How to Identify (and Support) a Panic Attack in Children and Teens

If it was of any use pandemic It was to talk more and more Mental Health : Lockdown, illness and unfortunate deaths have led to new spaces to delve a little deeper into depression, anxiety, stress and even panic attacks.

Nearly 5% of the Chilean population has suffered one, according to details an article from Clinica Davila. “They usually present as sudden anguish, without any signs or warnings, which increases the fear of suffering from them again,” they describe in the publication. Panic attacks are often frightening experiences, which can profoundly affect the daily lives of those who experience them. An emotional whirlwind where control seems lost, and every heartbeat resounds with fear overwhelming you. Even if they end and don’t always last long, the thought of a recurrence can become a constant worry that terribly affects the quality of life.

Flora de la Barra, a child and adolescent psychiatrist and academic in the Department of Psychiatry and Mental Health (Oriente) at the University of Chile, explains that the term “panic attack” is widely and colloquially used to refer to any reaction to anxiety. “But a real panic attack happens when you experience sudden and intense physical symptoms,” he says, such as:

• Accelerated Heart
• sweat
• tremors
• dizziness
• Difficulty breathing
• Nausea

“You may think you’re having a heart attack, dying or going crazy,” he says. This is due to “the activation of the body’s alarm system, which is designed to deal with a real threat, but which, in the event of a panic attack, is activated without this emergency”. Usually it reaches its maximum intensity after 10 minutes and decreases after half an hour.

“Panic attacks are described as having an episode with an abrupt onset,” adds Caterina Pesce, a child and adolescent psychiatrist at UC CHRISTUS Health Network, and they can appear as a reaction to the anxiety of the moment or simply out of the blue. “Rapidly, within minutes, you can reach the peak of symptoms,” he says.

According to Seattle Children’s Hospital , these attacks affect 1-2% of people worldwide. Among the risk factors is genetics, because if one of the parents has this problem, it is likely that it can also be expressed in their offspring.

“A panic attack becomes a panic disorder when the episodes repeat and the person is so afraid of having another attack that they begin to avoid places or situations that they associate with their attacks,” says De la Barra. The physical and emotional discomfort that accompanies these episodes can also create feelings of isolation and hopelessness.

An important detail that professionals point out is that girls and boys, when they are young, can have episodes of fear or nervousness. However, true panic disorder usually does not appear until adolescence. “Other anxiety disorders are more common at younger ages, depending on the age of the child, such as separation anxiety, phobias or generalized anxiety,” underlines the academic from the University of Chile.

Something common is to confuse an angry attack or expression with a panic attack. Both are different scenarios because the trigger stimuli are different. “Rage is usually preceded by frustration; panic disorder, on the other hand, due to nervousness and fear,” says De la Barra.

On the other hand, the risk factors increase the possibility of presenting the symptom and can be observed from an early age in children. “The inhibited / anxious temperament is more predisposed to suffer from panic disorder”, details the child psychiatrist from the University of Chile. The patterns that the child sees in his family and at school also have an influence, whether it is the constant fear or the problems encountered with anger.

“Physical symptoms and facial expression are also different between rage and panic,” he says. “In the first, there is a lack of control and aggression, while in the second, terror predominates.” Pesce adds that, in a fit of rage, “there is not this very acute physical symptomatology or a feeling of loss of control”. Unlike a panic attack.

In case of witnessing a panic attack in your daughter or son for the first time, De la Barra’s appeal is to try to calm them down and see how they react to this confinement. “As soon as you feel better, you should accompany them to cope and identify the situation that caused it,” he advises. “It’s always important to be there, to focus on your breathing, for example, and to hold back verbally,” adds Pesce.

If they recur and affect your normal life – avoiding everyday situations for fear of having a seizure – a pediatrician should be consulted to rule out physical illnesses. Once this hypothesis has been ruled out, it is advisable to consult a psychiatrist for children and adolescents, “who will study in detail the symptoms, the triggers, the reactions of adults, other fears and other psychiatric diagnoses – such as certain post-traumatic stress disorders – for which will examine the family history of anxiety disorders,” says De la Barra.

In addition, child psychiatry will surely work with a psychologist, who should carry out the therapy. “If there is another underlying problem, such as a learning or language disorder, the educational psychologist or speech therapist will provide academic support,” he adds.

“It is extremely important to seek professional help, as the use of pharmacological treatment will likely be necessary,” says Pesce.

Once the diagnosis of panic disorder is made, the specialist will define the course of treatment to follow. “The most effective is a combination of cognitive behavioral therapy and antidepressants,” says De la Barra. However, when they are teenagers, cognitive-behavioral therapy is often recommended first and only adds medication in the most severe cases.

“The goal is to reduce the fear that drives children to avoid situations that remind them of aggression. That way they are taught techniques to control physical symptoms, like working on deep breathing, so they feel they can control them,” he says. Once the fear of attacks fades, they decrease in frequency and intensity. “It’s time to gradually expose yourself to the situations that trigger the attacks,” says the professional.

Something that parents can support is to facilitate spaces in which the adolescent can talk about their crises, anxieties and concerns. “Because it’s a chronic anxiety disorder, many times parents fall into a negative cycle, avoiding situations that scare them, which inadvertently increases anxiety,” he says. The goal, on the contrary, is not to eliminate anxiety, but “to learn to tolerate it, because only then will it diminish over time”.

Another angle parents of a child or teen with these issues can approach is teaching them to distance themselves from fear. According to age, “think of fear as a stalker inside your brain,” says De la Barra. The challenge is therefore to “help him understand how his fear affects his life”. In addition to this, in general, it suggests:

• Not avoiding things or situations just because they cause anxiety (eg sleeping in bed at the appropriate age).
• Expressing positive, though still realistic, expectations (such as facing an exam or a difficult situation)
• Respect feelings, but don’t reinforce fears.
• Talk about the feared situation, but shortly before facing it. This will shorten the anxious anticipation (as in the run up to a college lecture).
• Show him a model of how well he handles his own anxiety.

It may be that while you are reading this article, an internal voice is telling you that “In my time, people weren’t so sensitive and these things were arranged in a different way.”. However, we are in other times, where feelings and emotions are not repressed but expressed. In this case, treatment of anxiety disorders in children and adolescents is important, as they are a risk factor for developing depression or more serious disorders later in life.

“Learning to recognize and deal with anxiety and fears from an early age will increase their resilience. That is to face the difficulties of life, to grow stronger in the face of adversity and to blossom fully”, Concerning responsible adults, such as parents, caregivers, teachers, mental health professionals, it is relevant that they accompany and guide the child or adolescent to overcome this difficulty.