Danielle Z. Kassow, Ph.D.
Hurricanes, earthquakes, war, terrorism, school shootings. We know how scary these events feel as adults, but how do they affect our youngest citizens, our children? Disasters, whether human-made or natural, have a significant effect on the health and emotional well-being of children (Madrid, Grant, Reilly, & Redlener, 2006). It has been one year since Hurricane Katrina changed the lives of so many and five years since September 11 forever left its imprint on all of our lives. As I reflect on the anniversary of these disasters I am reminded that post-disaster effects may not surface until long after the occurrence of the event and can last for years (Madrid et al., 2006). Although these events seem long ago, children continue to need support.
In its September 2005 professional journal, Pediatrics, the American Academy of Pediatrics (AAP) addressed the effects of disaster or terrorism on children. Much of the information contained in the report is important for parents and caregivers who are supporting children who have experienced disasters. Highlights from the report have been summarized below for parents and other caregivers. If you would like to read the full AAP report it can be accessed at AAP Report.
What is a Disaster?
The AAP (2005) defines a disaster as a catastrophic event that usually involves injury or loss of life and destruction of property. These events are traumatic, are generally outside normal everyday human experience, and are likely to involve emotional and physical injury. Natural disasters, such as storms, generally have a less injurious emotional effect on children than human-caused disasters, such as terrorism, in which harm is intentional. Short-term disasters that result in little or no disruptions in a child’s life, such as a blizzard, are less emotionally damaging than events that lead to long-term changes in the social environment of the child, as may be the case for families displaced by Hurricane Katrina. Long-term or chronic disasters, such as terrorism or war, may result in greater emotional disturbances, particularly if children have witnessed intentional acts of violence. Terrorism and war challenge what is humanly decent and this may add to the dismay that children experience. A child’s exposure to disaster may be direct, such as family displacement or witnessing a violent act, or indirect, such as viewing images of September 11th or Hurricane Katrina on the television.
How do Disasters Affect Children?
Although we have learned a great deal about children’s psychological responses to disaster from the events of September 11th, one of the challenges society faces is the uncertainty regarding the long-term effects of disasters or terrorism on children. Children and adolescents have reported being more worried about how to deal with stressful things than before the September 11th attacks. In the case of Hurricane Katrina, or other disasters, it is difficult to predict the long-term effects, but there are physical, behavioral, and emotional symptoms that parents and other caregivers can watch for.
When children experience a traumatic event some behavioral symptoms and adjustment reactions are expected and are normal. Exposure to the traumatic event can result in fear, anxiety, or depression, and most of the time these reactions are within normal limits. The emotional responses of children can range from mild stress reactions that are resolved in a short period of time to more severe and long-term consequences of Post Traumatic Stress Disorder (PTSD). PTSD includes significant distress and possible disruptions in an individual’s ability to function normally (see the AAP Report for a complete description of PTSD).
Children of different ages or stages of development interpret the world differently and at their own pace. This influences their responses to disasters or catastrophic events. As a result, children will display different levels of coping and adjustment after a disaster or crisis. Younger children’s responses are characterized by mood, anxiety, and behavioral symptoms. They will generally not be able to understand the nature of the disaster, for instance whether it was human inflicted or natural. Consequently, young children are more worried about the outcome of the disaster. For example, they may worry about what will happen to the dog they left behind or about their own or their family’s safety. Older children may better understand the underlying intent of the event and its implications. For instance, they may understand that September 11th was human inflicted and war could result due to the attacks. However, older children may still experience depression and/or anxiety, which may be characterized by unrealistic fears, and their behavior may include anger or despair.
Infants and toddlers, while too young to understand the disaster or talk about their distress, can be negatively affected by crises. Disruption of a routine, for example a bedtime routine, and/or loss of a loved one, may result in a return to earlier developmental stages, and even emotional disconnection. In the first year of life increased crying, irritability, and separation anxiety may result. Toddlers and pre-school-aged children are likely to experience sleep terrors and nightmares and may display a return to earlier behaviors such as helplessness, clinging, and increased temper tantrums. School-aged children may process the event through play, expressing trauma-related themes by drawing or acting out the event, or even displaying aggressive behavior. As with younger children, sleep disturbance and separation anxiety may be seen. School-aged children may also be withdrawn, unconcerned, complain about not feeling well (e.g., stomach aches), and may also exhibit behavioral problems.
Adolescents’ responses to disaster are similar to those of adults; depression and anxiety prevail. This does not lessen their risk of developing PTSD or more serious stress reactions or behaviors. Adolescents may complain of not feeling well, be withdrawn or uninterested, and are at increased risk for drug abuse and sexual relations. Self-harm and suicidal thoughts or actions are also of concern. AAP (2005) noted that adolescence is already a particularly vulnerable time for youth because they are experiencing complicated transitions. Further, adolescent interpretations and responses may vary in part depending on whether the child has developed abstract thinking abilities, which generally appear around the age of 16. Abstract thought allows for thinking about society and one’s own role in society (Bukatko & Daehler, 2001). The development of abstract thinking may allow adolescents to contemplate, for instance, the motive behind horrific acts such as September 11th, comprehend what happened, discuss its effects on society with peers and teachers, and perhaps even contemplate ways in which they can help their community.
The effects of these traumatic events on children are also due in part to a number of factors. The nature of the disaster itself, for example, was it natural or human inflicted? Did injury, property destruction, or loss of life occur? How much exposure did the child have to the disaster, and was the exposure direct or indirect? Were the child and those around him personally affected by the disaster? For instance, was their family displaced or did they lose a loved one? Has the child had previous losses? Does the child have a history of problematic emotional or mental health such as depression? The individual characteristics of the child such as resiliency or temperament; and the level of social support of the child also plays a role. Gender differences in how children react to disasters have also been found. Boys tend to display higher rates of behavioral reactions and require longer to recover than girls. Further, boys display more outwardly-focused behaviors such as violence, while girls display more inwardly-focused behaviors, such as anxiety or mood changes.
Children are also affected by their parents’ fears and stress about the disaster. Because children are dependent on adults for feelings of safety and well-being, children whose adult family members are not coping well are at increased risk for emotional symptoms after a disaster. Any impact of trauma on important adults in a child’s life may increase the emotional effect on children. An adult’s disordered mood or behavior may increase a child’s fears, and distressed adults may not be able to recognize a child’s distress. Studies after September 11th have found that parents are aware of the effects of their reactions on their children and they worry that they are not emotionally available for their child. This inability to support their child’s needs may add to a parent’s own stress. All these factors present challenges in recognizing how best to meet and provide for each individual child’s needs.
Stages of Children’s Response to Disaster
Parents and caregivers should expect children to respond to disaster in specific stages. The first stage, which occurs immediately following the disaster, includes reactions of fright, disbelief, denial, grief, as well as feelings of relief if loved ones are unharmed. The second stage occurs a few days to several weeks after a disaster occurs. During this time many children may regress in their development. For example, a child who is toilet-trained may return to bed-wetting. Emotional distress may appear, such as, anxiety, fear, sadness, depression, hostility and aggressive behavior, indifference, withdrawal, sleeping problems such as nightmares or difficulty staying asleep, complaints of not feeling well, negative thoughts about the future, and play-themes related to the disaster. Symptoms such as these are a normal part of the recovery process for children and parents should expect them to last for several weeks.
The AAP recommends that children who experience major loss or traumatic exposure, or who demonstrate severe distress or behavioral symptoms, receive counseling urgently, within one month of the event. Children with stress reactions and behavioral symptoms for longer than one month’s time may be at increased risk of developing PTSD or violent and delinquent behaviors later in life. It would be appropriate and necessary for such children to receive counseling from a mental health specialist.
What Parents and Caregivers Can do to Help Children
The AAP noted that while the world may be less safe since 2001, for the most part, we are safe. “We must allow children to have hope (AAP, 2005, p. 793).” Adults need to communicate this message to children and assure them that adults will take care of them and of each other. Keeping the dialogue open in our communities is vital for coping and adjustment. Doctors, others in the medical community, educators, mental health professionals, parents, and children need to talk to each other about these traumatic events. If adults do not ask a child what she is thinking or feeling about the disaster the child may think that the disaster is so terrible that it cannot or should not be talked about.
Parents also need to limit their child’s exposure to the media; exposure to a disaster by television viewing may be a risk factor for children. When young children see images of disaster or terrorism on television they may not be able to understand the physical distance between them and where the disaster occurred. They may need reassurance that the disaster did not occur in their own community. If children are exposed to the disaster by television, parents and other caregivers need to be available to discuss what their child saw, answer any questions the child may have, and ask the child how he is feeling about what he saw. Parents can help support feelings of empathy for others, by encouraging the child’s desire to engage in unselfish acts of kindness, for instance, a bake sale to help raise relief funds. This altruistic behavior empowers children and may help them develop resilience, the ability to recover from trying times in life.
Activities Parents can use to Talk to their Young Child
- Talking to children about how they are thinking and feeling is vital to their emotional health, but sometimes it can be difficult to find ways to talk about traumatic events with children. The following are activities that parents or other caregivers can use to talk with their children:
- Have paper, crayons, paints, pens and pencils on hand so that your child can draw, paint, or write about what she is feeling.
- Encourage children to write letters, poems, or stories.
- Have puppets, dolls, stuffed animals or other favorite toys available so that your child can act out what happened, and what she is thinking and feeling.
- Ask your child questions such as “How did that make you feel? Why do you think it happened? What can we do to fix it? How can we help other people? What can we do to help you feel better?”
- Help children feel empowered by making a family disaster kit together, allowing them to help select food, games, toys, and “security” items such as blanket or stuffed animal, to go in the kit.
- Hugs, backrubs, and holding your child may also be what he needs to feel reassured and safe.
- Lastly, seek help when you are unsure how to handle your child’s response to disaster. Your child’s pediatrician is a valuable resource.
American Academy of Pediatrics (2005). Psychosocial implications of disaster or terrorism on children: A guide for pediatricians. Pediatrics, 116, 787-795.
Madrid, P.A., Grant, R., Reilly, M.J., & Redlener, N.B. (2006). Short-term impact of a major disaster on children’s mental health: Building resiliency in the aftermath of Hurricane Katrina. Pediatrics, 117, S448-S453.
Bukatko, D., & Daehler, M.W. (2001). Child Development: A thematic approach (4th ed.). Boston, MA: Houghton Mifflin.
Appreciation is extended to Dr. Joseph F. Hagan, Jr., for his comments on an earlier version of the paper. The opinions expressed in the paper, however, are solely those of the author and do not necessarily reflect those of the reviewer nor are they an endorsement by the American Academy of Pediatrics.