Panic attacks are sudden episodes of intense fear accompanied by a set of physical symptoms such as rapid heartbeat or shortness of breath. A panic attack can occur without the presence of real factors that could contribute to fear. It may last a few minutes or hours and often starts without any warning signs. However, a panic attack is a common and treatable condition (1).
Read this post to know more about the causes, symptoms, risk factors, diagnosis, and treatment of panic attacks in children.
Symptoms Of Panic Attack In Children
A panic attack usually starts suddenly without any alarming signs or symptoms. These episodes can happen during night or day time. Some children may have frequent attacks, while others may have occasional episodes.
Signs and symptoms associated with a panic attack may include (2):
- Shortness of breath
- Chills or trembling
- Rapid heartbeat
- Hot flashes
- Chest pain
- Abdominal pain
- Hyperventilation (breathing fast) or heavy breathing
Symptoms may last for a few minutes, and children may feel tired or often sleep after the symptoms disappear. Children may behave detached from reality and often say they feel like they are going to die or going crazy. The child may start avoiding factors and situations that cause panic.
Beside the dramatic clinical presentation, panic attacks do not usually require medical emergency visit. However, if left untreated, children with panic disorders may have reclusive behavior and may not want to go to school or meet people.
If your child has panic attacks often, then make an appointment with a pediatrician or family physician. It is important to visit the doctor for a proper diagnosis (1).
Causes Of Panic Attacks In Children
The exact cause of panic attacks or panic disorders is not known. The following factors may have a role in the development of panic disorders (3).
- Changes in brain functions
The nature or temperament of a child may also play an important role in the development of panic and anxiety disorders. Children who are more sensitive to stress and negative emotions may have an increased risk for panic disorders. A few children may have panic reactions triggered by certain emotional stress situations such as school homework, fear of punishment from parents or teachers, etc.
Diagnosis Of Panic Attack In Children
You have to explain in detail the panic episodes of the child. Doctors may ask a few questions to identify any triggers or phobia related to panic attacks. They may also perform a physical examination and order some tests to exclude medical conditions that may resemble a panic attack (4).
If there is no evidence of other physical illnesses, then your doctor may refer your child to a psychiatrist. A detailed analysis by a psychiatrist could help diagnose the mental health disorders that led to the panic attacks. Mental health disorders, such as obsessive-compulsive disorder or social anxiety disorder, are a few examples of conditions that may cause panic attacks.
Treatment For Panic Attack In Children
Panic attacks in children and adolescents may be treated with medications and behavioral therapy.
- Medications: Selective serotonin reuptake inhibitors (SSRIs) is a class of antidepressant drugs that is often the preferred choice of treatment. Benzodiazepine is another group of drugs used. However, they can cause sedation and drowsiness (5) and hence may not be the preferred choice of treatment for children. The doctor will decide the drug and make a long-term or short-term prescription based on the age of the child, severity of the panic attack, and its recurrence.
- Behavior therapies: Cognitive-behavioral therapies aim to make children understand the realistic and unrealistic thoughts that lead to panic attacks. It could help them overcome their fears. Play therapy or talk therapy can be useful in overcoming anxieties in childhood (4).
Children with recurrent and more frequent episodes may require initiation of drug therapy before behavioral therapies.
Natural Remedy For Anxiety In Children
Children benefit from behavioral therapies and medical treatment from experts more than natural remedies. Support and encouragement of parents and caregivers are required for better results. Parents can work towards avoiding any panic attack triggers.
The following lifestyle modifications and home care can also help deal with the symptoms of a panic attack in children.
- Relaxation techniques: You may teach some relaxation techniques such as deep breathing and yoga to your child. These may minimize stress and help the child stay calm.
- Physical activity: Encourage your child to involve themselves in sports and activities, such as dance and martial arts. Exercises can help reduce stress.
- Sufficient sleep: Good deep sleep is important for physical and mental well being.
You may also join some support groups of parents dealing with panic attacks in children. This may help you manage stress and other difficulties caused by your child’s condition.
Herbal supplements and dietary supplements for the treatment of panic disorders are not monitored by the US Food and Drug Administration (FDA). If you want to use such products, then consult a pediatrician for advice on their safety and efficacy.
Types Of Anxiety Attacks In Child
- Unexpected (uncued) panic attack: These are panic attacks without any internal or external cause or trigger. It can occur at any time and in any situation.
- Situational (cued) panic attacks: These are panic attacks that occur due to exposure to certain types of stress or situations. They might be predictable and prevented by avoiding the triggers. Children usually can have cued panic attacks during family arguments, exam time, or in social situations.
- Situationally predisposed panic attacks: It is a panic attack triggered by certain situations, but may not always occur. This type of panic attack may also happen before or after the triggering situations, but not during the situation. For instance, a child may have panic attacks before or after school exams, but may not be panicky while writing the exam.
- Generalized anxiety disorder: It is a disorder involving excessive worry or anxiety on certain things such as academic performance, friendship, or family situations that could cause tiredness, sleeplessness, muscle tension, etc.
- Separation anxiety disorder: It is the fear of being separated from parents or caregivers and may cause a child to refuse to go to school. Physical symptoms, such as nausea or headache, can accompany this disorder. This form of anxiety is more common in toddlers than older children.
- Selective mutism: It is the refusal of a child to speak in certain situations. It may be seen in children of school-going age. An example of this condition is when an overly talkative child at home or other comfortable situations becomes inexplicably silent at school.
- Specific phobia: Some children may have intense fear or anxiety about certain situations or objects. This type of fear is called phobia. Fear of certain animals, water, heights, needles, closed spaces, loud noises, etc., are examples of specific phobias.
- Panic disorder: It is an anxiety disorder with recurrent panic attacks without any factors causing fear or worry.
- Social anxiety disorder:It is a type of anxiety disorder with extreme fear of social interaction or performance in peer groups or a class. A child with this disorder may cry, cling to adults, may freeze, and refuse to speak in situations that trigger anxiety.
Panic attacks and anxiety attacks may have similar symptoms. However, anxiety is excessive worrying about certain imminent events such as illness, academic scores, exams, being late to school, homework, etc.
Excessive anxiety may cause anxiety attacks, including physical symptoms of restlessness, tiredness, lack of sleep, or often try to avoid situations. This may last longer or can be chronic.
Panic Attacks In Children At Night
Panic attacks during nights are called nocturnal panic attacks. It is the sudden awakening from sleep with fear and physical symptoms without real triggers of fear (10). Children with nocturnal panic attacks may also have day time episodes. Symptoms are also similar to attacks that occur during the day. Panic episodes at night may last for a few minutes, but a child may require time to calm down and go back to sleep.
Nocturnal panic attacks are neither dangerous nor require emergency treatment. You may make sure that there are no physical reasons that could cause a panic attack in the night. If you suspect the child has some problem, then seek prompt medical care.
Risks And Complications Of Panic Attack In Children
Panic disorders can occur in children but can be more common during teenage and adulthood. There are some other factors, as well, that can increase the risk of panic attacks among children.
- Panic attacks or panic disorders in family members and close relatives
- Death or illness of parents, siblings, caregivers, or anyone close to them
- Separation from both parents or one parent due to divorce or other reasons
- Physical or sexual abuse
- Physical trauma
Arguments among parents and the birth of new siblings are some of the reasons that can make a child feel ignored, thus increasing the risk of panic attacks.
If left untreated, panic attacks may lead to certain complications such as (1):
- Anxiety disorders
- Suicidal thoughts and suicide
- Alcohol abuse
- Substance abuse
A panic attack may also interfere with personal relationships and may cause the child to become socially detached. In the long run, phobias and psychiatric disorders may increase conflict behavior.
Most parents may simply remove the child from situations that cause panic attacks. However, it may make the child more sensitive to such situations and exacerbate panic attacks. Instead, ask the child what is making them feel worried or afraid in particular scenarios and explain the ways to overcome the problem. If parental counseling does not work, then seek prompt medical advice.
2. Panic Disorder; The United States National Library of Medicine (NLM)
3. Anxiety disorders Symptoms & Causes; Boston Children’s Hospital
4. John R. Vanin, et al.; Panic Disorder: Diagnosis and Treatment in Primary Care; The American Academy of Family Physicians
5. Josephine Elia; Panic Disorder in Children and Adolescents; Merck Manuals
6. Panic attacks: A classic symptom of several anxiety disorders; MentalHelp; American Addiction Centers
7. Situationally Predisposed Panic Attack; American Psychological Association
8. John C. Thomas, Panic attacks: Can they really be stopped?; Liberty University
9. Childhood anxiety disorder; The Anxiety and Depression Association of America
10. Onur Burak Dursun, et al., Treatment of a Child with Nocturnal Panic Attacks ; Journal of Mood Disorders