Panic Attacks in Children: 5 Key Tips for Immediate Relief
Unfortunately, panic attacks in children are sky-rocketing right now, particularly in teenagers.
This is true not only among children who attend my psychology clinic, Everlief, but in the wider world too.
It’s estimated that 2.3% of teenagers are diagnosed with panic disorder.
Panic attacks in children can be incredibly distressing for the child, but for you as a parent (or teacher) too.
In most cases there is nothing wrong with your child’s brain or their body, it’s just trying to protect them.
Child Panic Attack: What Does it Look Like?
A panic attack is an intense physical and emotional experience where the body goes into full alert, fight or flight mode.
Panic attacks in children can happen even when there is no real danger, but the child’s brain perceives something as a threat.
For example, a child may have a panic attack because they are asked to read a poem aloud to the class.
Very often however, child panic attacks do not have a clear trigger, and may be the cumulative effective of more than one stressful event for the child.
Child Panic Attack Symptoms
Symptoms can include:
- Increased heart rate and/or palpitations.
- Shortness of breath.
- Chest pain.
- A tingly sensation, particularly in the hands or feet.
- Feeling lightheaded.
- Tunnel vision or blurred vision.
- Stomach discomfort or pain.
- Nausea.
- A feeling of sheer terror.
Once the brain triggers a safety alert, it cannot tell the difference between real or imagined threats.
It triggers the release of cortisol, adrenaline and other chemicals designed to put the body in emergency mode so that it can get to safety.
Anxiety Attacks in Children: Understanding “Panic About Panic”
Panic attacks can be a traumatic event in themselves.
They can be deeply distressing and the child may feel that they are dying or having a heart attack.
This can lead to intense fear of a repeat of the panic attack which can heighten your child’s anxiety further.
As you can see, this is a really unpleasant vicious cycle. The techniques I recommend will help your child escape the vicious cycle of panicking about panic.
Panic Attacks in Children: The Cycle of Avoidance
Understandably, children often try to avoid specific situations in which they have had panic attacks previously.
This can lead to loss of confidence and increased overall anxiety.
In severe cases this can become debilitating as we may generalise our fear to other situations.
For example, if a child’s anxiety was triggered by a new social situation such as a party, they may start to avoid all social situations.
Over time and with a “menu” of coping strategies including those I suggest below, you should aim to support your child to break the avoidance cycle.
Why is My Child Having Panic Attacks?
Stress can build up in children from a variety of sources such as school pressures, social challenges, or family issues.
When stress accumulates, it overstimulates the body’s “fight or flight” response. This overload can tip the scale, leading to a panic attack.
It’s like a stress “cup” that eventually overflows, triggering intense feelings of fear and physical symptoms like rapid heartbeat.
Addressing stress triggers early on is key to reducing and preventing panic attacks.
Explaining Panic Attacks to Children
As a parent, it’s important to explain to your child that a panic attack is a sudden feeling of intense fear and anxiety.
Let them know that while it can feel scary, it’s a natural response to stress and their body’s way of trying to protect them.
Explain to your child that during a panic attack, their heart may start racing, they may feel like they can’t breathe, and they may have other physical symptoms.
It’s important to reassure them that a panic attack can’t hurt them and it will eventually pass.
Understanding the science of panic attacks can make all the difference. It can help us manage and prevent panic attacks because we know it’s a normal response and it will pass.
Here’s a script you can use for children of approximately 5-10 years:
A panic attack is when your body suddenly feels very scared and your heart starts to beat fast.
Sometimes it can feel like you’re going to die, but it’s actually just your body trying to protect you.
You might feel like you can’t breathe, your hands might shake, and you might feel like you want to run away.
But remember, a panic attack can’t hurt you.
It will pass after a few minutes.
It’s important to take slow, deep breaths and remind yourself that you’re safe.
It can also be helpful to talk to a grown-up you trust.
Older children and teenagers will find this video helpful.
Anxiety Vs Panic Attacks in Children
An anxiety attack is a little different from a panic attack. Anxiety attacks are not officially recognised by the Diagnostic and Statistical Manual (Version Five) or DSM-V, whereas panic attacks are. Anxiety attacks can also involve severe anxiety but the symptoms of anxiety are less intensely physical in nature. Also, panic attacks tend to come on very suddenly.
What is Panic Disorder?
Panic disorder is defined in the DSM-V as:
“…an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur:
Note: The abrupt surge can occur from a calm state or an anxious state.
- Palpitations, pounding heart, or accelerated heart rate.
- Sweating.
- Trembling or shaking.
- Sensations of shortness of breath or smothering.
- Feelings of choking.
- Chest pain or discomfort.
- Nausea or abdominal distress.
- Feeling dizzy, unsteady, light-headed, or faint.
- Chills or heat sensations.
- Paresthesias (numbness or tingling sensations).
- Derealization (feelings of unreality) or depersonalization (being detached from oneself).
- Fear of losing control or “going crazy.”
- Fear of dying.
Note: Culture-specific symptoms (e.g., tinnitus, neck soreness, headache, uncontrollable screaming or crying) may be seen. Such symptoms should not count as one of the four required symptoms.
B. At least one of the attacks has been followed by 1 month (or more) of one or both of the following:
- Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, “going crazy”).
- A significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations).
C. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders).
D. The disturbance is not better explained by another mental disorder (e.g., the panic attacks do not occur only in response to feared social situations, as in social anxiety disorder; in response to circumscribed phobic objects or situations, as in specific phobia; in response to obsessions, as in obsessive-compulsive disorder; in response to reminders of traumatic events, as in posttraumatic stress disorder; or in response to separation from attachment figures, as in separation anxiety disorder).”
The Link Between Panic Attacks and Anxiety Disorders
If you child is anxious in many situations and has many worries, they may meet the diagnostic criteria for generalised anxiety disorder. This is sometimes known as GAD. GAD is one of the risk factors for panic attacks. If your body is often hyper-alert to dangers, it is more likely to go into overdrive and trigger panic.
Panic attacks can occur out of nowhere if your child has no history of anxiety. However, they tend to co-occur (occur “co-morbidly”) with other common anxiety disorders such as:
- Obsessive-compulsive disorder.
- Social anxiety disorder (sometimes called social phobia).
- Specific phobia.
- Separation anxiety disorder.
- Selective mutism.
Please note that clinical psychologists – like me – do not get too hung up with diagnoses of one type of anxiety disorder or another, however.
On one hand, diagnoses can be helpful because they help an individual to understand why they are struggling. They can also help others to understand.
However, on the other hand we don’t always want to pathologise that someone is having a hard time. They may be having a normal reaction (anxiety) to traumatic events in their lives.
Psychologists generally prefer to focus much more on the individual child and what is going on for them, rather than the diagnosis. We develop a collaborative formulation (an understanding of the contributing factors) with the child and their family. We then create a treatment plan to help resolve the anxiety, which often involves talking therapy.
How to Treat a Child During Panic Attacks
1. Stay Calm During Your Child’s Panic Attack
Above all else, stay calm. Family members need to be calm and containing to make the child feel safe through co-regulation. This will help them recover more quickly.
If they are at school or in another environment, make sure they can go to someone who makes them feel calm and contained.
Ideally this would be an experienced adult, but for older children could be a friend who is confident enough to help.
2. Reassure Your Child to Help Them Recover Faster From Their Panic Attack
If you’ve experienced a panic attack before, you will know that the symptoms can feel absolutely terrifying.
Some children might fear they are going to die.
You need to reassure your child that it’s just their body trying to protect them. The brain feels there is danger nearby, and has kick started the body into “survival mode”.
You can read more about physical symptoms of anxiety here. The panic attack will pass. The worst will pass in a few minutes and it is not dangerous, even though it feels horrible.
3. Teach Your Child Effective Breathing Strategies to Resolve Panic Symptoms Fast
Help your child slow and deepen their breathing by doing it with them.
Take a slow breath for around 5 seconds that goes all the way down into the tummy, not just high up in the chest.
Then very slowly and steadily release the breath.
Ask your child to do it with you.
Try to make the out-breath a bit longer than the in breath. Aim for deep breaths of around 7 seconds.
Keep going with this breathing for at least five minutes, making sure the child’s breathing starts to synchronise with yours.
This type of breathing sends signals of safety to the brain.
It’s the opposite of the fast, shallow breaths that are triggered when the brain feels danger is present.
4. Panic Attacks in Children: The Power of Grounding
Once you have set deep breathing in motion for 5 minutes or so, use “grounding” to make your child aware of their senses, noticing the world around them. Grounding is all about moving yourself “into the body” rather than being caught up in your thoughts and fear.
First, ask them to listen and focus on what they can hear, both far away and nearby.
Can they hone in on one particular sound?
A repetitive sound perhaps?
Next move on to touch. What can they feel?
Perhaps the ground beneath their feet, a chair against their back, or clothing against their skin?
If there is an item of clothing or piece of material nearby that provides a nice sensation, suggest that they could stroke or rub this gently to give their body some soothing feedback.
Next focus on what they can see around them, perhaps talking this through in an interested and curious way if they are struggling to do it by themselves.
You can also focus on smell and taste senses, if there are appropriate opportunities.
5. Child Panic Attacks: Sit and Wait For The Peak to Pass
Sit quietly with your child until the panic attack passes, reminding them to slow and deepen the breath regularly, checking that on the in-breath their tummy is filling out like a balloon, then gradually emptying on the out-breath.
This is not an exhaustive list of things that help with panic attacks, but I wanted to keep the guide nice and simple so that it is easy to follow.
Panic Attacks in Children: What to do Afterwards
- Explain to your child that most of the symptoms they had are caused by stress chemicals adrenaline and cortisol. Even young children can understand this. All the physical symptoms are designed to help us survive immediate physical danger. This was helpful a few thousand years ago when we had lots of physical dangers to fight or run away from. They are not so useful now, when it’s more likely to be mental stress we face. This video might help you explain things to your child.
2. Remind your child that they are they are not going mad. As soon as the stresses in their life reduce a little, and they feel a bit more in control, the panic attacks will reduce or stop altogether.
3. Take it easy. Your child may feel exhausted, even for a day or two after the panic attack. Make sure they have plenty of rest and down time.
4. Develop a plan for how your child would like to be supported if and when the panic attack happens again, both at home and at school. It’s a good idea to make a written plan to help you remember what to do. For example:
Remember, panic attacks in children are common, especially at the moment.
They are not caused by anything you or your child have done wrong.
There’s a lot you can do to help, both in the moment and afterwards.
What to Do If You Need Further Support
If you are looking for professional support, speak to your family doctor or health insurance provider. If you are in the UK you can find an independent psychologist who can help by searching the AChiPPP database (Association for Child Psychologists in Private Practice). This will ensure you find a healthcare provider who is properly qualified and accredited.
You can also explore my popular online course for parents, Outsmart Anxiety.
Treatment for Panic Attacks in Children
Cognitive behavioral therapy is a powerful treatment for panic disorder.
It is often combined with other forms of therapy.
You can find out more about different types of therapists and the talking therapies they offer in this article I wrote about child therapists.
In severe cases a child and adolescent psychiatrist may prescribe selective serotonin reuptake inhibitors (SSRIs) alongside talking therapy as part of the treatment plan.
For younger children under 8, cognitive behavioural therapy can be adapted but a child won’t have full ability to identify and challenge their problematic thoughts yet.
For this reason, with young children your therapist will work mainly with you, their parent, to enable you to support your child. Any therapeutic intervention with your child will be play-based.
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Dr Lucy Russell is a UK clinical psychologist who works with children and families. Her work involves both therapeutic support and autism assessments. She is the Clinical Director of Everlief Child Psychology, and also worked in the National Health Service for many years.
In 2019 Lucy launched They Are The Future, a support website for parents of school-aged children. Through TATF Lucy is passionate about giving practical, manageable strategies to parents and children who may otherwise struggle to find the support they need.
Lucy is a mum to two teenage children. She lives in Buckinghamshire with her husband, children, rescue dog and three rescue cats. She enjoys caravanning and outdoor living, singing and musical theatre.
To learn more tips for helping your child manage stress, join my Facebook group, Parent Tips For Positive Child Mental health UK.
