Can children have panic attacks?

Can children have panic attacks? Short answer YES. 

But first let’s define panic attacks.

Diagnostic Criteria for a panic attack per the  DSM-V requires that the person experience at least four of the following symptoms:

• recurrent heart palpitations or increased heart rate;
• sweating;
• trembling;
• shortness of breath;
• chest pain;
• feeling as if their choking;
• nausea or stomachache;
• dizziness;
• chills or feeling hot;
• numbness or tingling;
• derealization or depersonalization (feelings of unreality, feeling outside of oneself);
• fear of “going crazy” or losing control;
• fear of dying.

Understandably panic attacks can add to anxiety, meaning they can become an anxious event unto themselves. For example, a child with a social anxiety disorder who then has a panic attack at a social event, may now worry about having a panic attack along with their worry about the social event. Panic attacks complicate matters for sure.

That said sometimes panic attacks can seem to come out of the blue and not have a connected or predictable trigger. Sometimes they just happen and for many children and adults, those are scariest of all. For one, it really can feel like you’re going crazy. It’s one thing to have a panic attack because an angry dog leaps out at you barking but it’s entirely different to have one for no discernible reason at all. 

There is some discussion about panic attacks and children arguing that they are very uncommon in young children. Some experts argue that children cannot be diagnosed with panic disorder. The DSM itself reports that they rarely occur in children under 14. I’d say that doesn’t reflect my observation. I hear reports of panic attacks in younger children often enough that I think they may have been previously under reported.

I recently read some research about that and there was an argument made — an argument I agree with by the way — that children may be experiencing panic attacks and just not have the language to describe them. They may know that their tummy hurts but they may not have words to describe feeling shaky or sweaty. They are very unlikely to be able to describe feelings of depersonalization or derealization. And then there’s a whole argument about what a child is capable of developmentally. In other words, if a child is too young to have a strong sense of self, are they capable of experiencing depersonalization? Can a preschooler who is still learning the difference between fantasy and reality experience derealization? 

My guess is that a panic attack in a very young child may look like a meltdown. It may look like fear. And isn’t that ultimately what a panic attack is? Would we view a panic attack differently if we thought of it as a fear attack?

That said, generally panic attacks in children and adolescents are less likely to be related to panic disorder — panic attacks that come out of the blue, seemingly unrelated to another anxiety diagnosis — but they do exist in kids.

Children who describe more somatic symptoms — those tummy aches, headaches, dizziness, etc. that we talked about at the beginning of this episode — seem to be at higher risk to develop full blown panic attacks. This may have something to do with perceived sensitivity to bodily changes. 

What this means is that a child who is highly sensitive to feeling heart palpitations, or noticing sweatiness may be more likely to interpret that as rising anxiety. This may also explain why there is a strong genetic component to panic disorder, speaking to brain differences. Also — and this certainly makes a lot of sense — asthma is associated with panic disorder not just that children with asthma are more likely to experience panic attacks but children with a family history of asthma are, too. Again, this might be traced to a family sensitivity to subtle differences in breathing.

This leads me to something interesting that I read in the DSM under their discussion of cultural issues related to diagnosing panic disorder. There is a Vietnamese concept of “hit by the wind,” which describes having a panic attack after walking out into the wind and having it take your breath away. I’ve had so many parents tell me that their children get anxious or meltdown on windy days. They perhaps also feel “hit by the wind.” 

Children who report panic symptoms are also more likely to have separation anxiety. There’s been some research that shows that parents who have a panic disorder or who have panic attacks are more likely to have children with separation anxiety disorder. What’s the connection there? Well, we don’t know but I think it points to a need to acknowledge that anxiety disorders are complicated and that it makes sense to consider the presentation and the needs of the entire family.

Treatment for panic attacks is the same as treatment for other forms of anxiety, which is cognitive behavioral therapy and sometimes medication. The particulars for that treatment will depend on the presentation and age of the child or teen. But in general we work on helping the child to calm their body and increase their distress tolerance and limit their avoidance of the things that scare them. 

This discussion we’re having today about panic attacks, panic disorder and diagnosis I think is useful because it helps us see the limits of our understanding of individual experiences. We can’t climb inside a 6-year old’s brain to see what they’re experiencing and their ability to tell us is limited. Looking at the criteria can help us know what questions to ask, what diagnosis to consider, and how to case conceptualize in order to create the most effective intervention. But people — including children — are complicated and rarely fit neatly into any prescribed categories. I think it makes the most sense to look at the research but always be open to tweaking what we know if the individual in front of us is a little bit outside of the guidelines. So if a child is telling us that they have three symptoms of a panic attack, why refuse to label what’s happening to them if acknowledge their feelings of fear and their bodily sensations with the words “panic attack” will help us help them. 

Intervening early is always a good idea when it comes to kids. They don’t need a full blow anxiety diagnosis to benefit from the skill building that comes with recognizing their worries and helping them shift their thinking in ways that empower them to face those fears.