During your child's panic attack you will help your child;
1. Label her feelings
2. Provide empathy and reassurance
3. Help your child regain a sense of control
Panic attacks in children can be very scary for children and parents.
As a parent, it can be unsettling and even anxiety provoking when your child hyperventilates, cries, and is very panicky.
Staying calm yourself is one of the keys to helping your child during a panic attack.
Children do experience panic attacks but it is relatively rare until the age of 14 (less than 0.4% of children).
The incidents of panic attacks increase after adolescence and might have something to do with puberty.
Children may not be able to identify what is happening or what they are feeling during a panic attack. It is important as a parent to pay attention to changes in your child’s behavior.
What are the Signs a child is having a Panic Attack?
Signs that your child could be having a panic attack include crying, tantrums, freezing, or clinging.
Children may also experience difficulty concentrating, perform poorly in school, refuse to go to school, become more irritable, have difficulty falling asleep, and complain of stomach aches and not feeling well.
What is a Panic Attack?
A panic attack is a sudden and uncontrollable feeling of fear and anxiety.
Panic attacks in children can happen during specific feared situations and they can happen randomly during periods of non-threatening, normal activities such as sitting and watching TV.
Children may also experience panic attacks during specific times of the day such as before going to school, bed time, or other daily situations. A child may become more worried and anxious as these situations approach in time.
Panic attacks are the body’s evolutionary response to a perceived external threat. The fight, flight, or freeze response is helpful if we encounter a wild animal poised to eat us. The adrenaline that begins flowing through our bodies aids in our escape and survival. When the external threat is defeated or evaded, the symptoms disappear.
For most people today, however, there is no wild animal. It’s a false alarm that signals an internal threat or danger. It’s a misperception of danger.
After experiencing a first panic attack, the fear becomes about experiencing another one.
What are the Symptoms of a Panic Attack?
Palpitations, pounding heart, or accelerated heart rate
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
Numbness or tingling sensations
De-realization (feelings of unreality) or depersonalization (being detached from oneself)
Fear of losing control or “going crazy”
Fear of dying
What are the Risk Factors for Panic Attacks?
Family history of anxiety: Some research indicates that first-degree relatives of patients with panic disorder have higher rates of panic disorder than relatives of patients with major depression and relatives of healthy controls (Goldstein et al 1994).
Respiratory illnesses: Conditions such as asthma can cause breathing issues that lead to shortness of breath and feeling dizzy. This could cause the fear of internal physical danger, triggering a panic attack.
Environment: Physical and psychological abuse, traumatic events, the death of a loved one, divorce, abandonment, and maladaptive behaviors learned from parents pose a greater risk for the development of an anxiety disorder such as panic disorder.
Those with an anxiety disorder may have inherited anxiety from their families as a result of stressful family and life circumstances.
Other anxieties: Other anxieties such as separation anxiety, social anxiety, and phobias all have the potential risk to trigger panic attacks.
What Causes Panic Attacks in Children?
General Causes of a Panic Attack
Children may experience panic attacks in certain situations and with other anxiety disorders such as;
Sensory overload: Some children may be sensitive to sound, light, and touch. They can become overwhelmed if there is too much sensory stimulation such as in a noisy restaurant.
Changes in their environment or family: Moving, changing schools, or even a parent changing hair color could create anxiety and trigger symptoms of panic.
Separation anxiety: It is normal for children between the ages of 8 and 14 months old to experience anxiety when their parent is not near them.
Children often go through a stage when they are "clingy" and fearful of unfamiliar people and places. When this fear occurs in a child over age 6 years, is excessive, and lasts longer than four weeks, the child may have separation anxiety disorder.
Generalized anxiety: Children typically experience worry about their competence or performance with school or sports. Children’s worries usually shift from one concern to another.
They may seek more reassurance and approval from parents. Children may also conform more and lack confidence.
Children will usually have more physical complaints such as stomach aches or feeling ill and may avoid going to school.
Social anxiety: Children may become anxious when meeting new people, having conversations, being observed by others, eating or drinking around others, and performing or giving a speech are some of the situations that someone struggling with social anxiety would likely want to avoid.
Phobias: Children may be afraid of specific objects or situations such as fear of the dark, flying, enclosed places, heights, animals, insects, water, seeing blood, getting an injection, and choking or vomiting.
Vicious Cycle of Panic and Misinterpretations: Children may incorrectly interpret a situation or a physical sensation (such as dizziness) as dangerous.
This misinterpretation causes fear of survival which turns on the flight or freeze response.
This increases the heart rate and physical discomfort further and confirms your child’s misinterpretation of danger. The cycle of panic is then triggered and the person experiences a panic attack.
Root Causes of a Panic Attack
Beyond other anxiety disorders, fears, and worry there are physical and mental processes responsible for panic attacks and anxiety.
These are evolutionary biological processes that are meant to help us in times of danger but often become a nuisance when there is no danger.
Sympathetic nervous system: The sympathetic nervous system is responsible for the “Stress Response” also called the “Fight or Flight or Freeze Response” in order to provide us with the internal resources to deal with a real threat or danger.
Just remember that the sympathetic nervous system "Sympathizes" with you in times of danger.
It is fast, automatic, and is activated mostly without your conscious control. It is responsible for the physical sensations of panic or the fight, flight, and freeze stress response.
Amygdala: During times of stress or danger, your senses send messages to your amygdala in the brain.
The small almond shaped amygdala is your emotional center and is responsible for causing the emotional feeling of fear.
When your amygdala gets the message that there is danger, it sounds the alarm for your sympathetic nervous system to release adrenaline to help you react to the danger. This causes the symptoms you feel during a panic attack.
The thinking part of your brain also gets this message so that you can determine if the danger is real or not. If you have the thought or belief that the danger is real, then your amygdala will get that message from your thoughts and it will continue to sound the alarm.
How to Help Your Child With a Panic Attack
If you believe your child is having panic attacks or another related anxiety disorder, it will be helpful and important to seek consultation with a mental health professional to first verify the diagnosis and then receive appropriate treatment.
1. Label the feelings
Asking your child to label and name her feelings during a panic attack will help move her from reacting and panicking to problem solving. This will begin to increase her sense of control when she feels out of control.
Stay calm and use a soothing voice to ask what your child is feeling emotionally and physically.
If your child is not able to describe what she is feeling, then ask her about specific feelings;
“Are you feeling scared? Do you feel shaky or wobbly in the legs? Where in your body do you feel it and what does it feel like?”
2. Provide empathy and reassurance
Tell her that you know how scary this can feel.
Confidently tell her “You are safe, it’s going to be OK, you will get through this, and I am going to help you.”
Tell her that the feelings in her body will go away and that the feelings are similar to feeling excited.
3. Help regain a sense of control
Panic attacks cause kids to feel out of control and to be afraid that they will lose more control. So anything that they can do to feel more in control will be helpful.
Deep breathing is a great way to exercise control over one’s body. Encourage her to do deep breathing.
“Take a deep breath, fill up your lungs, and hold your breath for a count of 2. Then forcefully blow the air out like you are trying to blow up a balloon.”
Ask her to look around the room and name all the blue or green things she can see. Ask her what she can smell and what she hears.
This will shift her focus from the uncomfortable internal physical and mental feelings to external tangible objects.
Give her a glass of ice water and ask her to take a few sips.
Drinking cold water helps to activate the calming effects of the parasympathetic nervous system or the “Rest and Digest system.”
Please note that distraction techniques, deep breathing, and any other “relaxation” techniques will help your child feel a sense of control and will help to alleviate the symptoms of a panic attack but they will not stop panic attacks at the root cause.
It’s like giving your child Advil to reduce a fever but the Advil will not treat the underlying illness that is causing the fever.
4. Educate your child about panic attacks
Teach your child what anxiety and panic attacks are. “The feelings you are having is your body’s way of helping you if there is danger. But sometimes our body makes a mistake and prepares us when there is no danger. Kind of like a fire drill. There is no fire but the alarm stills goes off really loud.”
“This alarm in our body gives us extra strength and speed. That’s why our heart beats faster and we breathe faster, just like when you are running. Just like when you are excited for something fun.”
“These feelings go away quickly, especially when our body gets the message that there is no danger.”
Teach your child how unhelpful worried thoughts can confuse the body to mistakenly think that there is danger when there is no actual danger.
Teach your child not to avoid dealing fear or fearful situations. Kids will normally want to avoid even talking about what they are afraid of.
Avoiding only provides temporary relief. Avoidance falsely confirms that the danger is real and should be feared when it is not real. Avoidance ultimately maintains the fear.
5. Reduce your child’s fear of the symptoms
Help your child feel more powerful by being able to create, control, and understand the feelings of a panic attack with exposure exercises.
Running in place for 30 - 60 seconds (racing heart, breathlessness, chest discomfort).
Rapid breathing just long enough to begin experiencing dizziness, breathlessness, racing heart, numbness and tingling.
Breathe in and out through a small straw for 30 – 60 seconds while pinching nostrils (choking sensations, breathlessness, racing heart).