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Helpful Hints for Parents in the Midst of Separation or Divorce

What Children of Divorce want Caregivers to Know

  • I need to feel emotionally and physically safe.
  • I sometimes feel all alone and emotionally abandoned.
  • I may daydream about my absent parent.
  • I may regress to immature behavior.
  • I wonder if my parents still love me.
  • I feel as much distress as my parents do.
  • I may be will to do anything-even being “bad” to unconsciously try to get my parents back together.
  • I will remember any violence that I have seen or heard between my parents.
  • I often feel confused because I don’t understand adult issues.
  • I blame and shame myself when I hear negative statements about my parent(s). (lowered self-esteem)
  • I many express my anger inappropriately by acting out or withdrawing.
  • I may complain about feeling sick.
  • I may not eat or sleep as well as usual.
  • I may have trouble concentrating on my schoolwork.
  • I worry a lot about my family and my future.

Stages of Grief from Separation

The grief process of separation or divorce often follows the stages of acceptance of death described by Elizabeth Kubler-Ross. Children will move back and forth through these stages. Children need to be encourages to talk about their feelings of loss. If a child seems to get “stuck” in a stage for a prolonged time, consider getting professional advice.

Denial- This stage is often characterized by shock and numbness. Denial is used as an emotional buffer to the pain of loss. The child may pretend the separation didn’t occur or that it didn’t bother him/her.

Anger- In this stage the child may express anger toward God, the absent parent or the parent who remains for “sending the other parent away.” The child may even be angry at himself/herself for behavior that he/she believes made the parent leave. Feelings of rejection may contribute to the anger. Anger is a healthy and necessary emotion to feel. Accept the child’s anger by using reflective listening responses such as “You’re really feeling angry that your dad is gone.” Help the grieving child find appropriate outlets for his/her angry energy.

Bargaining- This stage may involve “making a deal” with God or parents in an attempt to “fix” things. Often a child will make promises of improved behavior so the parent will return. This indicates that the child is feeling guilty for the separation. When bargaining doesn’t work, more anger sets in.

Depression- When the reality of the separation sinks in, the child may feel helpless, very sad, physically sick or tired. The child may have internalized the anger, guilt, and loneliness. In extreme cases the depression can lead to suicidal thoughts. If this stage persists for two weeks or more, seek counseling.

Acceptance- If a child doesn’t get stuck in one of the former stages, he or she will reach this final stage of grief. Grief recovery time varies from a few weeks to two or more years. Once the reality of the loss is faces and accepted, life can move on with feelings of peace, happiness, and hope for the future.

Resources Used:

Bender, J.M. (2004). Getting Yourself Together When Your Family Comes Apart. Coping with

Family Changes. Chattanooga, TN: National Center for Youth Issues.

Helping your student prepare for taking tests

The best thing you as a parent can do to help your child do his or her best on tests and to reduce anxiety is to provide positive support by expressing confidence in your child’s ability to do their best. Let that be your expectation as well. Children should know that test scores are important, but are not the measure of your love and acceptance of them.

On test days, try to provide a calm, stress-free environment each morning as your child gets ready for school. Get up in plenty of time to avoid morning rush and anxiety.

Help teach and reinforce the following test-taking tips and strategies:

  • Get plenty of rest each night
  • Eat a good healthy breakfast
  • Have a positive attitude
  • Relax…Don’t fret
  • Try Hard…Do your best
  • Listen carefully and follow directions
  • Think before you answer
  • Read directions and questions carefully
  • Don’t rush…work at middle speed
  • Check over your work when finished
  • Don’t expect to know every answer


Anxiety is a sense of worry, apprehension, and/or fear. It is considered to be the number on health problem in America. Although everyone feels anxious from time to time, approximately 10 percent of children have excessive fears and worries that can keep them from enjoying life. Although quite common, anxiety disorders in children are often misdiagnosed or overlooked. It is normal for everyone to feel fear, worry and apprehension from time to time, but when these feelings prevent a person from doing what he/she wants and/or needs to do, anxiety becomes a disability.

Here are a few tips for dealing with an anxious child:

  • Genuinely accept your child’s concerns.
  • Listen to your child’s perceptions and gently correct misinformation.
  • Patiently encourage your child to approach a feared situation one step at a time until it becomes familiar and manageable.
  • Always try to get your child to events on time, or early- being late can elevate levels of anxiety.
  • Continually set equal expectations for all kids anxious or not. Expecting a child to be anxious will only encourage anxiety.
  • Role-Play strategies- how to react in certain situations. Explore both best case scenarios and worst case scenarios using realistic evidence.
  • Build your child’s personal strengths.
  • Help your child organize their school materials for the next day the night before.
  • Allow and encourage your child to think on his or her own.
  • Designate a “safe person” at school that understands your child’s worries and concerns.
  • Try not to pass your own fears onto your child.
  • Work together as a team (family members, teachers, child, etc.)
  • Set consequences- don’t confuse anxiety with other types of inappropriate behavior. Set limits and consequences so that you don’t allow anxiety to enable your child.
  • Have reasonable expectations


Does any of this sound like your child or teen?

  • clinging, crying, and/or tantrums when you separate
  • excessive shyness, avoiding social situations
  • constant worry
  • avoiding situations or places because of fears
  • complaints of frequent stomachaches or headaches
  • experiencing sudden and frequent panic attacks

If so, your child may be experiencing anxiety.
Here, you will find practical strategies and tools to help you manage your child's anxiety, whether your child is just beginning to show symptoms, or has been diagnosed with an anxiety disorder. To begin, continue reading, to find out more about anxiety -- how it looks, how it works, and how to recognize if it is problematic. If your child has been diagnosed with an anxiety disorder, you may prefer to click immediately on this disorder on the menu.

As a parent of an anxious child, you are not alone.
Anxiety is the most common mental health concern for children and adults. Because anxious children and teens are often quiet and compliant, however, they frequently go unnoticed by their parents and teachers. As a result, many never receive the help they desperately need. Unfortunately, untreated anxiety can lead to other problems later in life, such as depression, missed opportunities in career and relationships, increased substance use, and an overall decreased quality of life.

Parents often say that from a very young age, they knew there was something different about their child, but did not immediately recognize it as an anxiety problem. Some waited for their child to "grow out of it", never expecting their child to become even more debilitated over time. Parents of anxious children and teens are often confused about what to do, as well as frustrated, and overwhelmed.

The good news: Anxiety can be successfully managed!
Parents play an essential role in helping their child or teen manage anxiety. When coping skills and brave behavior is rewarded and role-modeled in the home, children and teens can learn to face their fears, take risks, and ultimately gain confidence.

Helpful Hint:
As a parent, remember that you are the most influential person in your child's life. See "Helpful Tips for Parents" and "Healthy Habits for the Home" for important ways in which you can begin to help your anxious child or teen.

What you (and your child!) Need to Know about Anxiety

Anxiety is normal. Everyone experiences anxiety at some point in time. For example, it is normal to feel anxious when on a rollercoaster or before an exam.

Anxiety is not dangerous. Although anxiety feels uncomfortable, it is temporary, and will eventually decrease.

Anxiety is adaptive. Anxiety helps us prepare for real danger, such as crossing a busy street. It can also help us perform at our best, and motivate us to study for an exam or practice for a big game. When we experience anxiety, it triggers our "fight-flight-freeze" response, and prepares our body to react. For instance, our heart beats faster, to pump blood to our muscles, so we have the energy to run away or fight off danger. Without it, we would not survive.

Anxiety becomes a problem when our body reacts in the absence of real danger.

For more information on how to explain anxiety to your child, see "How to talk to your Child about Anxiety"

The ABC's of anxiety

Children, teens, and adults experience anxiety in three ways:

  • Physically - what we feel in our body;
  • Mentally - what goes through our mind like worrisome thoughts;
  • Behaviorally - what we do or our actions, such as avoid or seek-reassurance.

The pattern of these experiences varies from person to person, and from situation to situation.

Anxiety is felt in the body. Often, when young children feel anxious, they do not actually recognize or describe it as anxiety or nervousness. Instead, they may say that they feel sick, or have a sore tummy. Teens may complain of headaches, chest pains, and sore shoulder muscles.

Children and teens can experience anxiety in their body in many ways:

  • rapid heart rate
  • rapid breathing, feelings of shortness of breath, or breath holding
  • discomfort or pain in the stomach, nausea
  • feeling very hot or cold
  • sweating
  • trembling or shaking
  • numbness or tingling
  • headaches
  • chest pain or discomfort
  • dizzy, lightheaded, or unsteady feelings
  • feelings of a lump in the throat or choking
  • feeling things are unreal or feeling detached from oneself

If many of these physical signs happen suddenly and intensely, your child may be having a panic attack. Panic attacks are uncomfortable but not dangerous.

Anxious children and teens worry! These worries can be about a current situation or about some future event. Young children may not be able to identify any anxious thoughts even when they are very anxious. This also sometimes happens for older children and adults. Here are some examples of anxious thoughts.

  • That dog might bite me!
  • What if I fall off my bike and everyone laughs?
  • What if my Mom doesn't come to pick me up after school?
  • What if the other kids don't like me?
  • What if I get lots of mistakes in my spelling test?
  • What if I throw up at school?
  • What if my Mom or Dad dies?

Anxious children and teens avoid! One of the most common behaviors seen as part of an anxiety situation is avoidance. In a situation of real threat (e.g., an aggressive looking dog), avoidance is very helpful, as the fight-flight-freeze response keeps us safe from danger. In other situations where there is no real danger, avoidance prevents children and adults from learning to cope with a challenging situation. Some examples of avoidance behaviour include:

  • Not wanting to eat in cafeteria
  • Not wanting to go to swimming lessons because of fear of putting face underwater
  • Not wanting to go to preschool or school because a parent is not there
  • Not wanting to raise hand in class or read out loud
  • Not wanting to sleep in your own bedroom

Key Point: Avoidance is a habit-forming, ineffective way of coping in the long run. With your patience and consistency, your child will practice of coping skills, and will learn to face his or her fears!

Anxious children and teens seek reassurance! It is normal and helpful for children and adults to ask for information, in order to better understand the degree of risk or threat in an unfamiliar situation. Anxious children and teens, however, may ask repeatedly for reassurance, even when they have already received a good deal of reassurance. For example:

  • "Are you sure you will be on time to pick me up?"
  • "Are you sure there won't be a bad storm tonight?"
  • "Are you sure I won't get sick?"
  • "Are you sure the kids will like me?"

Anxious children and teens engage in inappropriate safety behavior! Safety behaviors are things we do to make ourselves feel less anxious. Examples of safety behavior include:

  • Not attending age-appropriate activities unless a parent is there.
  • Not wanting to be away from home unless they have a cell phone.
  • Not going out unless they have a complete change of clothes with them, in case they are sick.

When does Anxiety become a Problem?

Anxiety is a normal emotion that is essential for survival. Specialists in child development have also noticed that certain fears are more common at certain ages. For example, it is normal for young children to experience some anxiety around strangers, and for older children and teens to experience some performance anxiety in front of peers.

For some, difficulty with anxiety starts to cause considerable distress or interference in everyday life. Common examples of distress are:

  • crying every day before going to school, because a parent does not stay
  • crying when the child sees a bee or a large dog that comes close
  • having an upset stomach every time there is an important test at school
  • lashing out or screaming

Anxiety may also interfere with normal activities and with the enjoyment of life. Common examples of interference include:

  • refusal to go on school field trips because of anxiety
  • being very slow in play or failure to join in with other children
  • wanting to stay home sick on the day of a school presentation
  • not wanting to participate in unfamiliar activities

Most people consider anxiety to be a problem when it causes significant distress or interference for the child or the family.

Sometimes the behaviors of anxious children and teens can seem unreasonable to others. These children and teens may be labeled as "difficult", "stubborn" or "too sensitive". Indeed, their actions can be very frustrating for the entire family! It is important to remember that an anxious child or teen who lashes out, cries, and avoids situations is, in fact, responding instinctually to a perceived threat. Like other animals, your child is reacting by either fighting (e.g. yelling, tantrums), fleeing (e.g. avoiding), and/or freezing (e.g. mind going blank).

Key Point: When encouraging your child to face his or her fears, remember that you are asking your child to fight against an instinctual response to danger!

Helpful Tips for Parents

Reduce Stress! Excessive stress and tension in your home (for example, arguing, fighting, too many lessons/activities, etc.) can have a negative effect on your child. Look at ways to reduce stress. For instance, plan some fun time each day (even if it is only five minutes) to read a story, go for a walk, watch a favorite TV program together, or listen to music. Also, try to deal with conflict between family members when it arises (have family meetings to discuss problems). Parents also need to be careful not to express frustration or anger by arguing or raising voices around their children.

Make a Routine! Establish a routine by setting specific times for meals, homework, quiet time, and bedtime. Help your child establish a bedtime routine, which may include a bath and reading a story, or just time to chat. This can set the stage for helping your child develop better ways to manage anxiety.

Work Together! It is important that you and your partner work together to help your child manage his or her anxiety. If parents are not consistent, it can be very confusing for your child. Try to agree on ways of handling your child's anxiety (for example, both agree to limit giving reassurance or both follow through on setting limits, such as not having your child sleep in your room), and be consistent in terms of rewards.

Give Consequences! Although your child may have problems with anxiety, that does not give him or her the green light for inappropriate behavior. It is important that you set expectations and limits for your child, and follow through on consequences for inappropriate behavior (such as losing television privileges for not completing chores). Set clear limits and consequences for inappropriate behavior, and discuss this in advance with all family members at a calm time. Children are happier when they know the rules and what happens when they break them! Be sure to give rewards and praise when your child is adhering to expectations.

Be Supportive! Recognize that it is difficult for children to face their fears. It is important not to laugh at your child or minimize his or her fears (for example, "don't be silly" or "you're being stupid"). Rather, let your child know that it is normal to have fears (we're all afraid of something), and that it is possible to "boss back" your fears. When your child is upset, make sure to listen to him or her, to send your child the message that it's okay to talk about feelings. Let your child know that he or she is understood, and help him or her figure out ways to cope with upsetting situations (for example, "I know you feel scared to go to Pam's place by yourself, but you're working on getting comfortable being away from home. How can we make this easier for you?"). It can also be helpful to use some humor when dealing with the world. We all benefit from finding the humor in things and being able to laugh at life's mistakes.

Encourage Independence! Although it is tempting to want to do things for your child, especially when he or she tends to be nervous and fearful, it is better to let kids do things for themselves! How else will they learn the skills and abilities to cope with life? Encourage your child to try things on his or her own, take some risks, and do things for him or herself. This can include giving him or her responsibilities around the house (cleaning own room or setting the table). It can also include helping your child brainstorm ways to deal with problems or difficult situations (such as how to handle an argument with a friend or make up marks at school for missed assignments). Encouraging independence does not mean you can't be supportive, but it means that you shouldn't take over or do everything for your child.

Avoid Giving Excessive Reassurance! It can be hard not to give your child reassurance, especially when he or she is scared or anxious; however, giving constant reassurance prevents your child from learning how to cope on his or her own. Teach your child to answer his or her own questions. Model how you think through problems or challenges, which helps your child learn to do it him- or herself.

Build Self-Confidence! It is important to praise your child for his or her accomplishments and for facing fears! Involve your child in activities that help him or her feel proud. Find activities that reinforce that he or she is good at something (sports, music, or art) and helps instill a sense of belonging and pride (such as cadets, scouts or girl guides, school helper). You can also give your child responsibilities around the house and let him or her be in-charge of something at home (for example, making sure the dog gets a long walk everyday).

Realistic Expectations! It is important to have expectations for your child and help him or her meet those expectations; however, understand that an anxious child will have some trouble doing things, and may need to go at a slower pace. Help your child break down goals into smaller steps that he or she can accomplish. It is important that your child is taking steps forward, even if the steps are small. Try not to push too hard or too fast, but let your child go at his or her pace.

Reactions! Although it is important to be understanding and caring, do not overreact or let anxiety trick you into thinking that something is too hard or impossible for your child (for example, thinking it's too hard for your child to sleep alone). Keep things in perspective. Yes, it might be challenging, but it can be done! On the other hand, sometimes we have a hard time understanding our child's anxiety or why something is so difficult for him or her. When we don't acknowledge that our child is having a hard time with anxiety, the child may try to hide it (and suffer alone) or the symptoms may become more pronounced, in order to get the attention he or she needs.

Dealing with Your Reactions! It can be very difficult dealing with an anxious child. Make sure you manage your own reactions. Do some things for yourself (call a babysitter, run a hot bath, read a book when the kids go to bed, talk to a friend about how you're feeling, go for a walk, or whatever helps you keep a positive perspective). Remember the basics: eat well, get enough sleep, and exercise! Also, give yourself permission to take time off. You can't be helpful to your child if you don't take care of yourself. You also need to be careful not to pass fears on to your children. Try to present a neutral reaction to situations and let you child know it's safe to explore things.

Take Risks! Anxious children need to try new things and take some risks, in order to build confidence and develop the necessary skills for dealing with the world. Encourage your child to try some experiments, such as making a phone call, talking to an unfamiliar classmate, or asking a question to a store clerk. Remember, you can model brave behavior by trying new things too!

Avoid Avoidance! Anxious children tend to want to avoid things that cause them anxiety. Although avoiding things temporarily reduces distress, it also allows fears to grow and makes things more difficult in the future. Avoid letting your child avoid things. Instead, encourage him or her to try things and take small steps towards facing fears!

Healthy Habits for the Home

Anxious children and teens prefer to have a sense of control in their lives. They do not cope well with a disorganized, "spontaneous" family style. They feel calmer when:

  • life is predictable
  • they know what is expected of them
  • they know what the consequences will be

Two ways to help make life more predictable for everyone in the family are setting limits and creating routines.

Setting limits is a challenge for parents, especially when the anxious child or teen becomes upset, moody, or has a 'meltdown'. If limits are repeated and enforced, they help everyone feel more secure and, usually, a child or teen's behavior will improve. It can be a relief to have adults in charge!

Routines also help to reduce anxiety. But anxiety tends to disrupt routines. You need to work hard to build family routines so life is more predictable for your child. Help your child adjust to new family routines by preparing him or her in advance. Ask your child to help plan the new routine, and introduce it gradually. Making an attractive schedule for the fridge provides a sense of control and order.

This includes bedtime routines! A bedtime routine involves doing the same things, in the same order, at the same time, just before going to bed. This ritual helps your child gradually relax and wind down. For both your child and the rest of the family, a routine that lasts about 15 to 30 minutes is best. However, stimulating activities should start to wind down about an hour before bed (e.g. turning computer games off).

Some activities you can include in a routine:

  • some warm milk or a snack
  • a warm bath
  • let your child choose what pajamas or nightdress to wear
  • read or tell a story
  • with young children, you can tuck your young child in with a blanket, teddy bear or some other thing that makes him or her feel secure

For older children and teens, you may want to include:

  • some one-on-one time to talk about the day
  • listening to some soft music
  • reading magazines together
  • practicing some relaxation tools (e.g. progressive muscle relaxation)

Remember...a good routine can take several weeks to establish, but everyone will feel better once it is in place.

It is important you do not get into the habit of permitting your anxious child to sleep in your bed. This becomes a habit which is hard to break. For more information on how to handle this situation, see What to do when your child insists on sleeping in bed with you.

Plan time for homework and projects: This needs to be a regular part of the schedule, as anxious children tend to put things off. Anxious children can easily become overwhelmed with a task. Thus, it can be helpful to

  • Break the task into small, manageable steps
  • Set a specific time and place to work
  • Praise and rewards for each step completed

Often the hardest part is getting started, so knowing that the TV program is on afterwards, or having computer time to look forward to can help motivate your child.

If your child is anxious about an upcoming event or project, you can adapt the Climbing My Fear Ladder form to break down the "goal" into manageable steps. Goals that work well with this activity are events that require preparation and/or performance (e.g. test, oral presentation, recital, job interview etc...).

Encourage physical activity: For the anxious child or teen, exercise may help reduce stress and induce relaxation. They often feel "tired all the time" because they are always exhausting themselves with worry, and don't feel like exercising. But exercise will improve energy and reduce worry. Try to find something fun to do together rather than making this a chore. Ongoing participation in a physical activity program encourages self-discipline, leadership, as well as opportunities to socialize with peers. Get the whole family involved!

Food and Nutrition: No one copes well when they are tired or hungry. Anxious children and teens often forget to eat, don't feel hungry, or have upset stomachs. They rarely eat a large full meal. It's okay for your child to "graze" as long as the snacks cover the basic food groups in a day. Offer frequent, nutritious snacks. Instead of stocking up on chips and soda, have fresh fruits and vegetables and low-fat dairy foods available in your fridge or kitchen. As much as possible, make meal time "family time" and sit down and eat together.

Last but not least, be a good role model! One of the first steps in creating a positive and predictable environment is to take stock of your own daily habits and ways of coping with your own anxiety. Use the coping tools to manage your own anxiety and share appropriate examples with your child. After all, you are the single biggest influence on your children!

How to Teach Your Child Calm Breathing

What is “calm breathing”?

Calm breathing is a technique that teaches your child to slow down his or her breathing when feeling stressed or anxious. 

Why is calm breathing important?

When your child is feeling anxious, his or her breathing will change. When we are anxious, we tend to take short, quick, shallow breaths or even hyperventilate. 

  • This type of anxious breathing can actually make the feeling of anxiety worse!
  • Doing calm breathing can help lower your child’s anxiety, and give him or her a sense of control
  • Calm breathing is a great portable tool that your child can use when feeling anxious, especially in situations when you are not there to help him or her through it.

How To Do It

Step 1: Explaining calm breathing to your child

This is a tool your child can use anywhere, anytime! Other people will probably not even notice when your child is using this tool. For older children and teens, explain that taking short quick breaths actually increases other feelings of anxiety (e.g. heart racing, dizziness, or headaches). Calm breathing will slow down his or her breathing.

Step 2: Teaching the calm breathing technique
  • Take a slow breath in through the nose (for about 4 seconds)
  • Hold your breath for 1 or 2 seconds
  • Exhale slowly through the mouth (over about 4 seconds)
  • Wait 2-3 seconds before taking another breath (5-7 seconds for teenagers)
  • Repeat for at least 5 to 10 breaths

Calm Breathing for Younger Children: Bubble Blowing 

A fun way to teach your younger child how to do calm breathing is the “bubble blowing” technique. Using a toy soap bubble container and wand (available at any toy store), have your child practice blowing bubbles. The breathing required for blowing soap bubbles is the same as what is used for calm breathing. Simply make sure your child waits a second or two before blowing another bubble. Then practice “blowing bubbles” without a bubble wand. 

Important Hint: Although “bubble blowing” is a great way to practice calm breathing, it is important to remind your child that he or she is doing this to learn how to breathe calmly. In other words, do not simply ask your child to blow bubbles without explaining this tool is used to help to manage anxiety. Here’s a script of how to introduce bubble blowing to your young child 

Talking about bubble blowing

“Today we are going to practice a new skill called calm breathing. This will be a new tool that you can use when you feel anxious, such as when you are at school. When you use calm breathing, you take slow breaths. A good way to practice it is to do some bubble blowing, because you have to take a slow, deep breath to make a big bubble, and you have to blow the bubble really slowly or it will pop! So let’s practice. Take a slow, deep breath in, hold it for a second, and then slowly blow some bubbles. Good job! Now let’s try that again.”

For Older Children and Teens: Belly Breathing  

Since calm breathing involves taking slow, controlled breaths from the diaphragm, another way to explain this technique is to present it as “belly breathing”. The steps for this exercise are as follows:

  • Inhale slowly for 4 seconds through the nose. 
  • Ask your child to pretend that he or she is blowing up a balloon in the belly, so your child’s belly should inflate when inhaling.
  • Wait 2 seconds, and then slowly exhale through the mouth. Ask your child to pretend that he or she is emptying the balloon of air, so the tummy should deflate.
  • Wait 2 seconds, and then repeat.

Helpful Hint: When belly breathing, make sure your child’s upper body (shoulders and chest area) is fairly relaxed and still. Only the belly should be moving!

Step 3: Practice, practice, practice!

In order for your child to be able to use this new tool effectively, he or she first needs to be an expert at calm breathing.

The only way to become an expert is to practice this skill daily!

Rules of practice: 

  • Until your child is comfortable with this skill, he or she should practice it at least twice a day, doing 10 calm breaths in a row.
  • When you are practicing calm breathing, start when your child is relaxed, before he or she is feeling anxious. Your child needs to be comfortable breathing this way when feeling calm!
  • Once your child is comfortable with this technique, he or she can start using it in situations that cause anxiety.

As a final note…

If you are using cognitive coping cards with your child (see Developing and Using Cognitive Coping Cards), calm breathing can also be used as a coping statement. For example,

  • I’m feeling a little anxious right now. Maybe I should do some belly breathing!”
  • “I don’t need to worry if I feel scared. I can always do some bubble blowing!”

How to do Progressive Muscle Relaxation

This exercise will help your child learn how to relax when he or she is feeling anxious or stressed. It can also help reduce physical problems such as stomachaches and headaches, as well as improve sleep. The technique involves tensing and then relaxing different muscles in the body. This can help your child learn the difference between being tense and feeling relaxed.

Helpful Hints:

  • Set aside 15 to 20 minutes to complete this exercise.
  • Find a place where you and your child can complete this exercise without being disturbed. 
  • Teens may prefer to do this exercise on their own. Encourage them to find a quiet place to practice. 
  • When reading the instructions, speak slowly and use a calm and soothing voice. Pause after each instruction to allow your child time to carry it out.
  • You can also record the instructions on a tape or CD. This can be helpful for teens who may want to do this on their own.
  • For teens, change some of the wording. Use “stomach” instead of “tummy.”
  • Make sure your child is not tensing too hard. He or she should feel tightness in the muscles, but not pain.· Ask your child to tense each muscle for 5 seconds before relaxing the muscle.

Getting ready

Have your child find a comfortable place to sit or lie down, close his or her eyes, and let the body go loose.  


Once your child is sitting comfortably with eyes closed, slowly read the following instructions:

“Take a deep breath in through your nose…hold your breath for a few seconds…and now breathe out…good…take another deep breath through your nose…imagine your tummy is a big balloon filling up with air…hold your breath…now breathe out and imagine that the air in the balloon is slowly escaping…Now I want you to pay attention to your body and how your it feels…. 

Let’s start with your legs…I want you to stretch out your legs in front of you and point your toes…squeeze the muscles in the top of your legs…now squeeze the muscles in the bottom of your legs…hold it…now relax…let your legs go limp…imagine that your legs are floppy cooked spaghetti noodles…relax all the muscles in your legs…notice how heavy your legs feel… now take a deep breath and hold…and breathe out… 

Now, make a fist with your left hand and squeeze…imagine that you are holding an orange and you are squeezing all the juice out of the orange…feel the tightness in your hand and arm… hold it tight…and now relax your hand… notice how your muscles feel when they are relaxed…now make a fist with your right hand and squeeze tight…imagine that your holding a lemon and squeeze all the juice out…feel the tightness in your hand and arm…hold it…and now relax your hand… enjoy feeling relaxed… now take a deep breath and hold…and breathe out… 

Let’s focus on your arms…stretch your arms out in front of you like you are reaching out to something…keep stretching…hold it…and now relax…let your arms drop to your sides…imagine your arms are cooked spaghetti noodles that are dangling at your sides…notice how relaxed your arms feel…relax your arms…now stretch your arms up above your head…try to reach for the clouds with your finger tips…hold…keep reaching above your head…now let your arms drop to your sides…relax you arms…let your arms go very floppy…notice how calm you feel… now take a deep breath and hold…and breathe out… 

Let’s move to your shoulder… pull your shoulders up to your ears…hold…keep holding…now relax… notice how relaxed you feel… now take a deep breath and hold…and breathe out… 

Now, pull in your tummy muscles…imagine that an elephant has just stepped on your tummy…suck in all the muscles in your tummy…hold it…good…now relax…let your stomach out…relax all the muscles in your tummy…notice how your muscles feel when you relax them… now take a deep breath and hold…and breathe out… 

Finally, wrinkle up your faces as much as you can…wrinkle your nose…mouth…eyes…forehead…cheeks…and push your lips together…Notice how tight the muscles in your face feel…hold it…good…now relax…let all the muscles in your face go limp…notice how relaxed you feel… now take a deep breath and hold…and breathe out… 

Now relax your whole body…imagine you’re a rag doll and try and relax all the muscles in your body. Notice how good you feel…so relaxed…so calm…now take a deep breath and hold it…and breathe out…you’ve done very well! When you are ready, you can slowly open your eyes.”

Quick Tense & Relax! 

  • After your child has had some time to practice the full version of the muscle relaxation exercise, introduce the quick tense and relax strategy.
  • In this approach, your child learns how to tense all the muscle groups (for 5 seconds) and then to relax all the muscles in his or her body at one time.
  • Your child can do this by taking a big breath, lifting up the shoulders, pushing out the chest and wrinkling up the face. Then, silently saying the word “relax” and letting the whole body go limp like a rag doll. Over time, your child can start to practice this strategy in more stressful situations (for example, in the playground or while in the car).

 Quick Relax!

  • Once your child has learned to tense and relax the whole body, the next step is to practice relaxing without tensing so that your child can easily use this strategy in a wide range of situations.
  • Ask your child to take a deep breath, then slowly let out the breath while silently saying the word “relax” and letting the whole body go limp like a rag doll. If the child wishes, he or she can go through several breaths, each time letting the body become looser and more relaxed after each breath.
  • The goal is to help your child develop a quick strategy to help him or her relax in any situation.

Helpful Hints:  

  • Practice! When your child is first learning these strategies, encourage him or her practice
  • Do it together! It can also be helpful to do the exercise along with your child or have the whole family participate. Make it a family project! However, some teens may prefer to do it on their own, so you might want to ask how much help they want.
  • Break it up! If your child is very young, break up the exercises into two parts and take a break in between.
  • When to practice? It can be helpful to practice the full version of the muscle relaxation exercise in the evening before your child goes to bed. Try the quick tense and relax or quick relax exercise at different times during the day.
  • Records! Have your child record his or her practice sessions. For younger children, make up a poster and give your child a star every time he or she practices. For teens, encourage them to note practice times in their day planner or on a calendar, and to “check it off” once they do it.
  • Coping Card! Encourage younger children to include muscle relaxation on their coping card.
  • Praise! Give your child lots of praise for completing this exercise! It can be difficult to learn to relax. Let your child know that it takes time and practice, just like learning any new skill.

Healthy Thinking for Younger Children

**For older children and teens, see Realistic Thinking for Teens

In general, anxious children think differently than other children. For example, they can easily come up with 101 ways that things can go wrong! They also tend to see the world as more threatening and dangerous. If a parent is late coming home, an anxious child may think “Mom got in a car accident!” What your child says to himself or herself is called “self-talk”. Anxious children tend to have negative or anxious self-talk. Some examples include:

  • “I will fail the test.”
  • “What if I can’t do it?”
  • “Things are not going to work out.” 
  • “They don’t like me.” 
  • “I’m stupid.”
  • “I’m going to get sick and die.”
  • “That dog is going to bite me!”

It is important for children to identify their self-talk, because anxious thoughts lead to anxious feelings, which lead to anxious behavior. For example: 

Situation = First day of school 

Thus, the first step is to get your child to start paying attention to his or her self-talk, especially anxious thoughts!


Step 1: Teach younger child about thoughts or “self talk”
  • Thoughts are the words we say to ourselves without speaking out loud (self talk).
  • We have many thoughts each hour of the day.
  • Thoughts are private – other people don’t know what we’re thinking unless we tell them. 
  • People can have different thoughts about the same thing.

 Here is an example of how to explain thoughts:

“We all have thoughts about things. Thoughts are words we say to ourselves without saying them out loud. Other people can’t tell what you are thinking unless you tell them. Because we have thoughts all the time, we usually don’t pay attention to them. They just come to us automatically! Let’s try and slow our thoughts down and pay attention to them.”

The What am I Thinking? activity can help with this explanation. You can also use picture books or movies to teach your child about thoughts. For example, point to a picture of a character and say, “Hmmm, I wonder what he is thinking?”

Remember, it can be difficult for young children to understand the concept of what a thought is, and it can be especially difficult to tell the difference between a thought and a feeling. For example, your child may say his or her thought is “I’m scared” (which is actually a feeling) versus “That noise is a burglar trying to break in” (which is a real thought). It is important to expose the thoughts underneath the feelings! For example, “What is making you scared? What do you think that noise might be?” 

One way to describe the difference between a thought and a feeling to a young child is to explain that a thought comes from your head, and a feeling comes from your heart.

Step 2: Help your child identify thoughts (or self-talk) that lead to feelings of anxiety. 
  • Often, we are unaware of what we are thinking, and it can take time to learn to identify our specific thoughts.
  • Questions to ask, in order to help your child identify his or her “anxious” or “worried” thoughts include:
    • What is making you feel scared?
    • What bad thing do you expect to happen in this situation?  
    • What are you worried will happen?

For young children, this may be as far as you can progress. Just identifying their thoughts is a big step in a long-term plan to help fight anxiety. One way to get your child to continue to pay attention to anxious thoughts is to use an actual stop sign as a visual reminder to “stop and pay attention”.

Remind your child that just because he or she thinks something, doesn’t mean it’s true! For example, just because your child thinks the elevator will get stuck, doesn’t mean it actually will (even though it might feel really scary). While children can usually describe thoughts that go with feelings of anxiety, in some cases children are unable to identify anxious thoughts, especially children who are very young or not very talkative. At any age, anxiety may be present before there are thoughts about the situation. If you and your child do not identify anxious thoughts, it is best not to press your child about this too much about this. By making too many suggestions, you may create anxious thoughts where there were none before. Instead, watch to see if your child mentions anxious thoughts in the future. The other approaches to managing anxiety work even when anxious thoughts are not identified. 

(The concepts below may be too difficult for younger children to grasp)

Step 3: Teach that what we think affects how we feel
  • When we expect bad things to happen we feel anxious.
  • What we think affects (or controls) how we feel.

For example, imagine you are out for a walk and you see a dog. If you think the dog is cute, you’ll feel calm; however, if you think the dog will bite, you’ll feel scared. Use the Thoughts and Feelings sheet to help explain this idea to your child.

Step 4: Changing unhelpful thoughts to helpful thoughts 
  • First, explain the difference between a helpful thought and an unhelpful thought:

Thousands of thoughts run through our head every day. Some of these thoughts are helpful thoughts, and some are unhelpful thoughts. A helpful thought makes us feel confident, happy, and brave. An unhelpful thought makes us feel worried, nervous, or sad. Can you think of some examples of helpful and unhelpful thoughts?

  • Once your child can identify the difference between helpful and unhelpful thoughts, ask him or her to imagine being in a particular scenario. It is best if the scenario is a bit uncertain. Ask: What is an unhelpful thought you could have? What is a helpful thought? For example,
Situation Unhelpful Thoughts Helpful Thoughts
A group of kids looking at her and laughing Oh no, they are laughing at me. I must look stupid! They are probably laughing about something funny, and I just walked by.
I don't actually know that they were laughing at me!
Not being invited to a birthday party She doesn't like me. I bet I am the only one who didn't get invited in the whole class. They probably just forgot.
Or maybe it was just a small party.
I have other good friends.
Getting a low grade on a quiz I suck. I am never going to do well in spelling. Well, I tried my hardest.
It's only one grade! I will practice more next time.

It is very useful to help a child identify unhelpful thoughts and create helpful thoughts. At the same time, anxious thoughts and feelings are normal. It is important to communicate that you and your child can accept anxious thoughts and feelings. They are not stupid or foolish. They are just one way of thinking and feeling, and there are lots of other ways of thinking and feeling. 

Step 5. Introduce the STOP Plan to your older child: 

1. Pay attention to signs of anxiety (= S)
2. Pay attention to anxious thoughts (= T) 
3. Think of other helpful thoughts (= O) 
4. Praise and Plan for next time (= P) 

Scared? Thoughts? Other helpful Thoughts? Praise and Plan

Sore tummy
Heart racing
Knees Trembling

I might throw up, and mom won't be here to help me.

I can ask to go to the bathroom and do my calm breaths.

I can get a drink of water.

My teacher cares, he will help me.

Good job for remembering to use the STOP Plan!

Next time, I will remember that feeling panicky doesn't last forever, and drinking water helps.

Now, use the STOP Plan Handout with your child! You will need to print several copies. First, go through the chart together with your child. You will likely need to do this several times over a couple of days. Once your child gets the hang of it, have your child complete it alone when faced with a scary situation. Eventually, your child will get used to the steps in the plan, and may not even need to write it down. Remember to praise and reward effort!

Developing and Using Cognitive Coping Cards

An important tool in your child or teen’s anxiety toolbox is the ability to change anxious thoughts to more relaxed and balanced thinking. However, it can be very difficult for children and teens to remember to use coping tools when they are anxious. They are so focused on their feelings of being in danger that they forget they have a way of telling whether or not danger actually exists (and it usually doesn’t). 

With practice, however, your child can learn to use coping thoughts on his or her own. This is really helpful as you might not always be there to remind your child to use the tools (for example, when at school, or sleeping over at a friend’s house).

A good tool to help your child or teen is Cognitive Coping Cards!

What are Cognitive Coping Cards?

Cognitive coping cards can be small index cards with short sentences of some of the coping skills your child can use when experiencing anxiety. The cards are portable reminders to boss back anxiety!

What sorts of things are helpful to put onto a coping card?

  • A reminder that physical symptoms (e.g., sweaty palms, stomach-aches) are just anxiety
  • The name your child has given to anxiety (e.g. “Mr. Worry”, “the pest”, “the bug”)
  • A reminder that anxiety is not dangerous and doesn’t last forever
  • Positive coaching statements (e.g. “I can get through this!”)
  • A reminder to use some coping skills (e.g. I can do relaxed breathing)
  • Some calming facts your child or teen has used before (e.g. the odds of getting kidnapped are really low)


Step 1: Make sure your child is involved

In order for coping cards to be useful, your child needs to feel that the coping statements will actually be personally helpful! Children and teens are more likely to use them if they have been involved in developing them. It is NOT a good idea for you to simply write them up and hand them over.

What to say to get your child involved:
“You have been really good at bossing back your anxiety these days! Now we can learn another way for you to be the boss. Why don’t we try to figure out some things you can tell yourself when your anxiety is acting up? We can write down some things on cards that can help you feel calm. These cards will be another tool in your anxiety-fighting toolbox!"

For teens: Although you should encourage your child to develop coping statements, older children and teens can be more independent when writing out their coping cards. They can decide what skills are most helpful for them. You can explain that when we feel anxious it is sometimes difficult to remember all the skills we’ve learned to battle that anxiety. Writing out those skills on coping cards might help them remember what has been helpful for them in the past, and what skills they would like to use next time. 

Step 2: Make it a game!

Making up the cognitive coping cards should not be a chore! Have fun trying to come up with good statements that your child will find helpful in managing his or her anxiety. Here are some ways you can make this tool a fun task: 

  • Get the family involved! Like all the tools in the anxiety toolbox, the whole family should work together on the goal of tackling anxiety. Parents, brothers, and sisters can all get involved in making these coping cards!
  • Make it an art project! Decorate the cards with colored ink, sparkles, stickers, gold stars, and different colors of poster board cardboard. This turns developing and using coping cards into a fun project.
Step 3: Remember to praise your child

As always, it is very important that you give lots of praise whenever your child is successful at managing anxiety, or whenever he or she tried to manage anxiety (but was not quite able to do it). This can include saying, “You are doing a great job! I’m so proud of you”, but it might also involve small, simple rewards (story time; playing a fun board game together; having a fun family day; or getting a new video game if your child has been working hard to boss back anxiety for a while).

Some examples of coping cards:

Coping card #1: Billy

Billy has panic attacks, and is afraid he is going to have a heart attack. He has started to boss back his anxiety by doing muscle relaxation, and facing his fears about his panic attack symptoms. 

My Coping Card to Beat Anxiety!

  1. Anxiety is not dangerous. It can’t hurt me! It’s just a bully!
  2. I can boss back my anxiety. I have done it before!
  3. If my heart is racing, I get sweaty, and my tummy hurts. That means that my anxiety is acting up. I’m not in danger.
  4. I could do some relaxation now.
  5. Am I falling into a Thinking Trap?*

*For more information on Thinking Traps, see Realistic Thinking for Teens

Coping card #2: Susan

Susan gets very anxious when she is at school. She is worried that the other kids don’t like her, and that, if they knew she had anxiety, that they would laugh at her and make fun of her. She has been learning to recognize her anxious thoughts and to try to challenge them and think of more realistic thoughts.

My Coping Card to Beat Anxiety!

  1. My face is getting hot and my head is getting dizzy! My anxiety is acting up again!
  2. Maybe I need to use the STOP plan now!*
  3. If I’m feeling anxious, I could do some calm breathing to calm down.
  4. I have lots of friends at school, and they like me even when I get anxious. They told me so.

Helping Your Child Face Fears

Behavioral Exposure

An important step in helping your child manage irrational fears involves facing feared situations or places. It is normal for children and teens to want to avoid the things they fear. However, avoidance prevents them from learning that feared situations or places are not dangerous.

The process of facing fears is called EXPOSURE. Exposure involves having your child repeatedly go into feared situations until he or she feels less anxious. Exposure is not dangerous and will not make the fear worse. After awhile, the anxiety will naturally lessen.

Starting with situations that are less scary, children and teens work their way up to facing things that cause them a great deal of anxiety. Over time, they build up confidence in those situations and may come to enjoy them. This process often happens naturally. A child or teen who is afraid of the water takes swimming lessons every week and practices putting feet and legs in the water, then the whole body and, finally, diving underwater. Children and teens with a fear of water can learn to love swimming. The same process occurs when children and teens learn to ride a bike, skate, or drive a car.

Exposure is one of the most effective ways of overcoming fears. However, it takes some planning, encouragement, modeling and rewards.

How to Do It!

Step 1. Understanding
  •  Help your child understand the importance of facing fears.
  •  Use an example. Ask your child the following question:

“Tim is afraid of the water, but really wants to spend time with his friends at the swimming pool. What can he do to stop being afraid of the water?”

  •  Most children and teens understand that, in order to stop being afraid of something, they need to face it.
  • You can give your child the following explanation to help him or her understand.

“It is important for you to face your fears so that you can learn that those situations are safe. Although it can be scary at first, with practice you will feel less anxious. You can start with some things that are less scary and take small steps towards facing the things that are scarier. Over time, you will feel better in those situations and may end up really enjoying them.”

Step 2. Make a list
  •  Working with your child or teen, make a list of situations, places or objects that he or she fears.
  •  For example, if your child is afraid to be away from you or to do things on his or her own, the list might may include: staying at a friend’s house while you leave for 10 minutes; playing alone for 20 minutes; or getting dropped off at a friend’s birthday party for 30 minutes. If your child is afraid of social situations, the list might include: saying “hi” to a classmate; asking the teacher a question; or calling a friend on the phone.

Helpful Hints:

  • Group Fears Together. Sometimes children or teens have a lot of different fears, so it can help to group similar fears together. For example, your child might have a fear of bugs, as well as a fear of going to school and being away from parents. Common fears among children include: being separated from parents or family members; interacting with adults or other children; physical danger (swimming or riding a bike); fears related to the natural environment (animals or insects); and fears related to medical procedures (doctor, dentist, injections).
  • Work together. Work with your child to come up with a list of feared situations. Although younger children may need more help, some teens may prefer to do it on their own. You may want to ask how much help they want.
Step 3. Build a Fear Ladder

Once you have made a list, help your child arrange things from the least scary to the most scary. You can do this by having your child rate how much fear he or she has for each situation on the list from “0” (No fear) to “10” (Tons of fear). Use the Fear Thermometer to help your child make the ratings. Younger children may not be able to give a rating, but can usually tell you which situations are easier and which are more difficult. Once your child has rated each situation, use the Fear Ladder Form to make a final list. For younger children, you may want to use a shorter version Hopping Down My Worry Path.

Helpful Hints:

  • Ask your child to identify a specific goal (such as sleeping alone in his or her own room), and then list the steps needed to achieve that goal (such as sleeping in mom and dad’s room on the floor; sleeping in one’s own room with door open, etc.). See Examples of Fear Ladders for some ideas on building your child's Fear Ladder.
  • If your child has a lot of different fears, build separate ladders for each fear theme.

Reward Brave Behavior

  • It’s not easy facing fears. Using rewards can encourage brave behavior.
  • Children and teens respond to praise and encouragement. For example, you can say: “You did it! You played at your friend’s by yourself.” “You did a great job of introducing yourself to the other kids!” and “I’m proud of you for sleeping in your own room.”
  • When your child is facing strong fears, it may be helpful to use specific rewards as motivation to achieve

Each ladder should include a whole range of situations. The ladder should identify some things your child can do now with some anxiety, some things he or she can do now with moderate anxiety and, finally, the things he or she finds too difficult to do now. It is important to start really small and take gradual steps.

Some things on the ladder can be broken up into smaller steps. For example, if your child is afraid to talk to classmates, this could be broken up into a number of steps such as saying “hi” to a classmate, asking a quick question, and then talking about his or her weekend.

It can also be important to consider other factors that may affect fear level. Some examples include: length of time (e.g., talking to a classmate for 30 seconds is probably less scary than talking for five minutes); time of day (e.g., spending time alone in one’s room in the afternoon versus evening); environment (e.g., swimming at local pool versus swimming in a lake); and who is with your child (e.g., going over to a friend’s place with mom versus an older brother). • See Examples of Fear Ladders for some ideas about building your child’s fear ladder.

Step 4. Facing Fears (Exposure)

Starting with the situation that causes the least anxiety, encourage your child to repeatedly engage in that activity (e.g., repeatedly saying “hi” to an unfamiliar person) until he or she starts to feel less anxious doing it. If the situation is one that your child can remain in for a period of time(such as being close to a dog), encourage him or her to stay in the situation long enough to see anxiety lessen (e.g., standing next to a dog for 20-30 minutes). Once your child is able to enter that situation without experiencing much anxiety, he or she can move on to the next thing on the list.

For some children or teens, it can help to model behaviors ahead of time. For example, practice with your child saying “hi” to someone or model petting a dog.

Encourage your child to track his or her progress. See the Facing Fears Form, which helps your child identify how anxious he or she was before and after facing the feared situation, and what he or she learned. Make copies and have your child fill one out each time he or she faces fears.

Helpful Hints:

  • Don’t Rush! It can be very scary facing the things one fears. Be encouraging and recognize that your child needs to go at his or her own pace.
Step 5. Practice

It is important to practice on a regular basis. Some things can be practiced daily (e.g., spending time alone in a part of the house without the parent in the same room), while other things can only be done once in a while (e.g., sleeping at a friend’s place). However, the more often a child practices the faster the fear will fade!

Step 6. A goal.

For example, offer a special gift (DVD, CD, book, treat, toy, craft) or fun activity (rent a movie or game, go to movies, amusement park, go out for lunch or dinner, play a game, make a special meal together). Once your child has successfully faced a specific fear, specific rewards may be phased out, but don’t stop praising!

Encourage your child to reward him or herself with positive self-talk (for example, “I really tried hard!”) and enjoyable activities (for example, watching a favorite movie) after facing a feared situation.

Helpful Hints:

  • Plan! It is important to plan out rewards in advance and to be consistent in using them.
  • Record it! For younger children, you can make up a poster that charts their progress and award stars each time they face their fears. This can help them work towards bigger rewards.

What is Panic Disorder?

Children and teens with Panic Disorder experience unexpected and repeated panic attacks. This is typically followed by at least one month of concern about having additional attacks and/or a fear of something bad happening because of the panic attack (such as going crazy, losing control, or dying).

Be sure to watch our video below for more the play button to start.

Panic Disorder Video

Key Points:

  • Panic Disorder usually begins in late adolescence.
  • Girls are more likely to experience panic attacks than boys.
  • Children and teens with a family history of anxiety or depression are at greater risk for developing Panic Disorder.
  • Problems associated with Panic Disorder include low self-esteem, poor school performance, problems with peer and family relationships, difficulty separating from parents or transitioning from home to school, sleep problems, and depression, as well as drug or alcohol use in teens.


The Story of 11-Year-Old Andrea
Andrea is an 11-year-old girl, who lives with her parents and older brother. As a baby, she often cried for hours on end. As she got older, she became upset whenever she was separated from her parents, and often "froze up" in social situations. More recently, Andrea has started worrying about her school performance. About a month ago, she had her first panic attack just before taking a test at school. Andrea said she had chest pain and trouble breathing. Her teacher thought it was a medical emergency and Andrea was taken to the school nurse. Since then, Andrea has had several panic attacks at school. Each time, the school nurse calls Andrea's mother, who comes, picks her up and takes her home. Recently, Andrea had another panic attack while out for dinner with her family. Now, she refuses to go to restaurants and has missed several days of school because of a fear of having another attack.

The Story of 15-year-old Ben
Ben is 15 years old, and lives with his mother. Four months ago, while riding as a passenger in a car that was traveling through a tunnel, Ben said his throat started to tighten and he was having trouble breathing. His mother noticed that he was very upset, and immediately took him to the E.R., where he was tested for allergies. The results were negative. Although he eventually settled and was able to breathe normally, he was shaken by the experience and was unsure why it happened. Unexpectedly, Ben had the same choking sensation a week later, while sitting alone in his bedroom. This time, he also felt dizzy and nauseous. Since the first attack in the tunnel, Ben has experienced 10 more episodes. Each time, the sensations come on suddenly and intensely, last for about 10 minutes, and passes over the next 30 minutes. Ben has started to worry about having additional attacks. He refuses to drive through tunnels and has started to avoid going shopping, out for dinner, or spending time with friends, especially if it means leaving his neighborhood.

What are Panic Attacks?

A panic attack is a sudden rush of intense fear or discomfort, which reaches a peak within 10 minutes, and includes at least four of the following symptoms:

  • racing or pounding heart
  • sweating
  • shaking or trembling
  • shortness of breath or feelings of being smothered
  • feeling of choking
  • chest pain or discomfort
  • chills or hot flashes
  • nausea or upset stomach
  • dizziness or lightheadedness
  • a sense of things being unreal or feeling detached from oneself
  • numbness or tingling sensations
  • fear of losing control or "going crazy"
  • fear of dying

Panic attacks are fairly common, and having one does not mean that your child has panic disorder. Panic attacks become a problem when someone worries about having more attacks, or fears something bad will happen because of a panic attack. Also, panic attacks can occur in other anxiety disorders. For example, children or teens with a phobia of dogs might have a panic attack when they are near a dog. In this case, however, the panic attack is expected, and the child is afraid of the dog, not the panic attack. In Panic Disorder, the panic attacks are unexpected.

What is Agoraphobia?

Children and teens can have Panic Disorder with or without agoraphobia. Agoraphobia involves fear and avoidance of situations or places where escape might be difficult, or where help might not be available should one have a panic attack. Children and teens can become fearful of entering situations where they might have a panic attack. For example, children or teens with agoraphobia might be afraid to go to school, be separated from parents, or be alone. They may also be fearful of going over bridges or into open spaces, traveling away from home, entering public or crowded places (such as restaurants or malls) or being in small enclosed places (such as elevators).

Recognizing Panic Disorder in Children & Teens

  • Children, especially if they are young, may have trouble describing their symptoms. Instead, younger children are more likely to talk about their physical symptoms (such as pounding heart, upset stomach, chest pain, or nausea), rather than psychological symptoms (such as a fear of "going crazy"). Teens may be better at describing what they experience during a panic attack.
  • Children and teens having a panic attack may become suddenly very frightened or upset for no apparent reason. They might feel like something is wrong or that something bad will happen; however, they may not able to identify exactly what is going to happen.

Note: Some children and teens might be embarrassed by their symptoms, and may not want to openly discuss what is happening.

  • Children and teens may stop participating in activities that they think could lead to panic attacks, such as driving through a tunnel, entering crowded places, or participating in physical activities (e.g., running). They may also refuse to attend school or participate in hobbies and interests.
  • They may do things to try and make themselves feel safer, such as traveling with someone they trust, staying where others can see them, or carrying something with them (such as a cell phone or water bottle).
  • Children and teens may experience more symptoms at home than at school. This is because they feel less need to hide their symptoms at home.

Note: If you suspect that your child has Panic Disorder, it is advisable to take him or her to a family physician for a medical check-up. Medical problems (such as diabetes, inner-ear disorders, or thyroid problems), excessive caffeine use, or adverse reaction to medication (such as asthma medications) may be playing a role in your child's anxiety or panic-like reactions.

Home Management Strategies for Panic Disorder

How to do it!

Step 1: Teaching your child about anxiety

This is a very important first step, as it helps children and teens understand what is happening to them when they experience anxiety. Let your child know that all the worries and physical feelings he or she is experiencing has a name: Anxiety.  Help your child understand the facts about anxiety.

Fact 1: Anxiety is normal and adaptive, as it helps us prepare for danger.

Fact 2: Anxiety can become a problem when our body tells us that there is danger when there is no real danger.

Step 2: Teaching your child about panic attacks

Help your child understand the facts about panic attacks.

Fact 1: Panic attacks are the body’s “flight-freeze-fight” response kicking in. This response prepares our body to defend itself (for instance, our heart beats faster to pump blood to our muscles, so we have the energy to run away or fight off danger). However, sometimes our body reacts when there is no real danger.

Fact 2: Panic attacks are harmless, although they can feel very uncomfortable or scary.

Fact 3: Panic attacks are brief (typically lasting only 10 to 15 minutes), although they sometimes feel like they go on forever.

Fact 4: Others (except those very close to you) cannot tell that you are having a panic attack.

For older children or teens, it can be helpful to discuss anticipatory anxiety, which is the body’s normal response to imagined future threats. Here is one way to explain anticipatory anxiety:

Two hikers are going for a hike in the woods. One hiker runs into the park ranger, who warns her that a bear has been spotted in the woods. The other hiker does not receive this warning and continues on his way enjoying an afternoon hike. The hiker who was alerted to the bear is very cautious and constantly on the lookout for the bear. She becomes sensitive to anything that suggests the bear is near (such as rustling in the woods) and may decide to avoid the woods altogether and not return to the park. This is what happens when you have a panic attack. Because you have been “alerted” to it, you may find yourself always on the lookout for another panic attack. This can make you feel nervous, which may lead to another panic attack. You may even start to avoid things that remind you of the attack.

Helpful Tips:
Listen! Make sure you take the time to listen to your child’s thoughts and feelings. Simply feeling heard can be very helpful to your child
Normalize! It is important to let you child know they are not alone. Lots of children have problems with anxiety and experience panic attacks.

Step 3: Building Your Child’s Toolbox  

You can help your child by giving them some tools to manage their anxiety and panic attacks. The purpose of these tools is to facilitate the most important step: facing fears. For Panic Disorder, tools in the toolbox include: 

Tool #1: Learning to Relax. This tool involves helping your child learn to relax. Two strategies can be particularly helpful:

  1. Calm Breathing: This is a strategy that your child can use to calm down quickly. Explain to your child that we tend to breathe faster when we are anxious. This can make us feel dizzy and lightheaded, which can make us even more anxious. Calm breathing involves taking slow, regular breaths through your nose. For more information, see Teaching Your Child Calm Breathing.
  2. Muscle Relaxation: Another helpful strategy is to help your child learn to relax his or her body. Have your child tense various muscles and then relax them. You can also have your child use “the flop,” which involves imagining that he or she is a rag doll and relax the whole body at once. For more information, see How to Do Progressive Muscle Relaxation.

TOOL #2: Realistic Thinking The next tool is targeted to older children or teens. It involves learning to identify scary thoughts that trigger and fuel physical feelings of panic. First, ask your child what he or she fears will happen during a panic attack. Examples include: “I will pass out,” “It will go on forever,” “I’ll embarrass myself and everyone will laugh,” or “I’ll die.” These thoughts tend to promote panic attacks and can be grouped into two categories:

  1. Overestimating: This happens when we believe that something that is highly unlikely is about to happen. For example, when a child or teen believes he or she will faint or die as a result of a panic attack. This type of thinking is usually related to physical fears (such as fainting and hurting oneself, having a heart attack, going crazy or dying).
  2. Catastrophizing: This is when we imagine the worst possible thing is about to happen and we will be unable to cope. For example: “I’ll embarrass myself and everyone will laugh,” or “I’ll freak out and no one will help.” This type of thinking is often related to social concerns (such as embarrassing oneself).

To help your child determine whether he or she is overestimating or catastrophizing, ask the following questions:

  • What would be so bad about that?
  • What would that lead to?
  • What would happen then? 

Here are some examples of how to help your child recognize whether he or she is overestimating or catastrophizing: 

Parent: What were you afraid would happen when you had the panic attack? 
Child: I wouldn’t be able to breathe. 
Parent: What would happen then? 
Child: I would die. (Example of overestimating

Parent: What were you afraid would happen when you had the panic attack? 
Child: I would be scared. 
Parent: What would be so bad about feeling scared? 
Child: I would get so scared that I would pass out. 
Parent: What would happen if you passed out? 
Child: Other kids might notice. 
Parent: What would happen if they noticed? 
Child: They would point and laugh. (Example of catastrophizing)

Challenging overestimating:

Encourage your child to think about scary thoughts as a question, not a fact. Then, have your child evaluate the evidence for or against the thought. Children and teens with Panic Disorder often confuse possibility with probability. For example, just because it can happen, doesn’t mean that it likely will happen. Here are some questions to ask your child:

  • How many times have you had this thought during a panic attack?
  • How many times has it actually happened?
  • Next time you have that thought, how likely is it that it will really happen?

Help your child understand that some of the things he or she fears are very unlikely. Even though your child has had the thought many times, it has not come true. Here’s an example of how to help your child challenge overestimating. 

Parent: So it sounds like you are afraid that you will die when you have a panic attack? 
Child: Yeah. 
Parent: Do you know what overestimating is? 
Child: Um…I’m not totally sure. 
Parent: Overestimating is when we take something that is very unlikely to happen, and we believe that it will actually happen. Does that sound familiar to you? 
Child: Yeah, I guess so. 
Parent: Can you think of something you might be overestimating when you are having a panic attack? 
Child: Um…I guess thinking I won’t be able to breathe or that I’ll die. I know it’s unlikely, but when I’m having a panic attack, it just feels like it will happen! 
Parent: Well how many times have you had this thought when you are having a panic attack? 
Child: A lot! 
Parent: Has your fear ever come true?
Child: No, but it sure feels like it might. 
Parent: But even when it feels like you are going to die, nothing bad happens. The chances of something bad happen are extremely small. It’s important to remind yourself of that when you are having a panic attack! 

Challenging catastrophizing: To challenge catastrophic thinking, ask your child to imagine the worst, and then help him or her figure out how to cope. Here are some questions to ask your child: 

  • How bad is it really?
  • Is it just annoying or is it terrible?
  • Will it make a difference in your life a week or year from now?
  • What could you do to cope if it did happen?

Help your child understand that some of the things he or she fears are more of a hassle than a horror, and that there are things your child can do to cope with the situation. Here’s an example of how to help you child challenge catastrophizing. 

Parent: So it sounds like you are worrying about having a panic attack at school. What would be so terrible about having a panic attack at school? 
Child: I might pass out and other kids would see. 
Parent: What’s the worst that could happen? 
Child: Everyone would be looking at me and laughing, and I would be so embarrassed I would just freeze. 
Parent: Sometimes when we feel anxious we tend to catastrophize. This means that we automatically imagine the worst will happen, and we believe that we won’t be able to handle it! Do you think that you might be catastrophizing? 
Child: I don’t know. Maybe. 
Parent: It sounds like you are picturing that you would make a huge scene if you had a panic attack, but the last panic attack you had at school was nothing like that. You left the school and went outside to get fresh air. Besides, does it really matter what everyone thinks? 
Child: Well, it would be very embarrassing. 
Parent: Have you ever been embarrassed before? 
Child: Um…yeah, once I tripped down the stairs at school. 
Parent: Were you able to handle being embarrassed? 
Child: Ugh, A few people laughed - I thought I would just die… But I guess after a while it was okay - no one seems to remember now. 
I wonder if you could handle being embarrassed if you had a panic attack?
Child: Well…I guess it wouldn’t be that bad. 
Parent: What could you do to cope if you did have a panic attack in class? 
Child: Um…I would probably want to leave, and be alone. I guess I could excuse myself and go to the bathroom. 

For more information on helping your child identify and challenge scary thoughts, see Realistic Thinking for Teens or Healthy Thinking for Young Children 

Younger children may have a more difficult time identifying exactly what they fear. However, they can benefit from coming up with some coping statements that they can say to themselves to help them deal with a panic attack. For example, “It won’t go on forever, it will end,” “My stomach is upset, but I’ll be okay” or “If I have to take a break, I can leave class and come back after.”

Tool #3: Making Coping Cards  

It’s not easy facing fears, so it’s a good idea to develop “coping cards” that your child can carry with him or her during the day to help manage anxiety. For some tips on how to help your child develop and use coping cards, see Developing and Using Cognitive Coping Cards with Your Child.

Tool #4: Facing Fears The most important step in helping your child manage anxiety and panic is to face what he or she fears. This includes:

  1. Unpleasant body sensations that feel similar to a panic attack.
  2. Avoided situations or places.

1. Facing feared body sensations: 

Children and teens with panic disorder are typically sensitive to physical sensations, such as increased heart rate, stomachache, or chest pain. In order to overcome panic, they need to repeatedly bring on the sensations they fear, so that over time those sensations no longer make them anxious. This also gives them a chance to discover that their fears do not come true (for example, they don’t pass out). Here’s a list of exercises you can try with your child to trigger physical sensations.

Exposure exercises:

  • Running on the spot for 30 - 60 seconds (racing heart, breathlessness, chest discomfort).
  • Running up and down stairs for 30 - 60 seconds (racing heart, breathlessness, chest discomfort).
  • Rapid breathing. Agree ahead of time on a length of time that your child can repeatedly perform it with minimal anxiety. Then, try increasing it by 15 seconds, up to a maximum of two minutes for teens and one minute for children (dizziness, breathlessness, racing heart, numbness and tingling).
  • Breathe in and out through a small straw for 30 – 60 seconds while pinching nostrils (choking sensations, breathlessness, racing heart).
  • Shaking head from side to side, or moving head around by drawing a circle in front of you with your nose for 30 seconds (dizziness).
  • Spinning around in place or spinning in a chair for 30 seconds (dizziness, nausea).
  • Hold breath for 15 to 30 seconds (breathlessness, dizziness).
  • Stare at your hand for two to three minutes (feelings of unreality – things looking and seeming weird).
  • Stare at a light on the ceiling for one minute and then try and read something (blurred vision).
  • Wear a tight turtleneck or scarf around your neck for a few minutes (tightness in the throat).

Model each exercise first and tell your child what you felt after doing it (For example: “Running on the spot makes me feel out of breath”). Then, have your child try each one, and rate his or her anxiety level from 0 (no fear/anxiety at all) to 10 (very severe anxiety/fear). Use the Fear Thermometer to help with the ratings. Identify the exercises that cause the most anxiety and bring on sensations that feel very similar to what your child experiences during a panic attack.

How to do exposure to feared sensations! Once you and your child have created a list of exercises, start with the exercise that is the least scary and build up to the exercise that is the most scary. The exercises can be broken up into smaller steps if necessary (e.g., start with running on the spot for 30 seconds, then 45 seconds, and finally, one minute). Have your child continue the exercise until he or she starts to feel the feared sensations, and encourage him or her to use the calm breathing technique and realistic thinking/coping statements. While doing the exercises, have your child rate his or her anxiety level, from 0 (no fear/anxiety at all) to 10 (very severe anxiety/fear). Use the Fear Thermometer to help with the ratings. Have your child repeat the exercise until his or her anxiety drops by about half (for example, if your child’s rating is a 6, have your child repeat the exercise until he or she experiences a 3). Focus on one exercise at a time. Once your child experiences very little anxiety when completing that exercise on several different occasions, move onto the next one.

Tip #1: Practices should be planned in advance and you should aim to have at least one practice session a day. The more your child practices the faster his or her fear will decrease!

Tip #2: Have the whole family try the exercises. Everyone can say what feelings they have after the exercise, and how anxious they feel. 

2. Facing feared places or situations:

It is important for your child to start entering situations that he or she has been avoiding due to fears of having panic attacks. Help your child identify feared situations or places, such as going places alone, entering crowded stores, or riding the bus. Then, arrange the list from the least to the most scary. Starting with the situation that causes the least anxiety, encourage your child to repeatedly enter the situation and remain there until his or her anxiety decreases. Once your child can enter that situation without experiencing much anxiety, move on to the next item on the list. Let your child know that he or she will experience anxiety when facing fears - this is normal. For more information, see Helping your Child to Face Fears: Exposure.

Step 4: Building on Bravery 

Learning to manage anxiety takes hard work. If your child is doing better, then you both deserve lots of credit! In a way, learning to manage anxiety is like exercise – your child needs to "keep in shape" and practice his or her skills regularly. Make them a habit! This is true even after your child is feeling better and has reached his or her goals.

Don't be discouraged if your child reverts to using old behaviors. This can happen during stressful times or during transitions, such as going back to school or moving, and it is normal. It just means that your child needs to start practicing using the tools. Remember, coping with anxiety is a lifelong process.

Helpful Tips:

  • Model it! Model how to face fears, so that your child can see how it should be done. Provide support and encouragement; however, be careful not to push your child too far too fast. Let your child work at his or her own pace. 
  • Don’t Fight It! Encourage your child to remain calm and tolerate the feelings of anxiety, rather than fight them.
  • Avoid Giving Excessive Reassurance! Resist giving excessive reassurance. Instead, encourage your child to use his or her coping strategies (for example, calm breathing or the STOP Plan/Realistic Thinking).
  • Praise and Reward! Remember to praise your child for his or her efforts! Facing your fears is not easy.