Panic Disorder

A panic disorder (classified as F41.0 in the ICD-10 diagnostic code) is characterized by recurrent panic attacks that seem to come out of nowhere. A panic attack is a sudden onset of intense fear accompanied by physical symptoms: a racing heart, shortness of breath, dizziness, chest tightness, and sweating. The peak is usually reached after a few minutes, and the entire attack typically lasts 10 to 20 minutes.

Children and adolescents often experience such an attack as life-threatening. Some think they are having a heart attack or are suffocating. Panic attacks themselves are more common during adolescence, but they can also occur in younger children. Experts only diagnose a panic disorder when such attacks recur and the child suffers as a result or their daily life is disrupted. Anxiety disorders are among the most common mental health issues in childhood and adolescence. According to data from the Robert Koch Institute’s BELLA study, about one in ten children in Germany is occasionally affected by an acute anxiety disorder.

Individual attacks are usually quite obvious to parents. The child turns pale, complains of heart palpitations, trembles, breathes rapidly and shallowly, and often wants to leave immediately or go home. Afterward, the child is exhausted.

What’s more important for diagnosis is what happens between attacks. Two patterns are frequently observed:

• Anticipatory anxiety: The fear of the next attack. The child worries for days that it might happen again and anxiously monitors their own body.
• Avoidance behavior: The child avoids places or situations where an attack has occurred before. This could be a crowded school bus, the classroom, or large crowds. Sometimes the child is barely able to leave the house alone.

When the time for the walk to school, social engagements, or going to school draws nearer, this avoidance is often the underlying cause. For some children, school anxiety is also a factor.

Both are classified as anxiety disorders, but they feel different to the family. With panic disorder, the focus is on sudden attacks—short and intense, with clear physical symptoms. Between attacks, the child may seem carefree at times, until anticipatory anxiety takes hold again.

In generalized anxiety disorder, on the other hand, there are persistent, difficult-to-control worries about many areas of life: school, health, family, and the future. The anxiety is more persistent and less tied to a single moment. Some children exhibit elements of both. A specialist—not an outside observer—determines which diagnosis applies.

During a panic attack, you can’t talk the fear away. It subsides on its own, usually within a few minutes. The parents’ role is to be a calm anchor during this time.

• Stay calm and stay with your child. Your own voice can be soft and slow. Use short sentences: “I’m here. This will pass.”
• Guide their breathing. Breathe more slowly together, exhaling longer than inhaling. Don’t push—just offer.
• Describe what’s happening. “This is a panic attack. It’s unpleasant, but it’s not dangerous.”

It’s less helpful to immediately remove the child from every situation or to overwhelm them with lots of questions. If you consistently avoid every triggering situation, you confirm to the anxiety that it was right, and the avoidance behavior increases. Approaches such as mindfulness and emotion regulation exercises help some children cope with the first signs of an attack between episodes.

Panic disorders are highly treatable, and the earlier treatment begins, the better the prognosis. Cognitive behavioral therapy (CBT) is considered the first-line treatment. It addresses several aspects:

• Psychoeducation: The child and parents learn how a panic attack manifests in the body and why it is not dangerous.
• Cognitive work: The child learns to recognize and challenge catastrophic thoughts (“I’m going to die”).
• Exposure therapy: Together with the therapist, the child gradually approaches situations they have been avoiding. The anxiety initially increases, and the child experiences that it subsides on its own.

Parents are involved in this process. A parent training program focuses on recognizing when well-intentioned behavior inadvertently reinforces anxiety and on how to support the child’s progress. Medications such as SSRIs (certain antidepressants) are only considered for children and adolescents if behavioral therapy alone is insufficient, and even then, they are used as an adjunct to therapy.

A good first step is to visit your child’s pediatrician. There, a physical examination can rule out any other underlying causes for the heart palpitations and shortness of breath, and the pediatrician can refer you to a specialist. Seek support if the episodes recur, or if your child increasingly avoids certain situations or withdraws.

Janike is a social worker and parent coach currently training to become a child and adolescent psychotherapist. She is not licensed. Rückenwind is here to support you as parents during this time; it does not provide diagnoses or replace therapy. Only a child and adolescent psychiatrist (KJP) or a medical or psychotherapeutic specialist can determine whether a panic disorder is present and which treatment is appropriate.