panic disorder

The first time one of my kids had a panic attack, I didn't have any idea what to do. The pounding heartbeat, racing thoughts, shortness of breath, and feeling like you're losing control are disconcerting symptoms for adults to experience, but they're even more alarming for a child who doesn't know why it's happening. As a parent, it's scary not knowing how to help your child when they clearly need help.

The exact cause of panic disorder is unknown, but experts estimate it affects close to 4 percent of the population. Like other anxiety disorders, it also tends to run in families, which appears to be the case for my kiddos. But even people who don't have a full-fledged disorder can occasionally experience a panic attack, and it's good to know what actually helps.

My youngest was around six years old when he had his first bout of panic. It wasn't long after we'd tucked him into bed when he called for me with a shaky urgency in his voice. When I got to his room, he said he couldn't breathe and that his heart was going really fast. "I don't know what's going on," he said through chattering teeth. "My whole body won't stop shaking and I'm freaking out."

I immediately recognized the signs of panic, having gone through it with his older sister, but he was a lot younger than she had been when she had her first episode. Thankfully, the tools we used with her also worked with him.

Here's how we help our kids through a panic attack:

1) Verbalize what's happening to them.

Panic attacks are intense for the person experiencing them and saying something like "Calm down" isn't really helpful. They want to calm down, they just can't.

For our kids, explaining exactly what's happening, what they can expect to happen, and what they actually can control is the first step toward regaining calm. After the first time through it, they don't need this much detail, but here's a basic script of where we started:

"You're okay, even though it doesn't feel like it. You're just having a panic attack. The fear part of your brain is sort of stuck for a bit, and it keeps revving up your body. It's like your brain thinks there's a tiger chasing you, even though there isn't. That makes your heart beat really fast and makes it hard to breathe. You might feel like you're losing control. You might even feel like you're going crazy. But it'll pass soon, I promise. Panic attacks are just temporary glitches. Your brain and body will calm back own, usually within ten minutes or so. Let's work on helping you feel better while it works its way out of your system."

2) Use "box breathing" to help them catch their breath.

Breathing intentionally is one of the quickest ways to reset when your body is in a heightened state. The best technique we've encountered for this is an exercise called "box breathing" or "square breathing." It's actually a tool Navy Seals use to keep calm under stress, but it's so simple even kids can use it.

Slowly draw the shape of a square in the air, starting from the bottom left-hand corner. As you draw the first line upward, have your child breathe in for a count of five. Then have them hold their breath while you draw the top line, then exhale while you draw down the right side. Finally, have them hold the exhale while completing the square with the bottom line. Then repeat—breathe in, hold, breath out, hold. Around four or five seconds for each breath and hold wonders for getting breathing under control, which helps calm the brain and body.

Here's a quick video that shows how it works. (With our kids, I usually draw the box for them while talking them through the breaths and holds at first, then have them start drawing the box with me as they start to calm down.)

Box breathing relaxation technique: how to calm feelings of stress or anxietyyoutu.be

3) Ground them in reality with the "4-3-2-1" exercise.

Panic is the brain gripped by a state of fear that doesn't reflect what's actually happening. It's basically the amygdala—the fight or flight center of the brain—wigging out for no apparent reason. The intense fear triggers the fight or flight response, forming a sort of feedback loop, with the body freaking out because the brain's freaking out, which makes the body freak out, and so on.

Getting the brain to focus on the body's physical senses can help break that loop and bring the body and brain back to a state of calm (or at least calmer). For this, we use a simple grounding exercise we call "4-3-2-1." (What we do is a variation of the 5-4-3-2-1 method developed by Captain Tom Bunn to help people cope with a fear of flying. You can see that method here.)

Have the child look for and then name, out loud:

- Four things they can see. ("I see my lamp. I see the cat. I see the window. I see my teddy bear.").

- Three things they can feel. ("I feel my pillow. I feel your hand. I feel the sheets.")

- Two things they can hear. ("I hear cars outside. I hear the heater running.")

- One thing they can smell. ("I smell your lotion.")

I always have the kids say a full sentence for each thing they count, as that reinforces the physical aspect of the exercise. Without fail, my kiddos are always calmer when they get to what they can smell. Super simple, but super effective.

It's important to note that these exercises don't stop an attack in its tracks. Panic usually just has to run its course. What they do is take the edge off, make the attack more tolerable, and help the kiddo wait it out without feeling like they have no control at all while it's happening.

Panic attacks and anxiety attacks (which share similar symptoms and can respond to the same tools) aren't fun for kids or for parents. But when a kid knows what's happening and a parent has tools to help them manage it, they're a lot less scary for everyone involved.