The Pediatrician Next Door – Ep. 133: "Panic Attacks: What Triggers Them and What Helps?"

Host: Dr. Wendy Hunter
Guest: Dr. Natasha Burgert, pediatrician and author of Managing Childhood Anxiety for Dummies
Release Date: September 17, 2025

Episode Overview

This episode tackles the misunderstood, often frightening experience of childhood panic attacks. Dr. Wendy Hunter, a seasoned pediatrician, is joined by anxiety expert Dr. Natasha Burgert. Together, they dive into the biological reality of panic attacks, how they differ from anxiety attacks, why "calming down" isn't so simple, and evidence-based approaches parents can use to help their kids. Listeners are guided through real-life scenarios, practical strategies, and myth-busting explanations, all wrapped in the show's trademark blend of science and parenting reality.

Key Discussion Points & Insights

1. Case Study: Panic Attack or Medical Emergency?

[01:02]

• Dr. Hunter shares an illustrative case: a healthy 12-year-old girl is suddenly overtaken by terrifying physical symptoms (chest tightness, tingling, dizziness, shortness of breath) while watching TV.
• The family rushes her to the ER, fearing heart or asthma problems.
• Dr. Hunter explains the typical skeptical parent reaction to her "it's just a panic attack" diagnosis and confesses her own professional doubts about oversimplification.

Quote:
"The other problem is that if we don't really understand what's going on, we can't know how to respond. Or worse, we might do things that make the panic even stronger." – Dr. Wendy Hunter [03:09]

2. Panic Attacks vs. Anxiety Attacks: What’s the Difference?

[05:12], [07:28]

• Dr. Burgert clarifies the crucial difference.
  • Panic attacks: Sudden, can happen without any obvious trigger, produce overwhelming physical symptoms, and are usually followed by a fear of recurrence (leading to panic disorder if persistent).
  • Anxiety attacks: More gradual onset, usually triggered by identifiable stressors, less severe, and not typically followed by the same dread of repetition.
• Panic attacks signal a body in “hyper alert” mode trying to protect itself, but often in the absence of a real threat.
• Approximately, the presence of dread over future attacks distinguishes panic attacks from anxiety.

Quote:
"A true panic attack by definition can happen in the middle of math class without any warning. It doesn't need to have that trigger. It's simply a stimulus that put that body into fight or flight." – Dr. Natasha Burgert [07:38]

3. The Physiology: Not 'Just in Their Head'

[10:02], [11:11], [12:21]

• Parents (and many doctors) struggle to believe panic attacks aren’t purely emotional, given the severity of physical symptoms.
• Dr. Burgert explains: the “alarm system” in the brain (the amygdala) can be tricked, sometimes by emotional, sometimes by physical factors (even caffeine).
• Hyperventilation during a panic attack increases blood CO₂, which heightens nerve sensitivity and can cause tingling, dizziness, and other dramatic symptoms.
• Panic attacks are real, physical events triggered by brain signals—NOT imaginary or voluntary.

Quote:
"I think panic attacks are 100% in the body, and they're triggered from the brain… It's 100% physical. And kids need to be validated for the physical symptoms that they are experiencing, because they're scary and they're severe." – Dr. Natasha Burgert [12:21]

4. Why Logic & "Calm Down" Don’t Work

[15:38], [16:38]

• Reassurances or "logical" advice in the midst of panic are usually ineffective, often making kids feel more isolated.
• During a panic attack, the thinking (“cognitive”) part of the brain is offline; all energy is directed to survival systems.
• Even kids who know breathing or grounding exercises struggle to use them once panic kicks in.

Quote:
"It doesn't work—the same way that if I said to a drowning person, 'just swim harder.' In that moment, they lose capacity to really use their cognitive brains." – Dr. Natasha Burgert [16:38]

5. Co-Regulation: What Actually Helps in the Moment

[18:54], [20:48]

• Parents' most powerful tool is "co-regulation"—staying calm, providing physical presence or touch, and modeling grounding techniques until the panic subsides (usually takes about 30 minutes).
• Co-regulation = parent providing an external source of calm when the child cannot access their own.
• For example, gentle, steady touch or calm breathing, letting the child mirror your state.
• Unlike with anxiety attacks, don’t try to quiz, distract, or force logic during a panic episode.

Quote:
"Co-regulation is articulating that you are doing something to calm your body and having your kid join in... It's going to take a million little moments of co-regulation before we can expect kids to be able to do that on their own." – Dr. Natasha Burgert [18:54]

6. Practical Strategies Before, During, and After

[22:43], [24:27]

• Breathing: Teaching kids about “the brake pedal” (parasympathetic nervous system), and practicing slow exhalation when NOT in panic (“If you can control your breathing, you can control your brain”).
• Grounding: Sensory strategies to anchor the mind during rising anxiety—calm strips, sensory rings, hedgehog bracelets, “I Spy”, identifying colors in the room, jumping jacks, or “5-4-3-2-1 senses” technique.
• Emphasis on practicing these tools outside of panic moments so they become familiar and available when needed.

Quote:
"Grounding activities are anything really to make them aware of their environment or aware of their physical self in space... All of these things are going to be engaging with our environment." – Dr. Natasha Burgert [24:27]

Memorable Quotes & Moments

• Dr. Hunter on parental skepticism:
  “It’s really scary to watch. I know this much. A panic attack is the body’s alarm system getting tricked… Your body thinks it’s running from a lion, even if you’re just sitting on the couch.” [08:38]

• Dr. Burgert on validation:
  “Kids need to be validated for the physical symptoms that they are experiencing, because they’re scary and they’re severe.” [12:55]

• On school nurses:
  “School nurses are so important in this. If it happens at school, they have to just sit with them and co-regulate with them and give them safety to know that their body is safe…” [17:55]

• On practice:
  “It takes a million little times to be able to learn how to do that on your own.” [23:29]

Segment Timestamps

• [01:02] Real-life case introduction: 12-year-old with panic attack
• [05:12] Dr. Burgert describes panic attack symptoms
• [07:28] Panic vs. anxiety attacks, key distinctions
• [10:02] Physiology of panic attacks—why real symptoms occur
• [12:21] Are panic attacks all in your head? (Short answer: no)
• [16:38] Why “calm down” doesn't work; cognitive brain is “offline”
• [18:54] Explanation and examples of co-regulation
• [20:48] Step-by-step: What to do during a child’s panic attack
• [22:43] Strategies to teach kids: breathing, grounding, the body’s brake pedal
• [24:27] Grounding tools and techniques to use with kids

Takeaways

• Panic attacks are very real, primarily physiological events—NOT “all in the head.”
• Distinguishing panic from anxiety attacks is important for choosing the best responses.
• In-the-moment strategies (logic, distraction, “calm down” commands) don’t work; co-regulation and gentle presence do.
• Proactive practice of breathing and grounding techniques can help kids regain control over time, but parents must be the anchor during active panic.
• Validation—acknowledging a child's distress as real—is the essential first step toward recovery.

Recommendations & Resources

• Book: Managing Childhood Anxiety for Dummies by Dr. Natasha Burgert (recommended for practical parenting strategies).
• Tools: Calm strips, sensory rings, hedgehog bracelets, and simple grounding games.
• For more tips and Q&A: pediatriciannextdoorpodcast.com

If you or your child struggles with anxiety or panic attacks, know you are not alone—and with understanding and practical tools, things can get better.