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Parenting Advice Panic disorder in 4-year-old


Panic Disorder in 4 Year Old

My 4 year old seems to be developing a panic disorder. He becomes very uncontrollably panicked when afraid. Last year he went out on boats all summer and tried many new rides at the boardwalk. This year, as Spring began, he has had two episodes of total panic: the first was on our new boat. Just as we were taking off from the dock, the engine back-fired and he flipped out to the point of almost falling in the water to get off the boat and screaming at the top of his lungs. I was sitting right next to him with my arm around him and we had quite a time calming him down.

The next episode was at the boardwalk. We put him on an airplane ride he went on last year, and half-way through he stood up and started screaming and pulling at the seat belt. Needless to say he was in the air moving and it took a minute to stop the ride and get him off. He could have been seriously injured if he had gotten that seat belt off and jumped - he scared us, the ride operator, and all the other kids. I think if he wasn't so panicked he might have actually gotten the seat belt off and jumped.

He has an above average vocabulary and is in preschool 3 half-days a week. This is his second year in preschool. His teacher feels he is doing well but is timid at times and does not always participate.

He has one more year of preschool. Both my husband and I work full time; dad is 9-5, I work 1-9 and he is either at school, with nanny, or at a friend's. He does not always play well with others and we are very concerned for him.

Suzanne Remeta

Jan's reply:

Hi Suzanne,

How frightening for all of you! My heart goes out to you.

There are many factors that may be playing a part here. I see them in two categories, so let's look at each one separately. You'll need to read this through carefully, attending to what seems to make sense to you, given all you know about your son and your family circumstances.

One category is physical health. Panic attacks can be caused by nutritional imbalance and/or allergies. The most important nutrients, which you may want to give him as a supplement or just see that they are in the food he eats each day are:

  1. Calcium and magnesium (in balance)
  2. Iron (in small doses to avoid constipation)
  3. Multivitamin and mineral complex with potassium (especially B Complex, B1 and B6, and vitamin C)
  4. Niacinamide
  5. Zinc
  6. Herbs: skullcap and valerian

Note: If you purchase supplements, check to be sure they are in a type and dose appropriate for his age.


  1. Visit a doctor who works well with children (ask friends or call the local La Leche League for a recommendation).
  2. Include in his diet (choose those he prefers, do not use force): apricots, asparagus, avocados, bananas, broccoli, blackstrap molasses, brown rice, dried fruit (a handy food to take to preschool and while doing errands with you), figs, fish (especially salmon), garlic, green, leafy vegetables, legumes, raw nuts and seeds (another handy food), soy products, whole grains (choose whole wheat instead of white bread, for example), yogurt.
  3. If possible, give him small, frequent meals instead of three/day.
  4. Limit meat intake (to avoid hormones).
  5. Sugar, carbonated soft drinks, and caffeine (cola and chocolate) must be avoided. (Your mention of the "Boardwalk" makes me wonder if there might be too many temptations there in terms of "junk food".)
  6. Keep a food diary to help detect possible allergies (but remember that it can take several hours for a specific food to have an effect.)
  7. See that he has an opportunity for regular exercise: walking, bicycling, swimming - whatever he prefers.
  8. Be sure his sleep is not interrupted by noise or other disturbances. Even more important, especially with the daily separation from both parents, is family co-sleeping - which not only will help him feel more secure emotionally, but can also serve to regulate breathing and blood pressure during the night.
  9. It's very important to help him learn to manage an attack, if one does occur despite your efforts, so teach him a breathing technique. One method is for him to inhale slowly to a count of four, hold his breath for a count of four, exhale slowly to a count of four, then do nothing for a count of four - and repeat this until the attack is over. Remind him that these attacks usually do not last long, especially if he stays in control. Simply having a specific technique like this one can give him the feeling that he is in charge and able to help himself out of these episodes. This will not only help to minimize the number and duration of the attacks, but help him to feel that he is competent and skilled enough to deal with stressful events in general.
  10. Probably the most important thing you (or the adult who is present at the time) can do during an attack is to stay calm yourself (even when you are understandably frightened for his health and safety). Speak to him in a quiet, calm voice, and in reassuring words. Anxiety attacks can in themselves become a cause, in that the fear of having an attack can bring one on. If he is reassured that this is a passing state of things and that he can control it, that will give him the assurance he needs to do so. This is such an important factor that I urge you: be sure that the other adults who care for your son are capable of remaining calm and reassuring during these episodes. If they are not, try to find another situation for him (ideally more time with you).

(Some of the specific remedies listed above are from the Prescription for Nutritional Healing by James F. Balch, M.D.)

Now on to the second category: possible psychological causes.

It can be very stressful for a child this age to spend so much time away from his parents. Our society fails to recognize the emotional needs of young children, and at the same time encourages us to meet our financial needs to the point that other important needs can be overlooked. If there is any possibility to lessen your work schedule, I urge you to give this serious consideration. Your child's behavior could be his way of telling you there is too much worry and stress in his life.

I hope these suggestions are helpful. Please let me know how things are going later this month.

All good wishes in this bewildering and worrisome situation.


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