Why is fear caused by punishment

Author: PD Dr. med. Gesche Tallen, editor: Julia Dobke, approval: Prof. Dr. med. U. Creutzig, last changed: 08/19/2020

In order to create the best possible quality of life for children and adolescents in palliative care, they must be helped to reduce fears and stress. To do this, it is especially important to recognize the various causes and signs of fear.

Causes of fear

Restricted activity, pain, the feeling of having been dispossessed of his body because so many other people now determine him, cause and stir up fears in those affected. The helplessness associated with it, the loss of the normal daily routine and the familiar social environment, the confrontation with death and many other problems can cause fear in those affected. Regardless of their level of development, children and adolescents think about the nature and causes of their illness. They come up with their own ideas. Often they feel guilty and perceive their illness as a punishment. They regularly experience emotional crises that make their previous worries even greater.

Special physical problems and complaints or side effects of medication can also be causes of anxiety, such as:

  • Brain tumors
  • Metabolic disorders (for example, lack of fluids, deficiency or excess of certain minerals in the blood)
  • Pain
  • Nausea and vomiting
  • Bleeding
  • certain medications (for example glucocorticoid e).

Important to know: Most children and adolescents do not express their fear directly with words. Instead, they react with defense. These defense mechanisms can differ depending on the course of the disease and the stage of development of the patient and can mask fear.

Signs of anxiety at different stages of the disease

While many children and adolescents initially successfully suppress a life-threatening illness at the onset of a life-threatening illness, i.e. around the time the diagnosis is made, when the illness progresses, they often react over-sensitive to most events in their environment. Most of the time, they unconsciously withdraw to an earlier stage of development, the so-called "regression". This withdrawal can be noticed, for example, through increased defiance and aggressive behavior towards the environment and oneself, rewetting or repeated outbursts of anger and despair. At the end of life, such intensive defense reactions occur less and less. It is therefore not always easy for relatives and carers to find out whether or not they still have feelings of fear. If the patient does not receive sufficient emotional and psychological protection in this phase, it is possible that they completely isolate themselves internally. So that such isolation does not occur, the patients need both the soothing therapy for existing complaints and continuous, intensive emotional support, especially during this time.

Signs of fear in different age groups

The following age groups often express their fear through certain behaviors or defense mechanisms that must be taken seriously:


Are often listless, increasingly inactive, wet again and withdraw internally.

Preschool Children

Often show separation anxiety, decreased tolerance for frustration (that is, they are more likely to cry or get angry more quickly than usual), sadness, and indifference.

School children (7-11 years)

They often deny their illness by ignoring it, at the same time they lose independence and are increasingly looking for attention, care and care. Above all, they fear for the integrity of their bodies (so-called "fear of mutilation").


Often behave rebelliously and aggressively. Their fears often relate to losing their independence (autonomy) and being excluded from their circle of friends.

Measures to reduce fears

Before the care team decides whether a certain treatment for anxiety, for example drug therapy, is indicated, it first investigates the possible cause (s) (so.) and try to fix it.

General and psychological methods (non-drug treatment)

The following non-drug measures can help reduce anxiety:

  • ensure unrestricted contact between parents / other important caregivers and the patient
  • Create an environment that is adapted to the emotional and medical needs of the patient (for most people it is their own home)
  • deal openly and sensitively with the patient (provide adequate information, answer all questions honestly)
  • Respect the patient's lack of need to talk about his or her fear / if possible do not initiate active discussions about the fear (can often trigger even more resistance)

It is often beneficial to let the patient decide for themselves when and whom to confide in. Most seriously ill children and adolescents do not enjoy talking to their parents about their concerns. It is therefore particularly important to give them the opportunity to speak to other, neutral, stakeholders such as psychologists. In addition, certain relaxation measures such as breathing therapy or also occupational and behavioral methods can help to free the patient from fears.

Treatment with medication

If the fears become so strong that they significantly limit important aspects of the quality of life such as independent action and communication, certain anti-anxiety drugs (so-called anxiolytics) can also be administered. The pediatrician, together with the patient and his or her parents, will carefully weigh the benefits and undesirable side effects against each other. If everyone agrees to treatment with anxiolytics (for example with benzodiazepines), this is usually only carried out for a short time. You should always use non-drug measures (so.) can be added.

Picture of a patient