Yesterday a horrible school shooting killed 20 young children in an elementary school in Newtown Connecticut. Many of the surviving children will have witnessed bloodshed at the site, and others around the nation may see images and videos of it on television. Naturally in the wake of such a tragic situation parents are struggling with the urgent issue of how to help their children and families.
Children of all ages will ask the primary questions:
• Am I safe?
• Are you, the people who take care of me, safe?
• How will these events affect my daily life?
• Why did this happen and is it going to happen again?
It’s important to provide answers to these questions, even if your children don’t put them into words. You should expect to answer these questions several times over the next few weeks. Let’s think both the immediate reactions and similar ones into the future.
Parents and caregivers should to try to address what their 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 while others will worry about such events appearing at their homes, neighborhoods or 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 they have spent in school or the times their older siblings have spent in school with nothing like this every happening.
However, simple reassurance in the immediate phase may not be all that calming. It needs to be repeated over the next number of weeks. Be patient with your kids.
Here are some guidelines for helping young children through this terrible tragedy:
Parents need to take care of themselves first
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.” Children are certainly reacting to what they have seen or heard. However, they are looking carefully at how their parents are reacting. This doesn’t mean you should remain austere or unemotional. You have to be honest and genuine. Expressing your own feelings of sadness, upset and concern is totally appropriate, but remember to do so in a calm, stable, comforting and reassuring manner.
All parents need three key aids
• Personal counseling,
• Family cohesion
• Community support.
To achieve this end, for parents who have lost a child and for those who have not, it is crucial not to be isolated. Families need to stay well connected at times like this. Parents need their spouses, partners, and extended family members to provide emotional support. In addition, for those in Connecticut and perhaps in other communities around the nation, local centers should be set up in the community so professional counselors, teachers, community leaders, spiritual leaders, law enforcement officials among others can all have a common place to meet, communicate and support each other. Such a forum helps provide stability and the sense of belonging to a “therapeutic environment.” This setting becomes a venue for all touched by the tragedy to address their concerns.
It is no wonder that religions of all varieties have rituals that embody the principles of counseling, family and community support. This is the therapeutic value, for example, of wakes, memorial services, and sitting shivah for a week in the Jewish tradition. In addition, individual and family counseling by child and adolescent psychiatrists and psychologists may prove invaluable.
It is also important to include older siblings in this effort. Older teens have to process such an event as well. They need the support of their peers, parents and community leaders and should not be excluded. It is often useful for them to have something to contribute to the mission at hand, whether this is cooking, cleaning up, running errands, making signs, or other duties that allow them to feel a part of a helping effort.
Every parent’s response is going to be different. Parents and caregivers should try to “take their own pulse.” If a parent is anxious about having a child go to school after this event, for example, the child is likely picking up on this, and may be sensitized to their parent's fear. It is always wise to reflect on one's own emotional reactions and, particularly with teenagers, voice them. “I know you can sense that I am anxious about the shooting, but this is a normal reaction. I also have to remind myself that schools and other public places are very safe.”
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 appear numb, 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 heart beat, 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.
Especially 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 going to school, though they too need to be reminded that school shootings are very rare indeed!
The conversation with teens may open new doors. For example, I would ask if they every heard of a school shooting? Then I would wonder with them what is more dangerous, going to school, or driving with a friend who has had a few beers? Schools are very safe and while there have been some shootings in the past, they are very rare indeed. However, kids die all the time from reckless driving, experimenting with drugs and other risky behavior.
The most important thing is to keep conversations about worries and concerns open.
Television coverage of this tragedy may be viewed with older schoolage 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.
Does my child’s personality factor into how I should respond to their concerns?
It is important to understand and know your kids. Anxious, shy, inhibited kids may not want to venture into school, but it is far better to encourage rapid re-entry, and ask the local schools to address safety issues right away. Others may want their parents to be present and many schools may allow this for a day or two. Frankly, if you keep kids away from school for too long, they may develop a phobia. While we don't want to push them, we do not want to give them the message that schools are dangerous places. They are not! Further, it would not be wise to have police or other security involved in routine school days as it gives the wrong message. The best policy is rapid return to school but discussing the issues of safety within school settings right away.
Should I limit my child’s viewing of news reports about the shooting to protect them from becoming traumatized by it?
Preschool kids should certainly not be allowed to watch TV or view the scene on computers. School-age kids should also be shielded as much as possible. The younger ones who see the scene repeated over and over from different angles may think it is still happening. Some do not know how far Newtown Connecticut is from their home. School-age kids, if they do see something on TV, should be encouraged to talk about it and ask questions.
Teenagers, on the other hand, have tremendous access to TV, computers, smart phones, etc. I would urge parents to watch TV with them, discuss how they feel about what they are seeing, and open a dialogue with them. Let them wonder with you why such things happen, how often they happen, what any motives of the suspect may be. These situations can open a dialogue about violence. You might ask, “What can we all do to prevent violence?” It may be that we cannot stop a very small number of individuals who are way out of line, such as Charles Manson or the Unabomber. But we may use this time to discuss the risks of available assault weapons, how to prevent or stop bullying, or how to manage conflicts between individuals without resorting to aggressive behavior.
Media portrayals of shootings and mass deaths have been shown to cause Post-Traumatic Stress Disorder (PTSD) remotely. This has been studied from the Oklahoma City bombing, the Challenger disaster, the scud missile attacks on Israel, and the 9/11 attack. The same principles as above should be maintained in terms of media access to these events, but parents should know that remote causes of PTSD have been documented in research.
How can I tell if my child has been traumatized by reports of the events?
There are a number of things to look for in many kids, remembering that age makes a difference:
• Changes in your child's eating and sleeping habits, energy level, and mood
• Refusal to attend school or go outside and play
• Your child seems socially withdrawn: refusing to play with friends and engage with family or siblings
• Your child begins compulsively re-experiencing the traumatic event and is plagued by intrusive thoughts and nightmares. However, school-age kids may play out the tragedy with toy dolls or figures, and this is quite normal and actually does help them "work it out."
• Heightened states of arousal: they become jumpy, irritable, emotionally unstable, or over-reactive emotionally.
Concerned parents should contact their pediatrician or a child and adolescent psychiatrist for an evaluation.
Copyright: Gene Beresin MD, MA