Panic Attacks in Children and Youth: Information for Parents and Caregivers
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?
- 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
Why Do People Have Panic Attacks?
Why Causes a Particular Panic Attack?
- 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.
- 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?
Self-Help: What You Can Do BETWEEN Panic Attacks
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…
- 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.
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.
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
For Family and Friends: How to Support Your Child/Youth DURING a Panic Attack
||You: “You look really anxious right now.”|
||You: “I’m here for you. We’ll get through this together.”|
||You: “Anything I can do to help?”|
||You: "Okay, let's do that..."|
||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)|
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’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.”
||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
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
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’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
Treatments for Panic and Anxiety: Medications
- 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
Finding Help for Anxiety
- 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:
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.
- 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
- Don’t Panic, Reid Wilson, 1996
- Anxiety and Phobia Workbook, Edmund Bourne, June 2005
About this Document
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Date of Last Revision: Jan 20, 2019