“It came out of nowhere.  One minute I was on the bus on my way to school, and the next minute I was dying.  I couldn’t catch my breath.  My heart was beating out of my chest, and I was shaking so hard I thought I was having a seizure.”

Meryl was having her first panic attack and it hit her like a speeding train.  After this first episode, there were more.  They struck in random places; at home while she watched her favorite TV show, on the bench during lacrosse practice, and during Spanish class.  The more frequent and intense the episodes became, the more terrified she was in anticipation of the next one. Meryl became superstitious in an attempt to predict and control the panic.  She began avoiding places from which there was no easy escape; the metro, the movie theatre, or a friend’s car.  The humiliation of an episode and the preoccupation with her distressing physical symptoms distracted Meryl from her schoolwork and her friends.

“My heart is speeding up.   Am I going to faint?  My chest feels tight.  Am I going to have a heart attack?  This is different than the last one.  This time it’s real.  I AM going to die.  I can’t breathe.  I’m so hot.  I’m burning up.  What does this mean?  This time it’s different.  This time I’m going to die. I have to get home where I’m safe.”

Meryl had never been a particularly dependent child. Conversely, she now felt like her parents were her only tickets to sanity during one of her attacks. At almost 16, Meryl was ashamed at this sudden reliance on her parents. Her shame soon turned to sadness and feelings of depression. When Meryl began staying home from school for fear of having an attack, Meryl’s parents called us for help.

Over the last 20 years, In Step has seen a steep rise in anxiety related suffering among our children and teens. Viewed as an internalizing disorder, anxiety is frequently not obvious to an outsider. This means there are many children suffering in silence.  Panic Disorders (PD) like the one Meryl struggles with, are both terrifying and agonizing. This painful disorder is challenging enough and is compounded when situations that evoke fear of panic are avoided.

It’s terribly challenging for the parent of the child with PD to know how to handle both the panic itself and the avoidance behavior.

When your child is experiencing real physical symptoms such as a racing heart, chest pain, sweating, trembling, dizziness, and nausea, it’s terrifying for you, too. If you don’t take them to the ER, what if you are wrong and something terrible does happen? When your child, crying hysterically, protests going to school, how can you force them to go?

The following are Five Steps for you to help your child who suffers with panic attacks:

Step One:  Call a Spade a Spade

The first and most important step is for you to help your child recognize the symptoms of a panic attack.  Help your child understand that the sensations s/he is experiencing are a result of physiological arousal stemming from the emotion of anxiety. As distressing and unpleasant as these symptoms are, they are not dangerous.

Step Two:  Ride Out the Wave of Panic

The scariest part of panic is the fear that the uncontrollable feelings will never end.  It’s critical to reassure your child that the panic will end.  And the sooner your child recognizes this fact, the more quickly the panic episodes subside. Children who are prone to panic typically are sensitive to bodily changes, and it is necessary to reassure them everyone experiences fluctuations in the body.  Your child is learning to tolerate a very uncomfortable set of sensations and you are helping them reinterpret and normalize sensations like a rapid heart rate.

A strategy that was useful in therapy with Meryl may seem counterintuitive to you.  In order to help her develop a tolerance of the sensations she experiences while having a panic attack, we recreate them.  For example, I ask her to do a number of jumping jacks so she can feel her heart rate rise.  She has built up a capacity to tolerate discomfort through practice exercises like these in session and at home.

Step Three:  Avoid Avoidance

It is common for a child with PD to try to anticipate which situations will cause a panic attack and then to want to avoid these situations.  Don’t collude with your child on this.  Avoidance is a slippery slope. By the time Meryl came to In Step, she was already beginning to miss school.

The typical cycle would go something like this:

    1. At night, Meryl felt significant worry about having a panic attack in school
    2. After much pleading from Mom and Dad, Meryl went to school.
    3. First period was math, her least favorite subject, and as she anticipated, she would have a panic attack.
    4. Meryl (or the school nurse) called her Mom sobbing and crying, begging her to pick her up from school.
    5. Wanting to do the right thing, Mom would pick her up
    6. Initially Meryl felt great relief
    7. As the night wore on, Meryl felt increasing anxiety
    8. REPLAY
      Breaking this cycle was a tricky one because the feeling of relief that comes with avoidance is so gratifying in the short term.


Meryl’s family worked very proactively with a multidisciplinary team at her school to work on her emerging school avoidance issue.  The team helped her identify a safe person at school to aid her during her panic attacks.

Step Four:  Model Panic Busting Self-Statements

Children with PD frequently exhibit maladaptive cognitions that unwittingly make their symptoms worse. In Meryl’s case, she interpreted her bodily feelings as signs that she was going to die and that if she didn’t come home from school that she would fall apart.   These thoughts are automatic and predictive, making them both destructive and grueling to combat.

These are statements you can teach your child in advance of a stressor:

    • I can manage this situation.
    • I’ve done this before. I can do this again.
    • What specifically do I need to do to manage this?
    • One step at a time. I can handle it.


For use when feeling overwhelmed:

    • I always get through it.
    • It’s getting better each time.
    • There is nothing physically wrong with me. This will pass.
    • Don’t run away. Stick it out.
    • Nobody ever dies of anxiety.


To reinforce post panic:

    • I did it. I got through it.
    • It wasn’t as bad as I thought.
    • I’m making progress.
    • I can learn to overcome my fears!


Step Five:  Encourage Relaxation

Relaxation training has been shown to be an effective technique for managing anxiety.  This is a process that involves practice with children.  Help your child practice a daily series of deep breathing and tension-relaxation exercises, moving slowly tensing and relaxing all of the major muscle groups.  Yoga, too, has great benefits to promote wellness and calm.

If you believe your child is experiencing panic attacks, please know that you are not alone.  Mental health professionals at In Step and elsewhere are here to help you.   If you have any questions or are interested in a scheduling a consultation appointment for you or your child, please call 703-876-8480 (in Fairfax) or 703-433-5771 (Sterling). Or you can email us at dara@insteppc.com and our Associate Director will connect with you to answer your questions and assist you in setting up an initial evaluation for services.