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Panic Attacks in Children

By Krissi Maarx

Karen, an eight-year old girl, was sitting outside at summer camp when she suddenly felt as if her surroundings were surreal. This is a common symptom of anxiety attacks known as de-realization. She then panicked when she couldn’t catch her breath, and so she grabbed the arm of the nearest camp counselor. Moments later, two more staff members had to pull her away from him because she refused to release her grip. This was in 1960, and the on-site nurse assumed that Karen had had “too much sun.”

Recognizing Panic Attacks in Children

Anxiety attacks in children are sometimes mistaken as tantrums or as symptoms of a physical illness. They can also co-occur with asthma, eating disorders, or depression. The symptoms of a panic attack include:

  • Dizziness or lightheadedness
  • Increased heart rate
  • Trembling and shaking
  • Sobbing
  • Shortness of breath or rapid breathing
  • Intense fear or worry
  • A sense of detachment from reality

After her first attack, Karen constantly felt nervous and uneasy, “like a rubber band—ready to snap.” On her first day of high school, she experienced another bizarre sense of reality and an incapacitating pang of fear, just as she’d had at summer camp. It repeated the next day. And then the next. She dreaded going to school because she couldn’t attend it without hyperventilating.

Some children may try to avoid school or refuse to attend it due to the discomfort of anxiety and fear of recurring attacks. When a child has frequent “sick days” or refuses to attend school due to anxiety, she may complain of headaches, stomachaches, and nausea or diarrhea, which may or may not be present.

Because panic attacks can come from an anxiety disorder, you may also notice symptoms of separation anxiety (fear of being apart from a parent), obsessive-compulsive disorder (intense worry and ritualistic behaviors), social anxiety, or generalized anxiety disorder. If a child has two or more panic attacks followed by continuous fear of having another, she may have panic disorder.

Treating Childhood Anxiety Attacks

While it’s not common for prepubescent children to have panic attacks, approximately 10 to 15 percent of children and adolescents do have an anxiety disorder, according to The Merck Manual. If left untreated, children with anxiety disorders may fail academically, have greater difficulty in relationships, resort to substance abuse, or develop agoraphobia.

When Karen could no longer attend school in 1967, her doctor unsuccessfully treated her for a sinus condition and then thought she had a brain tumor. After undergoing extensive medical testing to no avail, Karen lost hope that she would recover from these symptoms, and she was referred to a mental health professional. But because she did not receive the help she needed in a timely manner, she had developed agoraphobia (fear of open spaces) before her intake at a psychiatric facility.

Thankfully, our knowledge of anxiety and panic has dramatically improved since the 1960s, especially due to the anxiety research and trials conducted in the 1990s.

If you notice symptoms of panic in your child or suspect that she may have an anxiety disorder, you should contact her primary care physician for a medical evaluation before consulting a psychologist. Her physician will examine her for any underlying medical conditions, such as asthma, hypoglycemia, a sinus condition, and heart or lung disorders. He can then provide a referral for mental health services if needed.

Panic attacks can be as difficult to diagnose today as they were when Karen was young, especially when they occur during childhood and adolescence. But with proper diagnosis and adherence to an effective treatment plan, many children who suffer from panic attacks are able to cope with their anxieties.

The best treatment depends on the severity of the condition, but mental health professionals ordinarily use cognitive-behavioral therapy (CBT) alone or in conjunction with anti-anxiety or antidepressant medications, such as Luvox (fluvoxamine) and Prozac (fluoxetine).

With the help of CBT, children and adolescents learn to control the thought patterns that trigger panic episodes, and they develop healthy behaviors and coping mechanisms through gradual exposure to anxiety-inducing environments. Other forms of therapy may include dialectical behavioral therapy (DBT) or acceptance and commitment therapy (ACT), according to the Anxiety Disorders Association of America.

Considerations for Treating Childhood Anxiety Disorders

Because anxiety disorders tend to run in families, you may want to consider individual or family therapy if you and your child both struggle with anxiety. The Merck Manual notes that treatment of a parent’s anxiety in conjunction with treatment for the child is helpful in approximately 30 percent of cases.

Family therapy not only addresses anxiety disorders in other family members, it can help you identify and change any family dynamics that may contribute to the child’s anxiety. While there may be a genetic predisposition behind mental health disorders, our environments and relationships can also trigger or aggravate an anxiety condition.

Overprotective parenting is one example of a relationship that can contribute to anxiety in children. If you seem to live in fear of situations or consequences (real or imagined), it’s possible that your child will internalize those fears and feel anxious with or without good reason.

Today’s children also live with stricter scheduling than they once did, and they are under a lot of pressure to perform exceedingly well in academics, sports, and extracurricular activities. When children and adolescents face harsh consequences for average performance in these areas, they tend to develop anxiety and feel poorly about themselves.

In addition to these factors, nutrition is yet another consideration when treating anxiety and panic. Caffeine and sugar can produce physical effects similar to the symptoms of anxiety, which can then trigger a panic attack. This can also happen when a child devours a lot of sugary foods. Her blood sugar will crash to a below normal level as the sugar wears off, and the crash can feel like a panic attack or trigger one.

It’s important that you examine these issues when helping a child cope with anxiety. Psychotherapy and medication can be incredibly helpful, but they cannot always help children relieve the underlying source of their worries or physical symptoms.

To promote your child’s recovery further, provide a structured environment and encourage her to participate in healthy activities. You may wish to keep her away from settings and activities that trigger her anxiety, but doing so will only reinforce her anxious thoughts and behaviors. Again, with the help of CBT, it’s likely that she will be able to participate in healthy activities without having a panic attack.

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