How to Prevent and Manage Anxiety Attacks

Dr. Samantha Levy, PhD
September 3, 2024 / 5 mins read

As a parent of a child with chronic pain and other medical disorders, life is stressful. You may always be on high alert. You may often feel helpless and hopeless in terms of your child’s diagnosis and recovery. These feelings can lead to underlying chronic stress that either comes out in more minor ways throughout your day or can be lurking beneath the surface, then exploding in panic attacks.

Often, youth with chronic pain and other symptoms become panicked, which makes the pain worse, and then the worsening pain compounds the panic. In general, a classic panic attack feels like fear or extreme anxiety, accompanied by physical discomfort such as a racing heart, sweating, the sensation of choking, or the feeling of impending death.

I am going to use the terms panic or anxiety attacks generically here because what you or your child experience may or may not meet the criteria for panic disorder and may not feel as extreme as what I’ve described. While a panic attack typically subsides pretty quickly, some of our patients have prolonged feelings of extreme anxiety or fear without necessarily all of these symptoms. No matter what specific symptoms you–or your child–feel, these strategies should help both of you.

Guiding Your Child Out of a Panic Attack
It is understandable that when your child is having a panic or anxiety attack, you may feel unprepared to respond.

The first objective is only responding to your child’s “emotional brain.” This contrasts with your child’s “logical brain.” When panicking, the logical brain goes offline, so trying to assert logic will be unsuccessful at best–and will probably make things worse because your child will become more panicked with the realization that he is not being understood.

Realize that your child’s nervous system is in a survival, fight-or-flight state, and focus on calming the system down without explaining why his panic is illogical or his thinking is distorted. Start by taking a few deep breaths and calming your own nervous system. People’s nervous systems tend to sync up, so your child can calm down more quickly if you are calm. If you appear to feel safe, your child will feel safer.

Have you ever been on a flight and felt anxious when the airplane hit turbulence–until you noticed with relief that the flight attendants were unfazed and serving drinks? Their calm made you feel better. So slow your speech and talk quietly and calmly to your child, indicating safety and comfort.

There are several techniques for calming oneself or helping a child experiencing panic. It is a matter of trial and error to determine which works best. The methods I will describe take practice and are ideally learned from a therapist, but hopefully, they are simplified here enough to be helpful. Learning and practicing these strategies when you are not panicking is most beneficial so that they become easy to access when you panic.

Cognitive statements to tell your child (or yourself):
The following suggestions are to be said slowly and calmly as a soothing technique, not as a rationalization or a way of convincing your child out of their feelings.

  • “What you are experiencing is very upsetting and scary, but NOT dangerous. Your nervous system provides an important function to keep you safe (fight or flight), and it is just misplaced in a situation that is not actually life or death.”

  • “You won’t have a heart attack, suffocate, choke, etc.”

  • “This feeling is going to be time-limited.”

  • “You can handle this. It isn’t an emergency. You can ride through this. It can’t hurt you, even though it feels uncomfortable.”

  • “You have done it before. It always goes away.”

Diffuse with physical activity.
Sometimes, physical activity is necessary to diffuse the overactive sympathetic nervous system. Here are some ideas:

  • Do jumping jacks, run in place, jump on a trampoline.

  • Do repetitive motions, like snapping a rubber band on the wrist or using a fidget toy.

  • Bounce a ping-pong ball on a paddle.

  • Swing, if you have one -- the motion is calming.

  • Try yoga/aerobic exercise.

  • Run up and down stairs.

  • Hit or mold clay or throw it onto a table.

  • Throw darts or throw soft objects at a wall.

  • Play a VR game or Wii that requires movement.

  • Express anger. Punch a pillow, scream into a pillow, throw something, shoot hoops, stomp, kick a yoga ball, etc.

Mindfulness

  • Have your child notice what is happening in her body and name the physical sensations. For example, “I feel my heart racing, I feel light-headed, I feel my stomach clenched, my vision is blurry, I hear voices telling me XYZ.” Tell your child to focus on one symptom without trying to change it. Just concentrate on noticing the sensation. Paradoxically, this often helps it change and then go away.

  • Focus on an external sensory occurrence. Sounds, sights, smells, tactile sensations. Example: “Name 5 things you see, 4 things you hear, 3 things you touch, 2 movements in your body, 1 thing you can smell.”

  • Do a mental activity with your child (or prompt your child to do one) that takes focus, such as counting backward by 7s or making anagrams with friends’ names. A game I find helpful alone or with someone else is coming up with 2 to 3 categories and naming things that fall into those categories alphabetically. Example: Animals and Professions by alphabet. One person starts with A and says, “Alligator, actor.” The following person does B and says, “Baboon, band leader,” etc.

  • Do something that pleases as many senses as possible simultaneously. Example: Have your child get into a warm bath with her favorite music playing, a candle burning with a scent she likes, and her favorite drink or snack.

  • Prompt your child to close her eyes and notice any thoughts or feelings she is having. Then, let them float away on a leaf, cloud, or bubble. Do not push the thoughts away. Just notice them and then let them go. This applies to all thoughts, whether positive, negative, or neutral. This exercise particularly needs to be learned and practiced when not in a panic so that it can be accessed when in a panic.

Breathing
There are many breathing techniques that can be helpful. It is a matter of personal preference what works best. Here are some to try for yourself or with your child:

  • Slow your inhale and exhale (but don’t inhale too deeply because you do not want to hyperventilate). Make the exhale longer than the inhale. For example, count to 4 on inhale and 5 on exhale. Some people prefer “box breathing,” where they have the exact count on inhale, pause, and exhale. As you slow down your breathing, let it be gentle, like water flowing through the gills of a fish.

  • I highly recommend having soap bubbles available to blow. Most people love blowing bubbles. They are pleasing to the eyes and provide a motion to engage in. They also require a deep inhale and a slow, smooth exhale to get a good flow of bubbles. If you don’t have any bubbles, you can pantomime and imagine blowing bubbles. As a next step, you can imagine having the worries flow out of you, filling up the bubbles, and then watching them float away and pop.

  • Put one hand up like you are indicating “Stop.” Use the pointer finger on your other hand to trace your fingers on the hand that you are holding up. Trace your thumb up from the bottom to the tip as you inhale; trace your finger down from the tip to between your fingers as you exhale; pause at the bottom between fingers; then breathe in as you trace your pointer finger up to the top of the next finger. Do this for all 5 fingers.

  • Inhale. On the exhale, hum the sound, “Hmmmm.”

  • Inhale. Exhale, making a low “Vvvrrroooommmm” sound, like a car. This particular sound is supposed to be very effective during panic attacks.

  • Inhale, then exhale with the sound, “Aaahhh.”

  • Put your hand or hands over your chest, centered over your heart. Imagine you are breathing calmly into your heart through your hands. Imagine that your nostrils are actually on your chest as if you are breathing directly into your heart, bringing it calm and comfort.

Relaxation

  • Use guided imagery. This can be done through an app (Calm, Insight Timer, Headspace, etc.) or with a hypnotherapist who can provide specific skills for you or your child.

  • Cross your arms over your chest so that the opposite hands are touching the opposite shoulders. Tap your hands on your shoulders, alternating between your left and right hands. Start fast and then gradually slow the speed of the tapping.

  • Progressive Muscle Relaxation. Focus on each part of your body, and let it soften and melt.

  • Tense each part of your body. Hold the tension for a few seconds and then release it. Start with your face and work your way down to your toes. Tensing and releasing is a way to diffuse the physical sensations of panic.

  • Once you discover a way to relax in general–when not panicking–pair calming words to your inhale and exhale. Example: “Feel” on the inhale and “Calm” on the exhale. It can be any phrase or word that feels comforting. Say those often while you breathe in and out when you are calm. Then, when highly anxious, say those words and feel your body become calmer from the association.

  • Drink chamomile or peppermint tea.

  • Use scented oils or a diffuser with preferred scents.

Distraction

  • Watch TV or play a video game or VR game.

  • Listen to music, a podcast, or an audiobook.

  • Talk to someone. Call or FaceTime a friend or family member.

  • Do an art project or play an instrument.

  • Do anything that you find distracting.

Other
Put an ice pack between your child’s eyebrows or splash cold water there for at least 30 seconds. You can also fill a bowl with cold water and have your child dip his face in it. This exposure to cold water on the face is a reflex called the Mammalian Diver’s reflex. It calms the body and lowers the heightened nervous system.

Different techniques will work for different people. Remember to practice the techniques when you and your child are not anxious or panicked. I hope these suggestions will help you guide your child–or yourself–out of a panic state to a healing calm.