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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.

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 or 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.

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 (ie, direct supervision and shelter), food, and safe drinking water. The next step is to consider the child's direct experience with the disaster, understand common reactions to the situation, and consider how to help.

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

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.
Pediatricians can also view these brief (1-3 minute) video clips of children and their parents explaining the impact of bereavement:

Supporting Pediatricians
The long-term needs of pediatricians providing care for the children in the areas affected by the 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. Pediatricians may also experience fear, tension, sadness, and exhaustion. See A Critical Concern: Pediatrician Self-care After Disasters and Dealing with disasters: AAP leaders, experts identify strategies to help pediatricians address their own needs

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.

Strategies for providing technical assistance and support to pediatricians in the months following the disaster should be implemented. Once safety is ensured 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 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.