Editor’s note: The following piece was written by Jerrold F. Rosenbaum, M.D., chief of psychiatry at Massachusetts General Hospital and professor of psychiatry at Harvard University, a member of the National Network of Depression Centers. The article was endorsed as a consensus document by the network, and is being distributed to the CU community by the University of Colorado Depression Center, 303-724-3300, coloradodepressioncenter.org.
In the wake of Friday’s shootings in Newtown, Conn., parents are struggling with the urgent issue of how to help their children and families. Many of the surviving children witnessed bloodshed at the site, and others around the nation may see images and videos of it on television. The key question is how to help young children in such a terrifying situation.
Children of all ages will ask the primary questions:
It’s important to provide answers to these questions, even if your children do not put them into words. You should expect to answer these questions several times over the next few weeks.
Parents and caregivers should to try to address what the child is experiencing by asking, “What are your questions, concerns, and what are you worried about?” Kids have different fears. Many will worry about continued school shootings, and others will worry about such events spilling over to other areas, such as their homes, neighborhoods and playgrounds. For kids of all ages, it is really important to let them know that these kinds of events are incredibly rare. They should be told (over and over) that your school and schools nationwide are very safe places. Ask them to think of all the time have spent in school, the times their older siblings have spent in school and that things like this really do not happen much at all.
Simple reassurance in the immediate phase, however, may not be all that calming. Reassurance needs to be given repeatedly over the next number of weeks.
Also, while it may seem counterintuitive to think about taking care of yourself, many studies have shown that in the wake of natural and manmade disasters, the emotional stability and security of parents must come first. It is akin to what we always hear from airline attendants: “If the pressure drops, put the oxygen mask on yourself first, then help the child next to you.” While children certainly react to what they have seen or heard, they also are looking carefully at how their parents are reacting.
What to look for in younger children? It is not uncommon for children (and adults) of all ages to experience features of acute or post-traumatic stress, even for those who witness the event remotely through media. The key features include: remembering, emotional numbing (for post-traumatic stress), and arousal. For remembering, many kids will have frightening flashbacks, or sometimes in younger children vague images of horror that they cannot describe. These images may interrupt sleep or intrude into the day. Some kids will react by regressed behavior such as clinging, and it is just fine to keep them close and allow this. After all, they need to feel attached! For other kids, they may shut down and avoid contact. While parents should not force physical contact, they should not leave them alone, but stay close, and try to engage them in playful and caring ways. Many children and adults will demonstrate signs of “arousal” such as rapid heartbeat, feelings of panic or “impending doom,” rapid breathing, nausea, sweating. This is the “fight or flight” response well known in situations of extreme danger. It may, in fact, come on in response to thinking about such an event.
Some kids will not be able to sleep, and want to be with their parents. This is one situation when bringing them into the bedroom, either into bed, or setting up a cot is called for. For others, sleeping together in a common room may work. The important thing is to stay close.
In the next few days to weeks some younger children may “re-enact” the event through play. They may play out games of shootings, people getting hurt, dying or taken to the hospital. Such play in younger children is normal and should be allowed, though it is really hard for many adults to tolerate it! But the important point is that kids work out their emotional conflicts through playing. This is a healthy response and assists their coping.
For younger children, turn off the TV! Remember, they may think the images and videos that are going to be continually covered by the media may mean these things are happening over and over. It may also increase their emotional distress, just as it will certainly increase the reactions of adults.
How to help children of all ages through this: The reactions to kids need to be tailored to their developmental level. School-age kids and teenagers may also be worried about schools, though they too need to be reminded that school shootings are very rare indeed!
The conversation with teens may open new doors. For example, parents could ask if the teen has ever heard of a school shooting? Then the parents could engage in a discussion about whether it is more dangerous to go to school or drive with a friend who has had a few beers. This may help reinforce that schools are very safe, and while there have been some shootings in the past, such incidents are very rare indeed. Kids die all the time, however, from reckless driving, drugs and other risky behaviors.
The most important thing is to keep conversations about worries and concerns open. Television coverage of this tragedy may be viewed with older school-age kids and teens to allow for a conversation But even with these kids, it is best to watch the television together and talk about it and one’s reactions.
Concerned parents should contact their pediatrician or a child and adolescent psychiatrist for an evaluation.
Metro Crisis Services is a valuable resource in Colorado for people seeking help for themselves or a loved one. They offer mental health crisis and referral services 24/7 at no cost: 888-885-1222.