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How to Tell the Difference Between Anxiety and Panic Attacks in Children

When your child is feeling intense fear, it can be difficult to tell whether they're having a panic attack or experiencing intense anxiety. Both can cause physical symptoms such as a racing heart, shortness of breath, and dizziness. But it's important to spot the difference so you can provide the best possible support to your child. In this blog post, we break down the differences between anxiety and panic in children, discuss what panic disorder in children looks like, and offer tips on how you can support your child having a panic attack. 

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What Is Panic Disorder in Children?

Panic disorder is a type of anxiety disorder. 

Recurrent and unexpected panic attacks characterize it. These are not attributable to substances (drugs or medication) or medical conditions.

To be diagnosed with panic disorder, one has to experience at least one panic attack, and a month or more of worrying about another panic attack happening. 

How Do You Recognize a Panic Attack?

According to the DSM-5, a panic attack is defined as a sudden onset of intense fear that includes four or more of the following symptoms:(1)

• Shortness of breath
• Nausea
• Racing heartbeat or palpitations
• Feeling of choking
• Sweating
• Feeling chills or warmth
• Shaking or trembling
• Dizziness or lightheadedness
• Feeling detached from reality
• Chest pain or discomfort
• Fear that one is dying 
• Feeling a loss of control
• Numbness or tingling sensations

How Prevalent Is Panic Disorder in Children?

Anxiety disorders are among the most common mental health disorders in childhood, with an estimated lifetime prevalence of 31.9% among U.S. adolescents aged 13-18.(2)

Panic disorder specifically has a lifetime prevalence of 2.3% in 13 to 18-year-olds.(3)

What Is the Difference Between Anxiety and Panic Attacks?

How does panic differ from something like general anxiety or social anxiety in kids?

One of the biggest differences between panic and other types of anxiety is that panic attacks are unexpected and usually happen without any warning signs. Anxiety is generally a response to a specific trigger, such as public speaking or transitioning to a new school.(4) 

With social anxiety, for example, a child may feel anxious about an upcoming event such as a school play or presentation. This type of anxiety may be more manageable because the child often knows when the event will happen and can prepare for it. In contrast, a child with panic disorder may not know when a panic attack will occur.

Children with a generalized anxiety disorder generally experience worries and fears that persist for months or even years. These can be about many things, such as school performance, making friends, or bad things happening to them. 

The symptoms of anxiety can look like excessive worrying and restlessness. It can also manifest as trouble sleeping, tantrums, stomachaches, frequent crying, and difficulty concentrating. Sometimes, children with anxiety may avoid certain situations or activities altogether. 

The signs of anxiety are generally broader than a panic attack and can range from mild to severe.

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How Do You Help a Child Experiencing a Panic Attack?

If your child is experiencing a panic attack, the best thing you can do is try to remain calm and provide reassurance. 

Here are some things you can do at the moment to support your child through the panic. 

Breathing Exercises

Just like treating an anxiety attack, taking slow, deep breaths can help your child with a panic attack. Explain to them that when they are having a panic attack, their breathing may become shallow and rapid, which can make the symptoms feel worse.

Focusing on the breath, and slowing down the exhalation can help to calm the body down.

Encourage slow inhalation through the nose for four seconds, hold for two seconds, and six seconds of exhaling through the mouth.

Stay Calm and in Control

During a panic attack, your child may feel like they are losing control. With a gentle and soothing voice, tell them that you are there with them. 

Don't minimize their feelings by telling them that it's not a big deal, or that they are overreacting. But do reassure them that the panic attack will pass and that you are there to help them get through it.

Refocus Their Attention

If your child is fixated on the symptoms they are experiencing, try to refocus their attention. This can be done by gently asking them questions about their surroundings, or by having them name objects in the room. 

Ask them to name five things they see, four they hear, three they feel, two they smell, and one they taste.

You can also help them to do muscle relaxing exercises, or visualize a positive memory. This can help to take their mind off of the panic attack and help the symptoms subside more quickly. 

Support Them in Facing Their Fears

When the panic attack is over, it's common for your child to want to avoid the activity or situation they were in when the panic attack occurred. While it's understandable to want to avoid triggers, it's important not to reinforce the anxiety by giving in to their avoidance. 

Instead, assure them that they can handle the situation and that you will be there to support them. This can be difficult for your child to do on their own, which is why there are specialized therapists who can help treat panic disorder. 

How Do You Treat Panic Disorder?

Anxiety disorders do not generally go away on their own, and panic disorder is no exception. If your child is experiencing panic attacks, it's important to seek professional help. 

If you're not sure whether your child is experiencing anxiety or panic, the best thing to do is to consult with a mental health professional. A clinician can assess your child, offer a treatment plan, and provide support for you and your family. 

Cognitive behavioral therapy (CBT) is the gold-standard treatment for panic disorder. CBT works by helping your child to identify and change the thoughts and behaviors that are contributing to their distress. It may include exposure therapy, where children gradually confront their fears in a safe setting, or thought reframing to challenge catastrophic thinking.

A therapist can teach your child healthy coping skills and help them develop a plan for dealing with future panic attacks.

Medication is another type of treatment for anxiety disorders and panic disorder, and it is often used in conjunction with CBT. Medication has the potential for side effects, so it's important to discuss the risks and benefits with a clinician before starting any medication. 

In general, medication should not be the first line of treatment for anxiety disorders in children, but it can be an effective part of a comprehensive treatment plan.

How Do You Get Help for Panic Disorder?

If your child is struggling with panic attacks, seeking professional help is the best course of action. At Handspring, our experienced therapists specialize in evidence-based treatments like CBT to support children and their families. Schedule a free consultation today to help your child find relief.

References:

1. https://www.ncbi.nlm.nih.gov/books/NBK519712/ 
2. https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder
3. https://www.nimh.nih.gov/health/statistics/panic-disorder 
4. https://www.medicalnewstoday.com/articles/321798 

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