12:44pm Tuesday 26 May 2020

When Tragedy Strikes: Timing and Honesty Key to Talking About, Dealing with Trauma, Hopkins Children’s Experts Say

Patrick Kelly, M.D.

kelly patrickIn the aftermath of the horrendous school shooting in Newtown, Conn., many parents and caregivers may wonder how, or even whether, to discuss such a traumatic event with their children.

Johns Hopkins Children’s Center experts urge parents to do so soon after the event, to be honest, yet comforting and to listen to their children.

Tragedies such as the Sandy Hook Elementary shooting — agonizing and senseless as they are — offer parents a chance to arm their child with coping strategies and address any underlying fears or anxieties the child may have, says Patrick Kelly, M.D., a child psychiatrist at Johns Hopkins Children’s Center.

“Early childhood trauma can have serious, even detrimental consequences, but if navigated properly it can equip children with lifelong coping tools and make them more resilient,” Kelly says.

Post-traumatic stress disorder (PTSD) develops in nearly all children who witness the death of a parent, in 90 percent of those who are sexually abused, in 77 percent of those who witness a school shooting and in 35 percent of those who witness violence at home, research shows.

Experts emphasize, however, that unless a child has an underlying anxiety disorder or a previously unresolved trauma, media exposure to disturbing news about a traumatic event is highly unlikely to cause pathological anxiety or PTSD.

When tragedy strikes — at home, down the road or thousands of miles away — broaching the subject early, being honest and straightforward and contextualizing the situation for the child are the best ways to ward off anxiety, experts advise. Doing so, they say, can help children deal with all types of trauma, including natural disasters, loss of a friend or relative or serious illness.

Deal with your own anxiety first: Do not start a conversation with your child until you have calmed down and the initial shock has worn off. Children have perfect radars for parental moods and can easily sense when something is off. Anxious parents can transmit their own anxiety to children, a phenomenon known as “trickle-down anxiety.”

Timing is everything: Start out by finding out how much the child knows already. Ask probing questions, but don’t be too pushy or insistent. If the child refuses to talk about a traumatic event, let it be. This could be a sign that the child is not ready to open up.  Research conducted among Katrina survivors shows that discussing trauma that is too fresh or too raw may be re-traumatizing, Kelly says. At the same time, he adds, don’t wait too long to broach the subject because you may miss a golden opportunity to frame and contextualize a traumatic event for the child before he or she gets bombarded by images and information from news outlets, social media and peers.

Questions such as “Is there anything you’re worried about?” “Is there anything you wish to talk about?” or simply “Did you hear about such and such event?” are good openers.

Honesty: Don’t try to conceal or minimize the extent of the tragedy, but don’t go overboard with excessive detail either.  A child’s age will dictate the scope and nature of detail a parent should go into. Younger children process trauma very differently from teens. For example, a 7-year-old may not fully grasp the permanence of death. Younger children also tend to continue their daily activities and regular play as normal and process tragedy in a piecemeal fashion, by finding out and accepting a bit more each day. 

Reassure children they are safe but remain realistic: Explain that while tragic events like devastating hurricanes or shootings do happen from time to time, they are very rare. Reassure your child that there are measures in place to protect her and that trustworthy people are in charge. Avoid making unrealistic promises like “This won’t happen ever again” or “This can’t happen to us” because a statement like this — if and when proven untrue — can undermine a child’s trust and make him view the world as an unpredictable and scary place.

Safety in routine: Routines and rituals are important for children because they can help maintain a sense of normalcy in an otherwise abnormal situation, Kelly says. Deviation from established routines can send a message that things are not normal. Whenever possible, stick to regular schedule, don’t cancel a play date and don’t keep the child home from school. This can be especially helpful for a child experiencing trauma first hand.

Preparation reduces anxiety: The aftermath of a tragedy is a good time to revisit the family emergency plan—all families should have one, Kelly says. Going over safety “do’s” and don’ts,” whom to call and where to meet in case of an emergency can give both the parent and the child some sense of security and control.

Some anxiety is normal: Don’t panic if a child shows some apprehension and anxiety in the aftermath of a traumatic event. This is probably a healthy sign that the child is processing the occurrence.

“Anxiety and fear are adaptive responses that keep us from taking unnecessary risks and help us navigate a complex world,” explains Renee DeBoard-Lucas, Ph.D., a child psychologist at Johns Hopkins Children’s Center.

So how can a parent distinguish between normal, healthy anxiety and worrisome symptoms that portend something more ominous?

“There is no single normal reaction but a range of normal reactions that will vary from child to child,” DeBoard-Lucas says. “Yet there are certain signs that should raise a red flag and prompt a talk with a pediatrician or a mental health professional.”

Normal signs of coping include some clinginess (especially in a younger child), a bit of crying, some apprehension, and asking a lot of questions about the event.

Some children, however, will go on to develop acute stress disorder, a state of heightened anxiety and fear following a tragic event. This phase is marked by hyper-vigilance, jumpiness and being startled easily. Acute stress disorder is considered mostly normal unless it lingers on for more than a few weeks. About one-fifth of children with acute stress disorder will go on to develop full-blown PTSD, Kelly says.

Red flags early on include persistent and recurrent nightmares, flashbacks, irritability, hyper-alertness, being startled too easily. Later-onset symptoms of concern include withdrawal, spending too much time alone, refusal to engage in a conversation, insomnia or too much sleep and emotional numbing.

 “When it comes to their children, parents have flawless sensors about what’s normal and what’s not,” Kelly says. “If something about your child’s behavior feels off, it’s best to talk with your pediatrician.”

Children with suspected PTSD can be successfully treated with trauma-focused cognitive behavioral therapy, a quick and intense treatment course designed to help the child get past the traumatizing experience.

Related Information:

Post-Traumatic Stress Disorder in Children
The National Child Traumatic Stress Network
The American Academy of Pediatrics
Trickle-Down Anxiety: Study Examines Parental Behaviors that Create Anxious Children

Founded in 1912 as the children’s hospital at The Johns Hopkins Hospital, the Johns Hopkins Children’s Center offers one of the most comprehensive pediatric medical programs in the country, with more than 92,000 patient visits and nearly 9,000 admissions each year. Hopkins Children’s is consistently ranked among the top children’s hospitals in the nation. Hopkins Children’s Center is Maryland’s largest children’s hospital and the only state-designated Trauma Service and Burn Unit for pediatric patients. It has recognized Centers of Excellence in dozens of pediatric subspecialties, including allergy, cardiology, cystic fibrosis, gastroenterology, nephrology, neurology, neurosurgery, oncology, pulmonary, and transplant. Hopkins Children’s Center is celebrating its 100th anniversary in 2012. For more information, please visit www.hopkinschildrens.org 

MEDIA CONTACT: Ekaterina Pesheva
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