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Panic Attacks in Children and Youth: Information for Parents and Caregivers

Summary: Panic attacks are periods of intense fear caused by the body’s alarm being triggered, leading to a sudden adrenaline surge and numerous distressing physical symptoms. Panic attacks can be scary and overwhelming. The good news is that there are many things that can help with panic attacks.
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Petra's Story

Petra is in her last year of high school. Unfortunately, it has been a stressful year -- there have been difficulties with peers, and the work has been very hard as well. Now she’s having periods out of the blue where she feels panicky and anxious for no reason. During these times, she feels her heart racing, starts sweating and has to leave the room, and ends up hiding in the bathroom until she feels better. Things are so bad that she is starting to skip classes in order to avoid having an attack…
 

How would you support Petra?

Introduction

Everyone gets anxious from time to time. The good part of having ‘just enough anxiety’ is that it helps warn us about potential danger. But if there is so much anxiety (such as panic) that it starts to cause problems, then it may be an anxiety condition (such as panic attacks)...

What Are Panic Attacks?

Panic attacks are brief periods of intense fear triggered by a sudden release of adrenaline, which causes physical symptoms such as:
  • Heart (or cardiac) symptoms, e.g. heart racing, pounding heart, chest pain

  • Respiratory symptoms, e.g. shortness of breath, feeling smothered

  • Gastrointestinal (GI) symptoms, e.g. nausea, vomiting or stomach pains

  • Inner ear (i.e. vestibular) symptoms such as feeling dizzy, lightheaded or faint

Although the period of intense panic is relatively brief (lasting only a few minutes up to half an hour), one can continue to feel anxious for hours afterwards. 

Why Do People Have Panic Attacks?

The good news is that as human beings, we have an alarm system designed to warn us about danger. This is useful, because when faced with physical dangers (e.g. being attacked by a sabre tooth tiger), this alarm system jumps into action, and creates a surge of adrenaline in our body, which then helps us either “fight” the danger, or take “flight” and run away from the danger. Eventually, the danger passes, and then our body gets back to normal. 
 
Unfortunately, our alarm system is not as well adapted to deal with the more long-term stresses that we face in modern society, such as school, work, relationships, and the sensory overload of modern society. As a result, our alarm system often becomes triggered, leading to panic attacks. 

Why Causes a Particular Panic Attack?

Some people are more sensitive to having panic attacks, such as those with
  • A family history of anxiety or panic disorders: In these cases, it may be that their bodies are simply wired to be more sensitive. 

  • More stressful childhoods to begin with, which makes the alarm system more sensitive. 

Panic attacks may be triggered by things such as: 
  • Physical stresses affecting the body (e.g. certain drugs or medications such as too much caffeine; stimulant medications; thyroid problems.)

  • Emotional or psychological/social stresses (e.g. problems with work/school, conflict with others)


What Is the Difference Between Panic Attacks, Panic Disorder and Agoraphobia?

Panic attacks: Sudden, brief period of intense fear with physical sensations. People can have panic attacks, but it is not called a disorder, unless it actually impairs one’s function or gets in the way of life.
 
Panic disorder: When a person has had several panic attacks, which continue to occur, and in addition, where the panic attacks cause problems with functioning with school, work or relationships. E.g. the person starts avoiding going places, or avoids doing things due to fear of having a panic attack.
 
Agoraphobia: When people avoid going out, generally due to fear of having a panic attack. Agoraphobia comes from the Greek words “agora-”, the marketplace, and “-phobia”, a fear. Literally, it means ‘a fear of the marketplace’.

Self-Help: What You Can Do BETWEEN Panic Attacks 

WHere are some strategies that you can practice ahead of time to help yourself in the event you feel the anxiety coming on: 
  • Practice deep breathing. When people are feeling anxious, they often tend to breathe faster. Unfortunately, breathing too fast can actually make you feel dizzy and lightheaded, which then makes you feel even more anxious… 



    Try this:


    • Take a long, slow breath in through your nose. Imagine your lungs filling with air.


    • Hold your breath, while counting “one, two, three”


    • Exhale slowly through your pursed lips, while you relax the muscles in your face, jaw, shoulders, and stomach. 


    • Repeat


Still having troubles? Consider other breathing exercises such as 

  • Combat breathing. Combat breathing is the type of deep breathing exercises taught to soldiers, and other professionals who need to know how to cope with panic and anxiety. There are many examples of Youtube videos, and apps, such as “Tactical Breather” to help teach this.


     
  • Breathing into a paper bag. A classic strategy that helps one breathe more slowly is breathing into a paper (not plastic!) bag. 


Breathing slowly helps with anxiety.

Other things that may be helpful to practice ahead of time:
  • Butterfly hug. The butterfly hug is a technique described by Dr. Francine Shapiro in her book “Getting Past Your Past: Take Control of Your Life with Self-Help Techniques from EMDR Therapy”. Look for 'butterfly hug' on Youtube.com to view videos on how to do this simple yet powerful technique.

     
  • Don’t avoid going places in order to avoid a panic attack. Because panic attacks are so distressing, people will sometimes avoid situations in a misguided attempt to avoid having more panic attacks. Unfortunately, that just makes the panic harder to deal with the next time around, and leads to people avoiding more and more situations. For example, a student who has a panic attack in a classroom might avoid going back to that classroom, out of fear of having another panic attack. Unfortunately, this can lead to people avoiding more and more situations. 


 

  • Use positive coping thoughts.
 Remind yourself that although the symptoms of panic are scary due to the adrenaline rush, they are not dangerous nor harmful; it is not a heart attack and you will not die from having a panic attack. The symptoms are just the body’s “fight or flight” response to stress. You will get through the episode 



Self-Help: What You Can Do DURING a Panic Attack

  • Notice that you are starting to feel anxious, with acceptance and without judgment. You might say to yourself: “I notice I’m starting to get anxious. Okay, that’s fine. I’ll get through this. I’ll some deep breathing. Either way, I know its not the end of the world. It may feel horrible, but its like a storm that I just have to ride out.” 
     
  • Try not to judge or criticize or feel sorry for yourself. Try to avoid critical thoughts such as, "Why does this always happen to me? I'm such a loser for feeling this way..." These thoughts are usually not helpful.  
     
  • Be self-compassionate. Remind yourself that you're only human. You might remind yourself: "Everyone's imperfect. I'm human, so its okay if I'm not perfect." Chances are, these are the same supportive things you'd tell a close friend or family member if they had anxiety and panic!
     
  • Deep breathing. Use the deep breathing that you’ve hopefully practiced ahead of time such as:
    • Breathing into a paper bag.
    • Taking a deep breath in the nose, then counting one to three, and then exhaling and repeating
    • Butterfly hugs

For Family and Friends: How to Support Your Child/Youth DURING a Panic Attack

Do’s
 
If your loved one is in the midst of having a panic attack, you might try the following: 
 
  • Make the observation that they may be feeling anxious. 

You: “You look really anxious right now.”
  • Show them that you accept them no matter what -- even if s/he is feeling anxious and having a panic attack. We all want to feel accepted deep down, and when we don’t feel accepted by others, it can make us feel anxious and unsafe at a deep level. 

You: “I’m here for you. We’ll get through this together.”
  • Ask how you might be helpful

You: “Anything I can do to help?”
  • If your loved one knows what is helpful, then great. 

You: "Okay, let's do that..."
  • Suggest options, if your loved one does not know what s/he wants. 

You: “I find deep breathing can be very helpful. Do you want to try some deep breathing with me?” (and then take some slow deep breathes with your loved one) 
  • Consider grounding and distraction strategies, which help a person cope with panic, by getting the person to focus on something other than the panic. 


You might try the 5-4-3-2-1 technique: 

• “Name five things you can see in the room with you.


• “Name four things you can feel.


• “Name three things you can hear right now.


• “Name two things you can smell right now.


• “Name one thing that you are grateful for in your life.”


 

Don’ts 

  • Don’t blame, judge or make the person feel bad for having anxiety. Negative judgment only makes the person feel worse.  After all, you have not lived life as that person with the body and brain that they were given...

Don’t say, “If you’d only listen to me, you wouldn’t have this anxiety.” “It’s your fault for having drunk all that coffee.” “It’s your fault for having stayed up all night.”




  • Don’t give advice or direction if its not welcome. When someone is overwhelmed during a panic attack, usually s/he wants validation and empathy first. When your loved one feels accepted and understood, s/he will calm down, and then will be more open to your suggestions or advice. 



Do not start with telling your loved one what to do, "You really should do deep breathing, get more exercise, cut down on your coffee, etc..."

Self-Help: Supporting Your Child/Youth BETWEEN Panic Attacks

Do’s 
  • Create a ‘What to do in case of panic plan’. Do talk with your child/youth when everyone is calm about what you might do if there is a panic attack. It usually has elements like this:

    • Here are the signs I am having panic…

    • Here are things that I can do about it…

    • Here are things that others can do to support me



       
  • Help your child/youth live a healthy lifestyle that is soothing and calming for your loved one’s body, brain and mind. As a parent, you can ensure that your child has

     
    • Nutritious meals.

       
    • Regular outdoor time. 
       
    • Enough sleep, i.e. usually 9-11 hours for the average teen.

       
    • Abstains from alcohol, cigarettes, marijuana and other recreational drugs 

       
    • Support for stresses. Look at what stresses your child/youth is under, and see if anything can be do to reduce or support your child with those stresses. 


  • Accept your loved one. At a deep level, human beings feel safest when they feel accepted by others. Thus, demonstrate through words and actions, that you accept and want to be with your loved one. 

     
  • Validate that they have anxiety, and that you are there to support them. 
    You: “I can see that you are feeling anxious… Let me support you!”


    You might ask how you might be helpful

    You: “How can I be helpful? How can I be supportive? What can I do for you?”  

Don’ts
  • Don’t judge or criticize. Especially for people with anxiety, judgment or criticism can be very difficult, and tends to make people with anxiety feel more anxious  

Treatments for Panic and Anxiety: Talking Therapy 

If the anxiety/panic is not improving on its own, then consider professonal help such as seeinga  counselor/therapist (such as a social worker, psychologist, or registered psychotherapist) for ‘talking therapy’ (aka psychotherapy). This is where you talk about the anxiety, and you work with the counselor/therapist to find ways to deal with your anxiety. 

Treatments for Panic and Anxiety: Medications 

Medications can be helpful for panic and anxiety symptoms when other things have been tried, but they have not been that helpful. 
 
Examples include:
  • Serotonin reuptake inhibitors (SSRIs), which work by increasing the function of the brain chemical serotonin.

  • Benzodiazepines, which work by increasing the brain chemical GABA, which directly reduces anxiety.

  • Monoamine oxidase inhibitors (MAOIs)

  • Tricyclic antidepressants 

Medications are prescribed by a medical doctor, such as family physician, paediatrician or psychiatrist.

Finding Help for Anxiety

If you are concerned that you (or a loved one) may have anxiety or panic then:
  • See your primary care provider such as a family physician. It is important to see your primary care provider,, because in some cases, certain medical conditions can mimic anxiety. Conditions such as problems with thyroid levels, heart problems, or other conditions may mimic anxiety. In such cases, treating the underlying medical condition is the solution.



  • Your family physician may also recommend other mental health professionals such as:

    • Psychologist

    • Psychiatrist

    • Therapist/counselor


Petra's Story, Part 2

Petra is a high school student who is starting to have panic attacks.

 

Petra tells her parents. She is relieved to see that they are understanding and supportive, and listen to her talk about how she is feeling, as opposed to jumping in with criticism or advice. They take her to see her family doctor, to see if there might be any medical problems that would explain her symptoms. 

 

Her doctor gives her the good news -- there are many things that can be done for anxiety and panic. The doctor recommends a few things: 

  • An app for calming and deep breathing strategies (e.g. Headspace, Calm.com) 
  • Lifestyle changes such as putting the devices away before bedtime, and getting more sleep 

Her doctor schedules a follow-up for 1-2 weeks later to see how things are going. In the event that things do not improve, she is reassured to know that there are other strategies such as counseling that may also be an option.  

 

Things gradually get back to normal as the panic attacks disappear. It has now been several months since her last attack, thanks to using her coping strategies and the support of her family. 

Canadian Resources

For adults
 
Anxiety Disorders Association of Canada
 
Anxiety Disorders Association of Ontario
 
AnxietyBC.com
 
Association des Troubles Anxieux du Quebec.
http://www.ataq.org
 
For youth

Readings

For parents
  • Helping Your Anxious Child: A Step-by-Step Guide for Parents, Spence Rapee, 2000
  • Freeing Your Child from Anxiety: Powerful, Practical Solutions To Overcome Your Child's Fears, Worries, And Phobias, Tamar Chansky, 2004
  • Keys to Parenting Your Anxious Child, Katharine Manassis, 1996
  • Monsters Under The Bed And Other Childhood Fears: Helping Your Child Overcome Anxieties, Fears, And Phobias, Stephen Garber, 1993
For mature youth and adults
  • Don’t Panic, Reid Wilson, 1996
  • Anxiety and Phobia Workbook, Edmund Bourne, June 2005

About this Document

Written by the eMentalHealth.ca Team. 

Disclaimer

Information in this pamphlet is offered ‘as is' and is meant only to provide general information that supplements, but does not replace the information from your health provider. Always contact a qualified health professional for further information in your specific situation or circumstance.

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Date Posted: Jan 20, 2017
Date of Last Revision: Jan 21, 2017

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