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When my kid is having a panic attack, how do I know, as parent, decide to “push” and guide my kid through her anxiety, or to “pause” and stop the situation for my kid to let her take a break. It’s heartbreaking to say “push” when I know it causes so much discomfort for my child. But it’s also heartbreaking to say “pause” when I know my kid will be even more frustrated to not have pushed through and overcome her anxiety. Which discomfort do I choose for my kid? Depends on level of discomfort and necessity of the task.

It’s very nuanced, so I will share some situations where I said “push” and where I said “pause”, as examples. A different day may have brought about different choices. A different parent/child dyad with different histories and life experiences, may also make different choices. The good news is there is no right answer. We can only make a decision with the information we have. And each new “push” or “pause” choice we have to make will have the benefit of information from the previous choices. Here is what I decided for my child who has mild anxiety and who has been through some therapy sessions.

1. Fear of going to a new activity. With her make up gymnastics class, held on a different day with different kids, she cried the first 5 minutes and then was fine. If she kept persistently crying the whole time, I would have given her a break from make up classes. But we talked about coping strategies, and she recovered quickly. She was 6 years old at the time. Now, she can go to new activities without crying, but is still a little anxious. Most recently, she went to a volleyball clinic for the first time. She kept asking the same questions over and over again – what if the coach doesn’t teach her how to play, what if no one is there, what if the older girls make fun of her? I just calmly answered her questions. I also started answering her with a question – what did mommy say the last time you asked this question? Her level of discomfort is medium, and it was temporary. I knew once she started practice, she would be fine, so I kept choosing to guide her to “push” with patience and encouragements, and of course practice ended up being a lot of fun, and she learned some skills from the talented coaches.
2. Not every new activity, however, has been a success. I tried signing her up for a soup kitchen for MLK day, sponsored by her school. She declined going to any of the meetings, despite a few opportunities and lots of encouragement from me. And she told me that she didn’t want to go, because it was kind of last minute, so she didn’t have time to prepare herself for it. She asked if she could do it next year. Given that the discomfort was high, and the task was not necessary – she already does other helping projects, and I have alternative plans we could do to honor MLK day – so I “paused” on this activity. I thanked the kid for explaining to me why she didn’t feel comfortable. I want her to be confident in her choices as she gets older and has more independence to make them.
3. Fear of flying in a plane. My kid gets stomaches and nausea on plane rides, and yes, the feeling is persistent for the whole plane ride. However, except the one time she vomited after arriving at my uncle’s home from the airport, my kid’s symptoms and discomfort resolves within 1-2 hours after her feet on are steady ground. Flying and travel and showing the world to my kids is important to me. While her level of discomfort is fairly high, I considered this a necessary activity for our family. Instead of “pausing” travel altogether, I chose to guide her to “push” through with some modifications to our current routines. We experimented with different strategies to see what worked to relieve her discomfort. She realized that mints and starchy snacks are helpful, so we packed a lot of them for the last trips to Asia and Europe. With that strategy, along with practicing breathing and mindfulness skills, her plan rides became a lot less stressful and more enjoyable!
4. Fear of not being able to go to sleep. Everyone once in a while, my kid has so many spinning thoughts that she can’t go to sleep. And then that insomnia makes her more worried about not being able to go to sleep. Sometimes she will come out of her room with tears streaming down her face, worrying about not falling asleep after laying down in her bed for 15-20 minutes. Her level of discomfort is pretty high, but it might be temporary, so we try to “push” through. Most of the time, she will fall asleep within another 20-30 minutes. Once we get to 60-90 minutes, I “paused” the situation, and put on waterfall or rain noises from youtube. So far she has been able to fall asleep with that, but if she couldn’t my next step would be melatonin.
5.  Fear of bullying and stye discomfort. One day my kid with anxiety woke up with a tiny, VERY tiny stye on her upper eyelid. She then had a very mild panic attack (1-2/10 – in retrospect, but probably every panic attack feels like at least a 5-7/10 by definition). “I don’t want to go so school!” *Tears. “What if people make fun of me for it?” *Tears. “I can’t go to school like this!” *Tears. Initially, I wanted to “pause”. She rarely missed school, one day was not going to affect her learning, and her discomfort seemed rather intense. However, I had this thought – what if… what if… I “pushed” her with a nudge to just focus on treating the stye first. Warm compress. Lay down. Then we played the likely or unlikely game (click explanation in the link) – likely or unlikely someone would notice the tiny stye? Likely or unlikely, given her rapport with her friends and classmates at school, that she would get bullied? Of course she immediately said likely, but each time I asked, the likely belief was diminishing, and the unlikely belief was gaining traction. After she was done with the warm compress, she felt better – physically and mentally – and proceeded to have a normal morning and went to school. I was truly prepared for her to miss school that day, and I think her ability to pivot so quickly was due to all the previous years of practice challenging her anxious thoughts and using breathing (see explanation in the link) and other calming techniques.

That’s how I balance supporting my kid through her anxiety, without letting her anxiety take over. I want my kid to grow stronger, not her anxiety. I want my kid to be in control of the situation, not her anxiety. As you can see, there is no absolute right or wrong choice for what that looks like. And it might look different from one day to another. Now, if I felt that the “pauses” started to take over my kid’s life, interfere social relationships, learning, and her joy in life, then I would have to “pause” the whole strategy and see if needed to pivot the plan to add more therapy or medication or other treatment options.

This is what I would do as a mom and as a pediatrician with many patients struggling with anxiety. This does not mean I apply the same treatment plan for every patient. In fact, I can’t. These are decisions best made by a parent, so my patients’ parents might make different choices than I would, because they know their kid best. This is just for general education purposes only. If you are concerned about your child’s mental health, please contact your child’s doctor. If you are concerned about a mental health crisis, or your child’s safety, please call 988 for help now.

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