David J Schonfeld, MD, FAAP
Children often become distressed after a disaster, especially if it has directly impacted them or someone they care about. They may also feel sad or sorry for others and want very much to help them. Worries that something similar will happen to them or their family may lead them to ask a lot of questions so that they can better understand what has happened and therefore what they can do to protect themselves and their family. Parents and other adults who care for children can do a lot to help them understand and cope.
Inform children and start the conversation. It is difficult to deal with something that you don’t understand. Even very young children will sense when something is wrong or upsetting the adults in their lives, even if they have been told nothing. Children should be notified about a disaster as soon as possible after it occurs, otherwise they will likely find out by overhearing others or through the media (including social media). Start by asking them what they may have already heard about the event; correct any misinformation or misunderstanding they may have. Provide information to them in simple and direct terms, without unnecessary detail. Television, radio, and social media often provide graphic information that may cause more distress, so limit the amount of viewing of television and other media sources immediately after the event (this is true for both children and adults). Ask children about what questions or concerns they might have and provide honest answers. When adults don’t talk with children about disasters, it suggests to them that adults either are not capable of dealing with difficult situations or don’t feel that the children are able to cope. Neither message is helpful.
After a disaster, children may show a change in their mood or behavior. They may become sad, anxious, or scared. They may be more resistant to separating from their caregivers to go to child care programs or school, or even to go to bed or play in another room. Sleep problems, headaches and stomachaches are common. After a disaster, children often find it difficult to concentrate on their school work. They may, for a period of time, become more self-centered or immature and appear more clingy, less cooperative, more demanding, and irritable. Older children and adolescents may turn to smoking, alcohol, or other drugs to deal with their feelings.
Children often show no obvious signs of distress. After a disaster, children may hide their emotions because they are ashamed of their reactions or because they want to protect their parents who are also visibly upset. They may try to take care of their parents, not because they are coping well themselves, but rather because they worry that their parents are having trouble adjusting.
Children may show post-traumatic reactions – but that’s not all. If a death has occurred as a result of the disaster, children’s reactions may be due to grief. Children need to cope not only with the disaster – but everything that follows. Disasters lead to a number of losses and changes, such as the need to relocate, change schools, or deal with reduced family income. These other stressors may be what bothers children the most after a disaster.
Help children cope with their distress. Adults don’t like to see children feeling upset and often try to reassure them there is no reason to be worried or sad. But let children own their feelings – if they feel sad or worried, then they are sad or worried. Instead of trying to tell children that they shouldn’t feel that way after a disaster, help them learn how to cope with troubling feelings. Share with them some of your reactions and feelings and how you coped with them (such as talking with others, writing about your feelings, or doing something positive to help others). We can’t expect children to learn how to cope if we don’t share with them that we also have felt distress and then model how to cope effectively.
Teaching children how to cope with distress every day is a good way to prepare for disasters. Just as you should prepare to respond to a disaster, you should prepare children to be able to cope with disasters. Helping them learn coping skills to deal with daily stressors or other challenging events in their lives and establishing yourself as someone that is there that can understand them and help them adjust makes it more likely they will cope effectively after a disaster. Let children know that their family, school and community have plans in place to deal with many kinds of emergencies, and that there are people specially trained to help with these situations.
There is help. Visit the American Academy of Pediatrics for resources and advice on how to support children after a disaster, and download the Pediatric Preparedness Resource Kit. Your child’s pediatrician can also provide specific advice for your children and/or recommend someone else that you can talk to you about your concerns.
David J. Schonfeld, MD, FAAP, is member of the American Academy of Pediatrics Disaster Preparedness Advisory Council and the Pediatrician-in-Chief at St. Christopher’s Hospital for Children in Philadelphia, PA. Dr. Schonfeld is also the Chair for the Department of Pediatrics at Drexel University College of Medicine and the Director for the National Center for School Crisis and Bereavement.