Promoting Adjustment and Helping Children Cope

Disaster preparedness plans must ensure that health care facilities, medical providers, and all adults who might be in a position to help are prepared to meet the emotional needs of children of all ages and developmental stages. The National Commission on Children and Disasters and the National Biodefense Science Board, Disaster Mental Health Subcommittee have outlined critical recommendations to mitigate the mental health consequences of disasters on children.

A child's reaction to a new situation varies greatly, depending on his or her developmental level, temperament, experience, skills, and the support that is provided by parents and other important caregivers. When children are exposed to circumstances that are beyond the usual scope of human experience (eg, a terrorist attack, natural disaster, or acts of violence), they may have difficulty understanding and coping with the events and may develop a range of symptoms, including trauma symptoms, depression, anxiety, or, if deaths are involved, bereavement.

Helping Children Understand and Adjust to Loss
Resources should be offered to children and their families early on to help them understand and cope with a personal loss.

	After a Loved One Dies - How Children Grieve, and How Parents and Other Adults Can Support Them
	Communicating with Children and Families: From Everyday Interactions to Skill in Conveying Distressing Information
	Death Notification and Bereavement
	Guidelines for Responding to the Death of a Student or School Staff
	National Center for School Crisis and Bereavement Web Site – This Web site offers comprehensive resources and training/consultation services to support schools during and after times of crisis and loss.
	The Pediatrician and Childhood Bereavement

Psychological First Aid and Mental Health
During or immediately following a disaster, efforts should be focused on helping children by providing psychological first aid and identifying children who will benefit from counseling or mental health services.

Exposure to media (viewing the news on a computer or on television) or being interviewed by the media can traumatize children further. Efforts should be made to protect children from media violence and to promote resiliency whenever possible.

	Feelings Need Check Ups Too: Addressing the Mental Health Needs of Children Following Catastrophic Events: A Resource for Pediatricians AAP CD ROM and AAP Toolkit
	Mental Health Issues (Chapter 8 of the AAP manual Pediatric Terrorism and Disaster Preparedness: A Resource for Pediatricians)
	Psychosocial Implications of Disaster: A Guide for Pediatricians

To ensure that the unique physical and emotional needs of children are
met during times of disaster, the pediatrician should be involved in community disaster preparedness planning. For more information, see Preparedness Resources for Pediatricians and Chapter/State Disaster Preparedness Initiatives.

Supporting Pediatricians
The long-term needs of pediatricians providing care for the children in the areas affected by the disaster must also be considered. While a pediatrician's first response might be to ensure personal safety and that of family and colleagues while also attempting to meet as many of the needs of their patients and families as possible, the experience of personal injury or loss and witnessing the impact of a disaster on patients and their families will influence their ability to respond professionally. Pediatricians may also experience fear, tension, sadness, and exhaustion. Strategies for providing technical assistance and ongoing support to pediatricians in the months following the disaster should be implemented. Once safety is assured and services are restored, planning a meeting or conference to provide pediatricians with education and training in a location outside of the disaster area is also advised.

Helping Families
It is easier for adults and children when there is a plan in place in advance
of an emergency or disaster situation. The AAP recommends that families develop a written disaster preparedness plan and that parents discuss these plans with their children. Talking to children in advance of an emergency or disaster helps them to get better prepared and to develop strategies for coping with emergency situations and every day life and communicates that you are available and interested in talking to them
about their concerns when they are upset or worried. When a disaster
does occur, it is important to engage them in conversation and help them develop strategies to cope and adjust.

The following may be helpful in current situations:

	American Academy of Child and Adolescent Psychiatry – Disaster resources for families focused on talking to children after traumatic events and handling post-disaster stress and mental health issues.
	H1N1 Flu (Swine Flu) Advice for Parents and Caregivers
	Managing Your Anxiety About H1N1 (Swine Flu)
	Talking to Children About Swine Flu (H1N1): A Parent Resource
	Talking to Kids About the Economy – Whether there are challenging economic times or an individual family experiences a financial crisis, it can have a major impact on children. The AAP offers tips for parents and caregivers and guidance for pediatricians.