Disasters and other crisis events have the potential to cause short- and long-term effects on the psychological functioning, emotional adjustment, health, and developmental trajectory of children. It’s important that pediatricians, and all adults in a position to support children, are prepared to help children understand what has happened and to promote effective coping strategies. This will help to reduce the impact of the disaster as well as any associated bereavement and secondary stressors.
Stress is intrinsic to many major life events that children and families face, including the experience of significant illness and its treatment. The information provided about how to help children cope after disaster and crisis is therefore relevant for many encounters that pediatricians will have with children, even outside the context of a disaster.
The first step in providing psychological support is to ensure that the basic needs of each disaster victim are met. For children, this means ensuring that each child has a safe physical environment (e.g., direct supervision and shelter), food, and drinking water.
Importance of Basic Services and Timely Triage and Referral
Children may exhibit a range of adjustment difficulties after a disaster; in many situations, children may be having significant distress but not show any obvious symptoms. In communities recovering from a disaster, it is therefore helpful for pediatricians not only to inquire about children’s symptoms, but also to ask families about what children were exposed to as a result of the disaster, what they understand about what has happened, any ongoing stressors that may complicate recovery. Pediatricians can also ask additional questions that explore and identify risk factors to difficulty adjusting. Timely referral to supportive services should be considered for children with marked or persistent symptoms, as well as those with significant risk factors.
Psychological First Aid
During or immediately following a disaster, efforts should be focused on helping all children who were impacted by the event to understand what has happened and providing psychological first aid. Exposure to media (viewing the news on a computer or mobile device 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. The AAP Council on Communications and Media created an interactive tool, the Family Media Use Plan, that helps families make healthy media use plans for their children. Key resources for pediatricians include:
Helping Children Understand and Adjust to Loss
Pediatricians can serve as a useful resource for children who have recently experienced the death of a family member or friend by helping their caregivers understand the importance of inviting and answering their questions, providing information to help guide them in understanding and adjusting to the loss, and helping them identify strategies for coping with the associated distress. It is also important to offer timely information about how to involve children in the funeral or other memorialization activities, how to enlist the support of school personnel, and bereavement support services available within the community.
Pediatricians can also view brief (1-3 minute) video clips of children and their parents explaining the impact of bereavement (the Website for the Coalition to Support Grieving Students houses multiple videos, accompanied by print materials, covering an even broader range of topics related to supporting children who are grieving):
The long-term needs of pediatricians providing care for children in the areas affected by a disaster must also be considered. Although 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. Supporting children and families in the aftermath of a disaster can ultimately be quite rewarding, but it is often exhausting and at times overwhelming. See A Critical Concern: Pediatrician Self-care After Disasters and Dealing with Disasters.
In addition, listening to trauma stories may have an emotional toll. Awareness of the impact of this indirect trauma exposure, known as secondary traumatic stress, helps to protect the pediatrician's health and ensures that children receive the best possible care. For more information about secondary traumatic stress, see Secondary Traumatic Stress: A Fact Sheet for Child-Serving Professionals.
To increase the likelihood that pediatricians will remain able to attend to the needs of their patients as well as their own feelings, they should try to: establish flexible routines to the extent possible, monitor oneself for negative thoughts, create realistic professional expectations, set healthy boundaries between personal time and professional hours, practice daily personal stress management, make a conscious attempt to reduce compassion fatigue, and make use of both professional and social supports, including counseling.
It is important to engage in awareness opportunities such as National Children’s Mental Health Awareness Day. For example, in 2018, the Centers for Disease Control and Prevention (CDC) Children’s Preparedness Unit (CPU) developed and disseminated the following: