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  1. What is anxiety
  2. Why is it important to talk about anxiety?
  3. When should I be concerned?
  4. Panic attacks
  5. Managing your child’s anxiety Tips for parents in managing anxiety and panic
  6. Resources

Even in the best of situations, all children experience some anxiety in the form of worry, apprehension, dread, fear or distress. Occasional nervousness and fleeting anxieties occur when a child is first faced with an unfamiliar or especially stressful situation. It can be an important protective mechanism, or signal for caution in certain situations. In fact, there are specific expected fears that accompany each stage of child development.

Children and teens often don’t recognize their anxiety for what it is. Instead, they may think there is something “wrong” with them. Children may focus on the physical symptoms of anxiety (e.g. stomach aches). Older children may think they are odd, weak, out of control, or even going crazy! These thoughts might make them feel even more anxious and self-conscious. So, the first step is to teach your child about anxiety and how to recognize it. Self-awareness is essential. Talking to your child about anxiety will not make them even MORE anxious. Providing accurate information about anxiety can reduce confusion or shame. Explain that anxiety is a common and normal experience, and it can be managed successfully!

Untreated anxiety/ panic disorder can:

  • have a long term negative impact as in the development of physical illness
  • cause relationship problems
  • cause other conditions such as substance abuse and depression
  • impact the social and occupational functioning of the child

For anxiety to be diagnosed as a disorder, the child’s ability to function needs to be assessed by a mental health professional.

Help is needed when:

  • a child is experiencing too much worry or suffering immensely over what may appear to be insignificant situations
  • worry and avoidance become a child’s automatic response in many situations
  • the child feels constantly nervous
  • coaxing or reassurance are ineffective in moving the child through the worry
  • anxiety is preventing the child from fully participating in typical activities of daily life e.g. school, friendships, or academic performance
  • anxiety lasts for weeks or months at a time
  • physical distress in the form of headaches, stomach aches, nausea, vomiting and sleeplessness are common
  • one has difficulty sleeping
  • there is reluctance to go to school or elsewhere outside of the child’s comfort zone
  • crying phases, tantrums and clinginess become frequent

Anxiety can also interfere with a child’s concentration and decision-making. An anxious child’s thinking is typically unrealistic, catastrophic and pessimistic. They may seek excessive reassurance and yet the benefit of that reassurance is fleeting. Irritability and anger can also be red flags for anxiety when a child becomes frustrated by the stress of worry, or worn down from sleep deprivation. For some children, feeling “different” from other kids can be an additional source of concern.

Panic attacks are when children, adolescents or adults have unexpected and repeated periods of intense fear or discomfort, along with other symptoms (see below). These periods are called “panic attacks” and last minutes to hours. Panic attacks often develop without warning.

Symptoms of a panic attack include:

  • intense fearfulness (a sense that something terrible is happening)
  • racing or pounding heartbeat
  • dizziness or light-headedness
  • shortness of breath or a feeling of being smothered
  • difficulty swallowing or the feeling that your throat is closing
  • feeling unreal or disconnected
  • trembling or shaking
  • sense of unreality
  • fear of dying, losing control, or losing your mind
  • feeling nauseous or having stomach distress
  • numbness/tingling in hands or feet

What happens during a panic attack is that the brain produces cortisol that sends a signal to the body to react, to help get away from the danger.  This is called the fight, freeze or flight reaction.

Fight can look like:

  • kicking
  • screaming
  • spitting
  • pushing
  • throwing anything one can get their hands on
  • hands clasped in fists, ready to punch
  • glaring
  • clawing at the air
  • gasping for breath

Flight can look like:

  • darting eyes
  • restlessness
  • excessive fidgeting
  • doing anything to get away
  • running without concern for one’s own safety

Freeze can look like:

  • holding ones breath
  • heart pounding and/or decreased heart rate
  • shutting down
  • feeling unable to move
  • escaping into one’s own mind
  • feeling numb
  • whining
  • daydreaming

Panic attacks can happen for lots of different reasons:

  • being in similar places or situations where the person had a panic attack in the past
  • somebody being ill or even just hearing about somebody being ill
  • having to do a presentation or talk aloud in class
  • being scared or seeing something the child has a phobia of, such as heights, spiders or injections
  • thinking he or she must do something or something bad will happen
  • the child being reminded of something very frightening or unsafe that happened to him or her, such as an accident, crime, abuse, violence or anything else they are having trouble coping with
  • upsetting thoughts about daily life and worrying about worrying
  • a harmless physical feeling such as sweaty palms or tight chest that he or she is then frightened of

Identifying a panic attack

Younger children, may have trouble describing their symptoms. They are more likely to talk about their heart beating fast, upset stomach, chest pain, or nausea, rather than symptoms, such as a fear of “going crazy”. For young children having a panic attack, they may suddenly become very frightened or upset for no clear reason. They may insist something is wrong or that something bad will happen; however, they may be unable to identify exactly what is going to happen. What you may notice is a change in behaviours such as being unusually clingy, crying, having a tantrum or refusing to do activities that were previously not an issue.

Adolescents may be better at describing a panic attack more clearly than younger children. Gently supporting your adolescent in having the courage to share with you what is happening may be a good strategy, rather than telling them there is nothing to be afraid of.

  • pay attention to your child’s feelings
  • stay calm when your child becomes anxious about a situation or event
  • recognize and praise small accomplishments
  • don’t punish mistakes or lack of progress
  • be flexible, but try to maintain a normal routine
  • modify expectations during stressful periods
  • plan for transitions (For example, allow extra time in the morning if getting to school is difficult)

When an Anxiety Disorder has been diagnosed

  • Keep in mind that your child’s anxiety disorder diagnosis is not a sign of poor parenting. It may add stress to family life, however. It is helpful to build a support network of relatives and friends.
  • It’s important that you have the same expectations of your anxious child that you would of another child
  • Remember that the siblings of an anxious child are also affected as they must absorb some of the fallout
    Parents can make the feelings normal without making it ok for children to express these feelings in unacceptable ways. It is important to correct the sibling’s perception that a child is somehow enjoying or benefiting from anxiety, and replace this perception with a more accurate understanding of the no-fault nature of anxiety.
  • Help your child become an expert on anxiety
    This is a very important first step, as it helps children understand what is happening to them when they experience anxiety. Teach your child that the worries and physical feelings s/he is experiencing have a name:  ANXIETY
    Explaining that millions of other people also have anxiety can be a great relief. Help your child become an expert on anxiety by providing him or her with facts and important information.

Teach your child about panic disorder and/or agoraphobia

  • See the section on ANXIETY for children for ways to explain anxiety and panic attacks to children
  • Panic attacks may feel uncomfortable or even scary, but they’re physically harmless. There is no medical evidence that panic attacks cause harm to the body or brain. Fortunately, panic attacks are brief (typically lasting only 5 to 15 minutes), although they sometimes feel like they go on forever.
  • Other people (except those very close to you), might not realise that you are having a panic attack.
  • For some children, these panic attacks are so upsetting that they become worried about having more attacks in a variety of situations. As a result, they believe they will be unable to manage in these situations that they stop going places and doing fun stuff. This is when agoraphobia can start to take over.
  • Let your child know that panic attacks are common, and that there are other children who have panic disorder. Help them understand that they are not the only one who feels this way. That they really are not alone.

Sometimes children have very severe anxiety, and despite all your best efforts, your child might still be struggling daily with anxiety symptoms. If this is the case, seek some professional help from your family doctor, psychiatrist, or a mental health care professional.

Panic Disorder is diagnosed if your child suffers at least two unexpected panic or anxiety attacks—which means they come on suddenly and for no reason—followed by at least one month of concern over having another attack, losing control, or “going crazy”. Panic disorder can begin during adolescence, although it may start during childhood, where the child may experience panic-like symptoms (“fearful spells”). The disorder sometimes runs in families.

If not recognized and treated, panic disorder and its complications can be serious. Panic attacks can interfere with a child’s or adolescent’s relationships, schoolwork, and normal development. Attacks can lead to not just severe anxiety, but can also affect other parts of a child’s mood or functioning. Some children and adolescents with panic disorder can develop severe depression and may be at risk of suicidal behaviour. As an attempt to decrease anxiety, some adolescents with panic disorder will use alcohol or drugs.

Several types of treatment are effective. Medication may stop panic attacks. Psychotherapy may also help the child and family learn ways to reduce stress or conflict that could otherwise cause a panic attack. Many children and adolescents with panic disorder respond well to the combination of medication and psychotherapy. With treatment, the panic attacks can usually be stopped. Early treatment can prevent the complications of panic disorder.

Home Management Strategies for Panic Disorder | AnxietyBC

Panic Disorder in Children and Adolescents

Panic Disorder | Anxiety and Depression Association of America, ADAA

My Anxiety Plan (MAP) for Panic Disorder and Agoraphobia | AnxietyBC

What to Do When your Child is Having a Panic Attack | Parenting Anxious Kids | Parenting Tips for Anxious Kids

For some tips for parents with anxious children

Calming Your Child’s Fight, Flight or Freeze Response

Calming Your Child’s Fight, Flight or Freeze Response

My Anxiety Plan (MAP) for Panic Disorder and Agoraphobia | AnxietyBC

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