Helping Children Cope

A Child’s Reaction to a Traumatic Event by Age

Below are common reactions in children after a traumatic event.

Birth through 2 years. When children are pre-verbal and experience a trauma, they do not have the words to describe the event or their feelings. However, they can retain memories of particular sights, sounds, or smells. Infants may react to trauma by being irritable, crying more than usual, or wanting to be held and cuddled. The biggest influence on children of this age is how their parents cope. As children get older, their play may involve acting out elements of the traumatic event that occurred several years in the past and was seemingly forgotten.

Preschool - 3 through 6 years. Preschool children often feel helpless and powerless in the face of an overwhelming event. Because of their age and small size, they lack the ability to protect themselves or others. As a result, they feel intense fear and insecurity about being separated from caregivers. Preschoolers cannot grasp the concept of permanent loss. They can see consequences as being reversible or permanent. In the weeks following a traumatic event, preschoolers’ play activities may reenact the incident over and over again.

School age - 7 through 10 years. The school-age child has the ability to understand the permanence of loss. Some children become intensely preoccupied with the details of a traumatic event and want to talk about it continually. This preoccupation can interfere with the child’s concentration at school and academic performance may decline. At school, children may hear inaccurate information from peers. They may display a wide range of reactions — sadness, generalized fear, or specific fears of the trauma happening again, guilt over action or inaction, anger that the event was not prevented, or fantasies of playing rescuer.

Pre-adolescence to adolescence - 11 through 18 years. As children grow older, they develop a more sophisticated understanding of the traumatic event. Their responses are more similar to adults. Teenagers may become involved in dangerous, risk-taking behaviors, such as reckless driving, or alcohol or drug use. Others can become fearful of leaving home and avoid previous levels of activities. Much of adolescence is focused on moving out into the world. After a trauma, the view of the world can seem more dangerous and unsafe. A teenager may feel overwhelmed by intense emotions and yet feel unable to discuss them with others.

Monitor and Limit Exposure to the Media

News coverage related to an emergency may elicit fear and confusion and arouse anxiety in children. This is particularly true for large-scale disasters or a terrorist event where significant property damage and loss of life has occurred. Particularly for younger children, repeated images of an event may cause them to believe the event is recurring over and over.

If parents allow children to watch television or use the Internet where images or news about the emergency are shown, parents should be with them to encourage communication and provide explanations. This may also include parent's monitoring and appropriately limiting their own exposure to anxiety-provoking information.

Meeting the Child's Emotional Needs

Children's reactions are influenced by the behavior, thoughts, and feelings of adults. Adults should encourage children and adolescents to share their thoughts and feelings about the incident. Clarify misunderstandings about risk and danger by listening to children's concerns and answering questions. Maintain a sense of calm by validating children's concerns and perceptions and with discussion of concrete plans for safety.

Listen to what the child is saying. If a young child is asking questions about the event, answer them simply without the elaboration needed for an older child or adult. Some children are comforted by knowing more or less information than others; decide what level of information your particular child needs. If a child has difficulty expressing feelings, allow the child to draw a picture or tell a story of what happened.

Try to understand what is causing anxieties and fears. Be aware that following an emergency, children are most afraid that:

• The event will happen again.
• Someone close to them will be killed or injured.
• They will be left alone or separated from the family.

Reassuring Children After an Emergency 

Suggestions to help reassure children include the following:

• Personal contact is reassuring. Hug and touch your children.
• Calmly provide factual information about the recent emergency and current plans for insuring their safety along with recovery plans.
• Encourage your children to talk about their feelings.
• Spend extra time with your children such as at bedtime.
• Re-establish your daily routine for work, school, play, meals, and rest.
• Involve your children by giving them specific chores to help them feel they are helping to restore family and community life.
• Praise and recognize responsible behavior.
• Understand that your children will have a range of reactions.
• Encourage your children to help update the family emergency plan.

If you have tried to create a reassuring environment by following the steps above, but your child continues to exhibit stress, if the reactions worsen over time, or if they cause interference with daily behavior at school, at home, or with other relationships, it may be appropriate to talk to a professional. You can get professional help from the child's primary care physician, a mental health provider specializing in children's needs, or a member of the clergy.

Recognize Risk Factors

For many children, reactions to emergencies are brief and represent normal reactions to "abnormal events." A smaller number of children can be at risk for more enduring psychological distress as a function of three major risk factors:

• Direct exposure to the emergency, such as being evacuated, observing injuries or death of others, or experiencing injury along with fearing one's life is in danger.
• Loss/grief: This relates to the death or serious injury of family or friends.
• On-going stress from the secondary effects, such as temporarily living elsewhere, loss of friends and social networks, loss of personal property, parental unemployment, and costs incurred during recovery to return the family to pre-disaster life and living conditions.

Vulnerabilities in Children

In most cases, depending on the risk factors above, distressing responses are temporary. In the absence of severe threat to life, injury, loss of loved ones, or secondary problems such as loss of home, moves, etc., symptoms usually diminish over time. For those that were directly exposed, reminders such as high winds, smoke, cloudy skies, sirens, or other reminders may cause upsetting feelings to return. Having a prior history of some type of traumatic event or severe stress may contribute to these feelings.

Children's coping with emergencies is often tied to the way parents cope. They can detect adults' fears and sadness. Parents and adults can make emergencies less traumatic for children by taking steps to manage their own feelings and plans for coping. Parents are almost always the best source of support for children in emergencies. One way to establish a sense of control and to build confidence in children before an emergency is to engage and involve them in preparing a family plan. After a emergency, children can contribute to a family recovery plan