First Aid for Panic

From Your Anxious Child: Emails to Parents by Edward H. Plimpton, PhD

First Aid for Panic

A child in the grip of panic, or perhaps even terror, is not a sight that a parent easily forgets. The circumstances can range from a trip to the dentist, the prospect of a thunderstorm  observing  something frightening, or just getting out of the car to go to school. But there is your child hyperventilating, and either huddled in a ball or pacing back and forth and feeling desperate.  And what can you do? Well, actually the first aid advice tends to be very similar, even when it comes from professionals who have every different orientations. The basic elements in bringing a panic attack under control involve the following:

1. The hyperventilating needs to be replaced by slow, deep “belly breathing.”
2. The disorientation and dizziness produced by the panic need  to be counteracted by having the child “ground” herself by feeling her feet on the ground.
3. The child needs help to get “out of their heads” by orienting to the immediate physical environment.
4. Challenging the self-talk that sustains the panic, as in, “I can’t handle this.”

The trick with children who are in a panic state is to translate those ideas into a format or language that helps them grab hold of the lifeline you are offering.  It may be that the best medicine you can offer at first is to be a calm, reassuring presence while you are waiting for this wave of anxiety to subside.  You don’t resolve the problem by being reactive, and in fact by being calm you create a sense of safety.  But of course we want to do more than just wait the panic attack out, we want to teach your child some skills to deal with these intense feelings.   Children of course depend upon their parents to help them regulate and manage their emotions  because their nervous systems are still under construction.  So the parent’s job is to help the child build a bridge to the basic first aid strategies for panic.  There are several elements in this bridge building:

1. The parent is actively modeling belly breathing, grounding techniques and orienting to the external world.
2. When possible, using pleasing imagery that will capture the child’s imagination. I like the image of breathing like a frog, but there are many possibilities: blowing up a balloon, blowing out birthday candles, or smelling a beautiful flower.
3. The immediate relief provided by avoiding the panic-inducing situation is powerful, which can lead to children avoiding participating in school or other activities. So the parent has to find a way to set some limits to help the child learn how to manage these feelings. Sometimes, “just do it” is appropriate to the situation. But that requires some judgment and sensitivity, not just getting tough, so the child is not just overwhelmed but can learn to deal with the problematic situation. A studied balance between being very firm and very flexible is optimal, and this rests on having a sense of how overwhelmed the child is.
4. The first aid is going to work better if the parent and child have practiced those techniques outside of the panic moments. In  the heat of the moment it is almost impossible to learn anything new.

Tags: panic disorder in children