make various sounds and vocalizations.

For some babies, sticking out the tongue may become a habit because it feels fun or interesting. A baby may also copy with their parents, caregivers or others around them do. One study in the Journal of Developmental Science found that this form of imitation may occur in infants as young as one week old. This mimicking and exploratory behaviors are all normal and help a baby learn about their body.


Sticking out the tongue can also be a sign of hunger, especially when a young child also opens their mouth and smacks or licks their lips. Young infants may stick out their tongue as they turn their head toward their mother's breast or a bottle. They may also clench their hands and put their fist in their mouth.

Sticking out the tongue can be a sign of teething in babies. Teething babies may also chew on their tongue, their hands, and other objects, which is why small things should be placed out of reach, better yet out of sight. Either way, constant supervision is required to prevent choking and other injuries.

Sticking out the tongue can also be a sign of mouth breathing or babies generally breathe through their nose. One or more issues may make this more difficult, congestion, block nasal passages, large tonsils, and other issues can cause infants to breathe through their mouth instead of their nose. If this happens, they may stick out their tongue more than usual.

Now, macroglossia is another possibility. Macroglossia is the medical term for a large tongue. A person with this condition may stick out their tongue more than normal. If the tongue does not fit inside the mouth, it may even stick out most of the time.


Macroglossia is typically secondary to some conditions such as Down syndrome, hypothyroidism, and Beckwith-Wiedemann syndrome that may develop from abnormal muscle growth or other genetic factors. So if as a parent, you think your baby's tongue is larger than it should be, be sure to share that concern with your baby's doctor. 

Micrognathia is also possible. Micrognathia is the medical term for a smaller than average jaw. It may occur due to genetics and may also cause the tongue to stick out because it does not fit in the mouth. In this case, the issue is not the tongue being too large but rather a jaw that is too small to hold a typical size tongue. 

Micrognathia may develop in some condition such as Pierre Robin sequence or cleft palate. So babies and children who stick out their tongue more than usual certainly deserve a quick check by your doctor to ensure there is not a health condition present.


However, most of the time, sticking out the tongue is normal, especially when it occurs in particular situations or while concentrating.

For more information about sticking out the tongue, I will put a link to an article from Medical News Today called What To Know About Sticking Out The Tongue. You'll find that in the show notes over at


Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that.


Don't forget, you can find PediaCast wherever podcast are found. We are in the Apple and Google podcast apps, iHeart Radio, Spotify, SoundCloud, and most other podcast apps for iOS and Android.

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Also, I want to remind you we have another podcast called PediaCast CME. That stands for Continuing Medical Education. It's similar to this program. We turn up the science a couple notches and offer free Continuing Medical Education Credit for those who listen, including doctors, nurse practitioners, physician assistants, nurses, pharmacist, psychologist, social workers, and even dentist.


And since Nationwide Children is jointly accredited by many professional organizations, it's likely that we offer the exact credits that you need to fulfill your state's Continuing Medical Education requirements. Shows and details are available at the landing site for that program, You can also listen wherever podcasts are found. Simply search for PediaCast CME.

Thanks again for stopping by and until next time, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So long, everybody.


Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.

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