No need to panic! How to help your child during a panic attack

By Dr. Sarah Ruiz, pediatric psychologist at CHOC 

Panic attacks are strong feelings of anxiety that come out of the blue without an obvious trigger. Kids and teens may feel intense anxiety along with different feelings in their bodies like their heart beating fast or feeling that they can’t breathe.

Panic attacks can begin at any age, with many reporting first having panic attacks in late childhood and their teen years. Studies have found that about 2% to 10% of teens report at least one panic attack in their life. Seeing your child have a panic attack can be scary and it’s not always clear how to best help. These feelings can be intense, but learning a bit more about panic attacks will help you and your child manage these scary symptoms better.

How do I recognize a panic attack?

Panic attacks are intense feelings of anxiety that can peak in about 10 minutes but can also last longer. These attacks are sometimes triggered, or brought on, by things happening around your child. Other times they may come out of the blue without any cause. You may see your child become quickly anxious and overwhelmed. Your child might also have other physical sensations that may be harder for you to spot, but kids and teens often report many physical feelings in their bodies including:

• Heart beating quickly.
• Shortness of breath or difficulty breathing.
• Feeling like they’re choking.
• Sweating.
• Shaking or trembling.
• Chest pain.
• Feeling like they’re going to throw up.
• Dizziness or feeling like they’re going to faint.
• Tingling.
• Chills or hot flashes.
• Feeling that things are not real, or like they’re watching themselves in a movie.
• Fear of losing control or “going crazy.”
• Feeling like they might be dying.

Because panic attacks are so uncomfortable, many kids or teens may start worrying that they will have another one. Some kids worry so much they start avoiding things they typically like to do or situations they think might lead to another panic attack.

Why is my child having panic attacks?

There are a lot of reasons why your child may be having panic attacks, and it is usually hard to find one set reason or cause. Stress, especially new or large changes, can often impact kids or teens and may be a reason why they have panic attacks.

Sometimes, kids and teens are predisposed to having panic attacks because they run in families or due to their own temperament or personality. Even if you or your child can’t find the reason or possible trigger, there are still things you can do to cope.

How can I help my child cope with panic attacks?

Knowledge is power!

Talk to your child and teach them more about panic attacks. Anxiety is an important and helpful emotion – it’s an alarm system in our body that lets us know when there is something dangerous or scary around.

Panic attacks are when there is a false alarm that comes without warning – our brain and body thinks there is something dangerous and is preparing us to get away or fight back (the fight-or-flight response). Knowing that a panic attack is a false alarm can help kids and teens know how to handle it and stay calmer when they have one.

Panic attacks are so scary and uncomfortable that many kids and teens think they might be having a heart attack or even dying. A panic attack will last minutes and although it is uncomfortable and scary, it is not harmful. Knowing this can help your child know what to expect, know that they are safe and get through a scary experience.

Validate how they’re feeling.

When your kid is having a panic attack, you may want to reassure them by telling them “You’re OK” or “Not to worry.” This can make your child more upset or scared. Instead, try acknowledging how they’re feeling and reminding them the panic attack will be over soon.

Say something like “I can tell you’re really scared. Panic attacks are scary but they will pass. I am right here with you. Why don’t we try a skill together?”

Try a coping skill. 

Staying in the here and now and focusing your child’s attention away from the sensations in their body can be helpful for kids and teens having a panic attack. Guide your child to practice mindfulness skills, like one that uses five senses to find things around them and grounds them to the present moment (use this video to try this skill). Focusing on things around them can help kids and teens calm down, pay less attention to scary feelings in their bodies, and get through the panic attack a little faster.

Another skill to practice is progressive muscle relaxation (use this video to try this skill). Progressive muscle relaxation helps kids and teens relax their bodies from head to toe by tensing and relaxing their bodies, bringing a sense of relaxation throughout their bodies.

Bonus tip: it’s important for kids and teens who have panic attacks to practice these skills every day! Learning how to use these coping skills can be hard at first, but it’s like a muscle – the more they exercise these skills the better it will help them when they have a panic attack. Make it part of their daily routine, especially during stressful or hard times when they may be more prone to have panic attacks. Even better, practice these skills with them! Children learn from what parents do, and if you practice these skills with them or on your own, it will help encourage them more.

Distract them.

If your child hasn’t learned a coping skill yet or is not able to practice it in the moment, something as simple as distraction can be powerful. Do something with your child that requires a lot of concentration, for example a puzzle or card game, singing a favorite song or counting backwards from 100 by 3s.

Help them be brave!

Sometimes kids and teens start avoiding things or situations they worry might trigger a panic attack. For example, kids may start avoiding school, leaving home, and even avoid favorite activities like spending time with friends or sports.

While it makes sense that kids and teens would avoid things that make them worry (no one likes being in scary situations), in the long run, it will not only get in the way of their lives but will make their worry worse. Encourage kids to practice being in these situations, beginning with small steps, even if it makes them feel worried or nervous. Use praise and, if needed, small rewards to help them be brave in these situations.

What if my kid needs more support for panic attacks?

For some kids, panic attacks happen so frequently and cause so many difficulties in their lives that they can be diagnosed as panic disorder. If your child is worrying often about when they might have another panic attack or avoiding places or situations that may trigger a panic attack, consider finding more support.

Talk to your child’s pediatrician, they’ll be able to offer guidance, and help determine if your child might benefit from therapy or counseling. Panic attacks are treatable and research with adults shows that there is a good chance of recovery from panic attacks including full remission of symptoms.

Cognitive Behavioral Therapy (CBT) is an evidence-based treatment for anxiety, meaning there is a lot of research showing it is helpful. CBT will help your child learn skills to understand how they feel, think and act when they are scared or worried. It will teach your child different skills to manage their anxiety and will utilize exposures (a therapy approach that helps kids manage their anxiety in situations that make them feel nervous) as well as relaxation to address their panic attacks. Therapy also helps parents find ways to best support and respond to their child during a panic attack.

More resources on anxiety to share with your child or teen:

• My Anxious Mind: A Teen’s Guide to Managing Anxiety and Panic by Michael A. Tompkins and Katherine A. Martinez
• What To Do When You Worry Too Much: A Kid’s Guide To Overcoming Anxiety by Dawn Huebner
• CHOC’s coping skills video library on CHOC.org and Youtube
• CHOC’s mental health guides

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