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My daughter, 6, had what I think was a panic attack, and she has extreme nightmares. Should I worry?

One panic attack does not suggest a disorder, but if the nightmares are impairing, it's worth investigating 

Rachel Busman, PsyD

Co-Director, Selective Mutism Program, Anxiety and Mood Disorders Center
Child Mind Institute

Q: My daughter is 6 and her father, who lives in California, comes in town one or two times a year to visit. On his last visit she came home after spending the day with him and had what I would describe as a panic attack. She complained that she couldn't breathe and was gasping for air, she said her heart was hurting, and she began to get very clammy. It lasted about an hour and I was able to calm her down. She also has extreme nightmares a few times a week that cause her to be afraid to go back to sleep for up to two hours. What would you recommend?

A: What your daughter experienced does sound like a panic attack, which is a rush of physiological symptoms—people can experience shortness of breath, rapid heart rate  sweating, dizziness—oftentimes out of the blue, and other times in a situation of anxiety. The good news is that panic attacks themselves are not dangerous and usually they subside in several minutes.

But having a panic attack is not indicative of a panic disorder. Many people have one panic attack. A panic disorder is when you have recurrent episodes such as this, accompanied by a fear that something catastrophic will happen—you feel that you're going to die or go crazy—and you begin to act in ways designed to avoid having another panic attack.

That said, if your daughter is having extreme nightmares multiple days a week and she's afraid to go back to sleep for up to 2 hours, that's beginning to rise to the level of impairing and pervasive, and something you might want to check out with your pediatrician or a mental health provider. I'd suggest describing the panic attack and any other extreme fear reactions you've seen, along with the nightmares, and discuss how to handle them. Depending on how long they've been happening, they may warrant her being assessed further to understand better what's going on, and the best possible response (e.g. treatment)

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