As images of the blasts at the finish of the Boston Marathon and explosions in the small town of West, Texas reverberate around the world, parents and teachers are asking themselves: After a disaster, what do we say to our kids? How do we talk to our children about horrific, senseless acts of violence that we can’t comprehend ourselves? How do we keep kids safe and secure in a world that doesn’t feel safe and secure? How do we support our children’s grieving while we grieve ourselves?
Grappling with the aftermath of disaster is difficult enough for healthy adults. But for children, disaster can be earth shattering.
For guidance in how to help our children cope with disaster, ehealthMD turned to developmental-behavioral pediatrician David Schonfeld, MD, FAAP, Director of the National Center for School Crisis and Bereavement. In addition to his duties at the Center, Dr. Schonfeld is Pediatrician-in-Chief at the St. Christopher's Hospital for Children and Chair of the Department of Pediatrics at Drexel University College of Medicine.
ehealthMD.com: After a disaster like the one at the Boston Marathon last Monday, parents and other adults struggle with what they should say and share with children – and what not to say and share with them. What sort of guidance would you give to parents, teachers, and others who work closely with children?
Dr. Schonfeld: Start by asking what they’ve already heard. Most children will have heard something, no matter how old they are. Then after you ask them what they’ve heard, ask what questions they have.
Start with these two steps, no matter what their age or developmental stage. Older kids, teens, and adults might ask more questions and may request and benefit more from additional information. But no matter what age, it’s best to keep the dialogue straightforward and direct.
In general, you want to share basic information with children, not graphic details, or unnecessary details about tragic circumstances. The same goes for adults. People want to be able to understand enough so they know what’s going on. They don’t need to know a lot of graphic information, and they don’t need to witness horrific images.
ehealthMD: So could you give some sample language an adult could use in a conversation with a child?
Dr. Schonfeld: Say you ask the child what she or he has heard and if they have questions, and the child says, “I heard that a lot of people went outside and they were hurt.”
The adult could say something like, “Yes. Yesterday in Boston, Massachusetts” (and here you might need to give some context, depending on whether it’s nearby or far away, for example, ‘That’s a city/state that’s pretty far from/close to here’), there was a race where people were running, and a bomb went off. A couple people died, and a lot of people got hurt. We don’t know why the bombing happened. The police and government are trying to find out, so they can try to make sure that it doesn’t happen again.”
Then you follow up with more information based on the child’s reactions and questions.
ehealthMD: What about for the very young child, say 4 years old? Would that be too much information? Wouldn’t it be better to tell them that some people got hurt and grownups are working to make sure it doesn’t happen again?
Dr. Schonfeld: You don’t want to be too vague. If you just say, “Something happened in a faraway town and some people got hurt,” that doesn’t tell the child enough about what happened. The child may not understand why this is so different from people getting hurt every day and why so much is being said about it.
Even the youngest child needs accurate information. After the shootings in Aurora, Colorado [in July 2012], I prepared a small summary presentation for the teachers in the schools to help them communicate with students in the context of what was being done to keep people safe. The underlying message for them to convey was, “It’s okay if these things bother you. We are here to support each other.”
Someone asked what grade level to start this discussion, and someone suggested second or third. I commented that “Even kindergartners have heard of Batman.”
Afterwards, someone who worked there told me about her experience with her daughter. “I chose not to tell my child,” she said. “She’s just starting kindergarten, and I didn’t want to scare her. But last night we were talking at dinner about going to see a children’s movie, and she said she didn’t want to go because people got shot at movies. She’d heard about it at swimming lessons.”
The reality is that even young children will hear about major crisis events. It’s probably best that they hear about it from their parents/caregivers or other trusted adults.
ehealthMD:Are there any special considerations for children with developmental differences?
Dr. Schonfeld: If you have a child with a developmental delay, gear your responses to his developmental, rather than physical, age. For instance, if you have a teenage child whose level of intellectual functioning is more similar to a seven-year old, gear your response toward her developmental level. Start by giving less information. Provide things in the most appropriate and clear way you can.
What’s helpful to a child with autism spectrum disorder may be different. For instance, the child may find less comfort in cuddling than some other children. Try something else that does calm and comfort them.
Ask yourself, “Given who my child is, his personality, temperament, and developmental abilities, what might work for him?”
ehealthMD: Why is it so important to communicate openly with your children after a disaster?
Dr. Schonfeld: It’s understandable that we wish to protect our children from information that’s upsetting. And at times we can help filter all of the information in the aftermath of a crisis and present it in a way that they can accommodate and adjust to. But if we don’t share the information at all, it is likely that what they do hear from others won’t be as accurate, and it may be more frightening.
Even more importantly, it communicates that we are the adults they can count on. If you don’t say anything, children will jump to one of two conclusions (or maybe both). First, they may believe that you, the adult, can’t deal with the situation – and they lose some faith in you as a competent and trustworthy adult. Second, they may think that you believe they’re incompetent.
My younger daughter was in fourth grade on 9-11. The teachers at the school chose not to tell the children what had happened. Although she thought something was going on; she wasn’t informed until she was home alone with her older sister, who watched it on television in class. Both my wife and I were at work.
Later, while she was talking with me, she understood that the teachers didn’t tell them because they didn’t know what to say. The message she got was, "No I can’t talk about this at school. My teacher isn’t comfortable speaking about this."
That’s not the message we want to convey to our children. That’s why I encourage parents to say something.
ehealthMD:There has been an onslaught of disturbing, graphic images in the media the last few days. How much should children see and hear from the media?
Dr. Schonfeld: We need to remember that the mass media is not developed for the purposes of children. I don’t think it’s best for adults to view graphic images in the media either.
Keep your children away from – and avoid yourself if you can – repetitive graphic images and sounds; not just on television, but on radio, which can feature evocative interviews, social media, cell phones, computers – any source of media. Try to limit it.
With older children, if you do want them to watch the news, videotape it first. That allows you to preview it and evaluate its contents before you sit down with them to watch it. Then, as you watch it with them, you can stop, pause, and have a discussion when you need to.
If you regularly get the newspaper, don’t suddenly cancel it. They’ll ask – with good reason – “Where’s the paper?” Instead, keep the subscription coming but before they see it, explain what’s in the paper and that it may not be a wise idea for them to view it for this particular reason.
Children will generally follow good advice, but you have to give them some latitude to make decisions about what they’re ready for. You can block them from seeing the newspaper that comes to the door, but not the one on the newsstand. You need to be aware of what’s out there.
ehealthMD: What about information – correct or incorrect – that children might hear from other children or overhear from adults? How can parents handle that?
Dr. Schonfeld: After your initial conversation with your children, let them know that you’re available and willing to talk more. Tell them that they will probably hear more and encourage them to come to you for questions. The goal is to start a dialogue. You can say things like, “We can look together in the print media if that’s important to you to know.”
That’s how you will get less reliance on rumors: If your kids know you’re a reliable, accurate, and open source of information.
Recently, my eldest daughter called me for advice about a work trip to another country that was dealing with an infectious disease outbreak. She wanted to know how safe it was to travel there and if I thought she would otherwise be comfortable there It goes to show that if you start that pattern of being a reliable source of information early, they actually do go to you before they go to Google!
ehealthMD: We’ve talked a lot about the importance of sharing accurate information with children when disasters happen. But there’s information – and then there’s coping with that information. How can adults help children to talk about feelings and fears that might come up in the aftermath of disaster?
Dr. Schonfeld: When children tell us about negative feelings – whether that be sad, angry, scared – we tend to try to talk them out of their feelings.
“Oh, you shouldn’t feel that way,” we’ll say. But that is how they feel. They own their own feelings. And we have to let them have those feelings.
Instead of telling children they shouldn’t feel afraid, a better strategy is to ask “Why do you feel afraid?” This allows you to start a dialogue and clarify misinformation and misperceptions. Ask children what they’re concerned about, and you may be surprised how they see the events Adults have worries and fears, based on their misunderstandings, too. If you don’t ask, you won’t understand – and therefore can’t address effectively – their fears.
If someone says, "I’m scared," we tend to talk about what he should and should not be frightened of. When you try to explain to somebody why they should not be scared based on why you think they should not be scared — that’s called arguing. If you want to reassure somebody, you have to firstfind out what they are concerned about and give them an explanation that matches their concerns.
It’s not inappropriate that they feel the way they do – your job is to help them cope. For instance, your child might say she’s afraid to go outside. Start by repeating back what you think your child has told you, and then provide reassurance based on facts and acknowledge that those fears are real – even if you don’t think they’re valid. “You’re telling me you’re scared when you go outside and there’s a large group,” you might say. “We’re doing everything we can to make sure we’re safe. Even though the bombing is a rare event, it’s still a little scary.”
Another effective strategy is to share with your kids what you do when you’re scared. In this way, you’re teaching coping strategies while allowing them to own the feeling. It’s helpful to share a little of our own concerns as adults. It’s an opportunity to express to children that feelings are okay and they can develop ways to cope with those feelings.
If your kid says, “I’m kind of scared when I go outside,” you can say, “I was scared to go outside, too, even though I know it wasn’t something I needed to be.” Then share what you did to cope: “So you know what I did? I talked to your dad and asked if he would come with me on the walk.”
Sometimes simply sharing will help. Talk about feelings. Write about it. Share that you have your own feelings of fear and sadness, too.
ehealthMD:What are the signs that a child might not be coping well?
Dr. Schonfeld: One of the most common signs that a child isn’t coping well with a disaster? None.
Children do very well at hiding emotional distress. Kids learn very early one that adults don’t like talking about difficult topics, often because we convey the message to our kids that “I can’t bear to see you suffering.”
I remember traveling to China after a major earthquake and visiting a school where teachers had been yelling at the kids for crying. This was in a school where 60 to 90 of their schoolmates had been killed. I helped the teachers to see that instead of yelling at the children, they needed to try to reassure them. Acknowledge that this is difficult; I’m here to talk with you about it.
Eventually, if children don’t have a chance to practice healthy coping, you’ll see signs that they’re having difficulty adjusting. Some of things you might see are:
Sleep problems: Watch for trouble falling asleep, staying asleep, difficulty waking, nightmares, or other sleep disturbances.
Physical complaints: Children may complain of feeling tired, having a headache, or generally feeling unwell. You may notice your child eating too much or less than usual.
Changes in behavior: Look for signs of regressive behavior, including social regression, acting more immature, becoming less patient and more demanding. A child who once separated easily from her parents may become clingy. Teens may begin or change current patterns of tobacco, alcohol, or substance use.
Emotional problems: Children may experience undue sadness, depression, anxiety, or fears.
Don’t wait for the signs. Start the discussion early, and keep the dialogue going.
ehealthMD: What if an adult is having difficulty coping?
Dr. Schonfeld: When adults don’t do well, kids don’t attend to their own needs. I’ve seen this especially with single parents or parents of teens, who may draw on their kids to get emotional support. You can get comfort just by being with your kid – physically snuggling or playing, for example – but if you start expecting your child to take care of you, giving them more adult-like responsibilities, your kid might not have a chance to process her own grief.
I worked with one kid, a 17-year-old whose sibling had a sudden death. The mother really struggled with it. A couple of months later, when she went back to work, she became concerned about her son. He told me, “I don’t know, I was doing okay, but now I’m having trouble.”
Sometimes, when parents are struggling, kids put off their own distress until they’ve taken care of their parents. And this had happened in this instance. The kid told me “I was going to lose it if I had to go through one more night when she was crying on my shoulder. I had to take care of my mom.”
Adults need to get support from other adults – not their kids. Yes, you can derive comfort from your kids, just from the joy of being with a child. But don’t expect your kid to take care of you emotionally after a crisis.
ehealthMD: When is it time to seek help -- and how do you get that help?
Dr. Schonfeld: The time to get help is whenever you think it would be helpful.
I know that argument seems circular, but there’s no magical mixture or set of signs that says, “It’s time.” The issue is that in really difficult times, even typical reactions can be painful.
Many of us want to avoid stigma. We ask ourselves, “Am I normal?” Yours may be a normal reaction, but is it bothering you? Then why does it matter? When you break a bone, it hurts – that’s normal. It doesn’t mean you don’t splint or cast it.
If you think you would benefit from help, get it.
To find help, talk to the people that you usually rely on for help – your child’s pediatrician or other pediatric health-care professional, professionals in school settings, counselors. Reach out to the same people. They can help guide you to where to get help.
ehealthMD: Any last thoughts?
Dr. Schonfeld: We can help our children – and ourselves – through difficult times of grief and loss by talking openly, sharing our physical and emotional presence, and modeling coping behaviors.