This study examined the role of peritraumatic panic symptoms during trauma in childhood acute stress. Children (N = 60) who had suffered traumatic injury were administered the Child Acute Stress Reaction Questionnaire, the Child Depression Inventory, and the Physical Reactions Scale to index panic attacks that occurred during the trauma. Panic attacks were experienced during their trauma by 100% of participants with acute stress reactions and 24% of participants without stress reactions. Panic attacks during trauma accounted for 28% of the variance of acute stress reactions, with an additional variance accounted for by age, time since the accident, and dysphoria. These findings are discussed in terms of fear conditioning models of posttraumatic stress.