Expert: Joyce A. Anthony - 7/26/2008

Question
My six year old is diagnosed with a mood disorder probably bipolar but his doctors are hesitent to make this diagnosis at his age.  For the past three days we have gone to the ER three times for chest pains which he has been getting several times a day for the past four days.  They did chest Xrays, EKG, blood work, listened to his lungs and heart, blood pressure, temperature, O2 sats... everything was normal.  He has been having more irritability, depression, sleepiness, and definetly more anxiety.  He did not want to be at daycare.  Yesterday he was screaming at school telling the teachers that snakes were eating him bloody.  His chest was pounding and hurt him, his belly felt sick, he was all sweaty, breathing heavy, shakey, and his teacher could feel his heart racing.  He seemed fine this morning, but as soon as we got to his daycare he said "Mommy my chest and belly hurt.  I need to go to the hospital.  I can not be at school."  Last week he was telling me that there is another man in his body in control of him.  Last week also he got a small cut on his foot and was freaking out yelling because his belly was laughing at him.  Nobody was laughing... He has been different since he was a baby.  He never liked too much noise, light, sensory, people, or such.  He has always had severe seperation anxiety and refuses to sleep in his own bed since birth.  Do these sound like panic attacks to you?  If they are Panic Attacks what can we do to make him feel better during these attacks?  What techniques can we use to help him calm down? Can he get hurt from having them? His psych nurse added Paxil 5 mg twice a day to his Risperdal (which she just decreased)and his Clonidine.

Answer
Hi Janice:

It certainly sounds like your son is bipolar.  Anxiety is often present with this disorder.  The school anxiety may come from your son being afraid he'll "get in trouble" for something like an outburst.  He feels safer with you.  It also sounds like he may be experiencing hallucinations.  I would discuss with his psych nurse the possibility of substituting the Paxil with Seroquel.  The Paxil could create a manic situation if he is indeed bipolar, while the Seroquel will not only calm him, but also help alleviate any hallucinations.

While he is in the midst of one of these attacks, there is not a whole lot available for you to do, which makes this one of the most difficult things to go through.  If he will allow you, and some kids won't, hold him gently and talk in a soft voice.  It doesn't matter what words--just so they are calming, loving ones.

One thing that may help the panic with school seems strange but is often a comfort to a child.  Before he goes inside, give him a kiss in the palm of his hand and fold his fingers over.  Tell him that kiss is there for him whenever he feels he needs it and it will let him know you love him.  This often works.

                    Joyce A. Anthony