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Panic Attack


  • Anxiety attacks (also called panic attacks).
  • Symptoms are fast, deep breathing (hyperventilation), fast heart rate, feeling dizzy and many others. The body goes on "red alert." Patient feels like they are dying or losing control of their body.
  • Normal anxiety, worries and fears also covered.

Anxiety Attacks: Facts

  • Happens in 1-2% of people.
  • Risk factors: anxiety attacks are genetic. They tend to occur in families.
  • Age of onset: teens or young adults
  • Cause: release of stress hormones as when "under attack"
  • Triggers of attacks: life stressors, though many attacks are unexpected
  • Length of attacks: 20-30 minutes
  • How often attacks happen: no set pattern
  • Side effect: patient avoids social settings for fear of having an attack
  • Treatment, if frequent: Cognitive Behavior Therapy (CBT). SSRI meds may also be prescribed by a provider. They can turn down the volume on anxious thoughts.

Normal Anxiety and Worries:

  • Anxiety is a normal response to stressful events.
  • It also protects us from real dangers.
  • All people feel anxious at times. It is a normal emotion that will always be part of you.
  • But, anxiety can be managed so that it does not keep you from doing normal things.
  • When your child is anxious or worried, help them talk about their feelings.

Behavior Scale: How to Judge Severity

  • Mild Symptoms: symptoms do not keep the child from any normal activities. School, play, relationships and sleep have not changed. Treatment: parenting groups or books.
  • Moderate Symptoms: symptoms keep the child from doing some normal activities. New behaviors mainly happen at home. They affect how the child and parent interact. They may also keep him or her from going to child care or school. Your child may not sleep well because of these symptoms. Treatment: most often, brief counseling from a mental health provider or your child's doctor.
  • Severe Symptoms: symptoms keep the child from doing most normal activities. They affect the way the child acts with parents. Symptoms also impact relations with siblings and friends. Adults at child care or school may also be impacted by the child's actions. Treatment: these patients often need to be seen urgently by a mental health provider.

When To Call

Call 911 Now

  • Severe trouble breathing (struggling for each breath, can barely speak)
  • Acts or talks confused
  • You think your child has a life-threatening emergency

Go to ER Now

  • Breathing fast now and this is your child's first attack
  • Heart is racing or pounding now and this is your child's first attack
  • Anxiety attack is suspected and this is your child's first attack
  • Passed out (fainted) and now awake
  • Drug or alcohol use is suspected and has symptoms now
  • Psych hospitalization in the past for similar symptoms patient is having now

Call Doctor or Seek Care Now

  • Anxiety attack (has been diagnosed in the past), but care advice is not helping
  • Child is very upset; can't be calmed down (or call 988, the Suicide and Crisis Lifeline)
  • You want an urgent psych exam for your child
  • You think your child needs to be seen, and the problem is urgent (or call 988, the Suicide and Crisis Lifeline)

Contact Doctor Within 24 Hours

  • You want a referral to a mental health counselor
  • Patient takes psych meds and you have med questions
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • Anxiety or panic attacks have never been diagnosed by a doctor
  • Symptoms of anxiety or fear and won't go to school
  • Symptoms of anxiety or fear interfere with sleep
  • Symptoms of anxiety or fear keep from doing normal things
  • You have other questions or concerns

Self Care at Home

  • Anxiety attack (panic attack) was diagnosed in the past
  • Normal anxiety symptoms

Care Advice

What You Should Know About an Anxiety Attack:

  • During an anxiety attack, your child feels overwhelmed by fear.
  • Sometimes, they even fear that they are dying.
  • Tell your child that the symptoms are scary, but harmless.
  • The symptoms most often stop in less than 30 minutes.
  • Here is some care advice that should help.

Start Exercises to Help Relax:

  • Do anything that has helped in the past.
  • Try to help your child put herself into a relaxed state.
  • How to relax: lie down in a quiet place. Relax each muscle in your body, from head to toe. Take deep, slow breaths. Think about something pleasant. Pretend you are in a favorite place.
  • Since fast breathing is often part of a panic attack, deal with that first.
  • Once breathing is under control, the panic attack will often end.

Slow Your Child's Fast Breathing:

  • Reassure your child they are healthy and the symptoms are from fast breathing.
  • Talk in a calm voice.
  • Getting control of their breathing will often stop the anxiety attack.
  • Help your child slow down to 1 breath every 5 seconds (12 per minute).
  • Try to breathe quietly instead of deeply.
  • Try to do belly-breathing, instead of chest breathing. Move your belly button out and in versus raising the shoulders up and down.
  • Try to breathe through the nose with the mouth closed.
  • Caution: re-breathing into a paper bag is not recommended. Reason: it can make the attack worse.

Anxiety Attacks - Find the Triggers:

  • Try to find the events or triggers that bring on anxiety attacks.
  • Keep a diary of attacks.
  • Write down what happened just before the attack started. Include details of where you were and what you were doing. Also write down the main symptoms, how long it lasted, and what helped.
  • Look for patterns.
  • Avoid events that make your child anxious.
  • If it can't be avoided, teach your child how to cope with those times.

Prevention - Reduce Future Anxiety:

  • Help your child talk about events that trigger the anxiety. Talk about how to cope with these triggers the next time they occur.
  • Help your child worry less about things he or she can't control.
  • Exercise each day. Being active helps manage stress.
  • Teach your child the importance of getting enough sleep (at least 8 hours each night). You can cope with stress better if you get enough sleep.
  • If over-achievement is the cause of your child's anxiety, help your child find more balance.
  • Do something fun and relaxing each day. Examples are playing music, walking, reading, or talking with friends.

Avoid Caffeine Products:

  • Avoid or reduce drinks with caffeine in them. Reason: it is a stimulant and can make anxiety worse.
  • Examples are coffee, tea, colas, and energy drinks.

What to Expect:

  • The symptoms most often stop in less than 30 minutes.
  • Future attacks will happen, so learn how to manage them.

Resource - NAMI Helpline:

  • If your child is already in treatment, call your mental health provider.
  • If not, call your doctor or find a local mental health resource.
  • For non-urgent concerns, go to the National Alliance on Mental Health (NAMI) website.
  • NAMI Helpline is an information and referral source for finding local mental health programs. Their toll-free phone number is: 1-800-950-NAMI (6264).
  • NAMI is not a 24/7 crisis line.
  • For urgent mental health crises, call the 24/7 Suicide and Crisis Lifeline: 988.

Call Your Doctor If:

  • Anxiety attack does not end within 30 minutes using this advice
  • Anxiety attacks become more frequent
  • Your child has never been seen for these attacks
  • You think your child needs to be seen
  • Your child becomes worse


Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
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