and Addressing Childhood Panic Disorders: A Parent's Guide - Pediatrics

Dr. Pei Rensheng reply Pediatrics

---

1.
When we encounter our children's fearful reactions, we often respond with a reprimanding tone: "You need to be braver! What is there to be afraid of?" However, children's emotions are very real, and their willingness to express feelings and talk about them is a good thing for parents! We can take a guiding approach, first calming their emotions and then identifying the causes of their anxiety.
It is concerning if a person has no feelings of fear or anxiety at all! Worry and fear can be seen as warning signs; if a child does not exhibit "stranger anxiety," it may pose a danger, as anyone could take them away.
Different age groups experience different fears.
For example, infants around eight to nine months begin to recognize their parents and may fear strangers; toddlers over one year old may fear separation from their parents, exhibiting separation anxiety; after the age of three, some children may fear specific things, such as lightning or animals like dogs, cats, or cockroaches; and in middle school, they may fear others' evaluations and worry about their performance! The external behaviors triggered by psychological anxiety also vary with age and can be broadly categorized into three stages:
1.
Preschool age: Infants crying is the most primitive expression of anxiety and fear.
By the age of three or four, if a child who previously ate and used the bathroom independently starts to show regressive behaviors, assistance is needed.
Physical symptoms may include headaches and stomachaches.

2.
Elementary school age: Continuing the reactions from preschool, such as crying, withdrawal, and regression, but children begin to have the ability to explain their feelings and may choose to avoid anxiety-inducing situations.
Physiological responses may include dizziness, trembling hands, and difficulty breathing, among others.

3.
Adolescence: Including more mature middle and high school students, new worries arise regarding others' evaluations and concerns about their social performance! As for "panic disorder," this is a sudden condition where a person may feel perfectly fine one moment and then suddenly experience intense anxiety and nervousness, leading to shortness of breath, inability to move limbs, and a racing heartbeat.
This situation is commonly seen in adolescents and appears to differ from your child.
In facing various fears, we must first understand external factors.
When external factors are apparent, such as family changes, personal accidents, car crashes, earthquakes, or fires, these can affect a child's sense of psychological safety and fear of facing situations again.
For example, after the 921 earthquake, doctors received many cases, and each child's reaction was completely different; some feared earthquakes, while others feared the dark—because the earthquake occurred late at night, children formed a situational connection and became afraid when it got dark.
If external factors are not obvious, it may be that the child is particularly sensitive.
There was a case where a child refused to go to school, and after two or three consultations, it was discovered that the child had heard about deaths in the nearby air raid shelter, which made them afraid to attend school! When parents face these situations, the first important step is to calm the child's emotions, helping them stabilize before addressing each child's unique needs.
Some children may just need companionship to alleviate their unstable emotions; others may need a little time alone to rest; some may need to be held or comforted; and for some children, the more you care, the louder they cry.
In such cases, as long as you confirm that the child is in a safe environment, you can tell them that once they feel better and stop crying, the adult will come back to communicate with them.
How can we talk to children about emotions, worries, fears, and anxiety? Encourage children to express their worries and fears, identify the causes, and observe if there are specific situations, such as at school; specific times, or people, events, or things.
Parents can discuss these with their children.
A common situation is that children may not want to go to school on Mondays because they had too much fun on the weekend, or some may fear a specific subject! If these occurrences happen too frequently or persist for too long, assistance should be provided, such as counseling.
I recommend using encouragement to gradually change the child's behavior.
For example, for a child with "separation anxiety" who is afraid to go to school alone, initially, you can accompany them to the classroom; after some time, gradually shorten the distance, first just to the school gate; then walk partway with them, allowing them to walk a portion on their own; and finally, say goodbye at the front door! If it is a "phobia," such as a child being afraid of dogs, start by showing them pictures of dogs, then gradually allow them to interact with newborn puppies, observing quietly, and slowly guiding them to approach the puppies.
If they show willingness, you can gradually encourage them to interact with larger dogs!
In addition to behavioral approaches, cognitive teaching is also particularly important.
For instance, if someone in the family has passed away, the child may associate this with worries about their parents leaving or dying.
At this time, you can reassure the child that the likelihood of accidents is not that high, which can help alleviate their anxiety.
One child once asked his parents what would happen to him if they had an accident.
The father cleverly replied, "Don't worry, I have enough insurance to take care of you financially, and besides, there are other family members who will look after you! They love you just as much!" Such reassurances can significantly reduce the child's worries.
Additionally, it is helpful to clearly communicate your usual whereabouts, such as saying that you can be reached at the office in the morning, on your mobile in the afternoon, and specifying what time you will be home at night!
2.
If a child has been experiencing frequent gastroenteritis, it is best to consult a pediatric gastroenterologist to rule out infectious diarrhea.
Once the gastrointestinal system stabilizes, if the child continues to eat very slowly, remember that scolding is not a good method; it will only make them eat even slower.
Regardless of how slowly they eat, as long as the family is full, you can take the food away.
If they haven't eaten enough, that is their issue.
After a few instances, they will likely start eating faster.
The above describes general situations, but actual applications may vary for each child.

Sincerely, Dr.
Pei Ren-Sheng, Pediatrician.

---

Reply Date: 2006/04/23