Panic Disorder in Children and Teens

________________________________________________________________________

KEY POINTS

• Panic disorder is having sudden surges of intense fear, called a panic attack, that happen repeatedly and without warning.
• Panic disorder can be treated with therapy and medicine.
• Let your child know that he or she is safe and protected. The support and understanding that you provide can help children deal with scary emotions.

________________________________________________________________________

What is panic disorder?

Panic is a sudden surge of intense fear and physical symptoms that feel severe. When panic attacks happen to your child a lot and your child fears another attack, it is called panic disorder. These attacks can happen many times a day and without warning. Your child might worry about having these attacks throughout the day.

The panic attack can affect daily activities. Attacks may happen daily, weekly, or there may be days or months between attacks.

Panic disorder may last for a short time or may continue for many years. With treatment, most children improve in less than a year.

What is the cause?

The exact cause of this disorder is not known.

• The brain makes chemicals that affect thoughts, emotions, and actions. Without the right balance of these chemicals, there may be problems with the way your child thinks, feels, or acts. People with this disorder may have too little or too much of some of these chemicals.
• Certain parts of the brain and nervous system cause the emotional and physical surge of fear. A stressful event may trigger the panic. But often panic begins with no identified stressful event.
• PD tends to run in families. If a parent has panic disorder, children are more likely to have it. However, more than half of those with panic disorder do not have a family member with a history of this disorder.
• Your child is at more risk if he or she was physically or sexually abused in the past.

Many people with PD also have agoraphobia, which means they avoid going places or doing things because they are afraid they will panic and have no help. It is common to have depression along with panic disorder. Panic disorder is more common in girls than boys.

Panic disorder usually starts in the teen or young adult years. Children who were often scared when separated from their parents are more likely to develop PD later.

What are the symptoms?

Panic attacks tend to come on suddenly. Children or teens with PD may:

• Cry in fear
• Tremble or shake
• Be short of breath or feel as if they can’t breathe
• Feel as if they are being choked or have trouble swallowing
• Feel sick to their stomach
• Sweat
• Feel their heart pounding or feel as if something is pressing on their chest
• Feel they are going to die or that they are going crazy
• Feel very helpless to stop the attacks

Along with these main symptoms, children or teens may:

• Be on guard all the time or startle easily
• Eat very little or become very picky eaters
• Have trouble concentrating due to worry
• Not do as well as they could in school
• Have frequent headaches or stomachaches
• Have trouble falling or staying asleep, or have nightmares

These feelings start suddenly and get very strong, usually within 10 minutes. Symptoms usually last from 20 to 30 minutes. The attacks may be expected when your child is thinking about a situation, but attacks are often unexpected or happen without warning.

If your child has a panic disorder, these symptoms come repeatedly. Panic attacks may happen at certain times of day such as bedtime, or with daily events such as going to school. When this is the case, the child often worries as these times approach. The child feels helpless to prevent the attacks.

How is it diagnosed?

Your child's healthcare provider or a mental health therapist will ask about the child's symptoms, medical and family history, and any medicines the child is taking. Your child’s provider will check for a medical illness or drug or alcohol problem that could cause the symptoms.

A mental health therapist who specializes in working with children and teens may be best qualified to diagnose PD.

How is it treated?

Cognitive behavior therapy (CBT) helps children learn what causes them to feel panic and how to control it. CBT teaches skills for managing the fear and the worrisome thoughts about whether an attack is coming.

Family therapy may also be helpful. Family therapy treats the whole family rather than just the child. Children often feel supported when parents and siblings attend therapy with them and work as a group.

Several types of medicines can help treat panic disorder. Your child’s healthcare provider will work with you to select the best medicine. Your child may need to take more than one type of medicine.

How can I help my child?

• Support your child. Let your child talk about the scary feelings if your child feels ready. Do not force the issue if your child does not feel like sharing his or her thoughts. Do not criticize your child for having panic attacks or acting younger than your child’s age. Let your child know that he or she is safe and protected. The support and understanding that you provide can help children deal with scary emotions.

  Stay in touch with teachers, babysitters, and other people who care for your child to share information about symptoms your child may be having.

• Help your child learn to manage stress. Teach children and teens to practice deep breathing or other relaxation techniques when feeling stressed. Help your child find ways to relax such as by taking up a hobby, listening to music, playing, watching movies, or taking walks.
• Take care of your child’s health. Make sure your child eats a variety of healthy foods and gets enough sleep and physical activity every day. Teach children and teens to avoid alcohol, caffeine, nicotine, and drugs.
• Check your child’s medicines. To help prevent problems, tell your child’s healthcare provider and pharmacist about all the prescription and nonprescription medicines, natural remedies, vitamins, and supplements your child takes. It is important that your child take medicine as prescribed. Talk to your provider if your child has problems taking medicine or if the medicines don't seem to be working.
• Learn about your child’s condition. Knowing how panic disorder affects your child helps you better understand how treatments, medicines, and lifestyle changes can help. Know for what symptoms you should call your healthcare provider or therapist.
• Contact your healthcare provider or therapist if you have any questions or your child’s symptoms seem to be getting worse.

Get emergency care if your child or teen has thoughts of suicide or self-harm, violence, or harming others.

For more information, contact:

• National Institute of Mental Health
  866-615-6464
  https://www.nimh.nih.gov/index.shtml
• Mental Health America
  800-969-6642
  https://www.mhanational.org/