How to talk to children about traumatic events, from Lucile Packard Children’s Hospital Stanford expert

STANFORD, Calif. – News reports from 2013 were marked by several tragic events that shocked audiences around the world, from bombings at the Boston marathon to Typhoon Haiyan – presenting a challenge for parents whose children are exposed to these events, whether by television, newspaper or the Internet.

Honest, age-appropriate communication with children is one of the most important elements of helping youngsters handle news of traumatic events, according to Victor Carrion, MD, a child and adolescent psychiatrist at Lucile Packard Children’s Hospital Stanford and Stanford Children’s Health. Carrion, also director of the Stanford Early Life Stress Research Program, has conducted extensive research on childhood trauma – and in the following Q&A, has several suggestions for parents to help their kids process difficult news.

What are the potential short-term psychological effects on school-age children hearing or seeing information about traumatic events?

Carrion: The short-term effects include children becoming concerned about their own safety -- and if they are very young, such as preschoolers and first- and second-graders -- they may even be concerned about the safety of their family. Children can also be concerned about who will be taking care of them, or wonder if the tragedy that has happened will happen again. In addition, children who are closer in terms of proximity to the event will be at increased risk for symptoms of post-traumatic stress disorder -- however, because the images in the media can sometimes be so prevalent and vivid, the psychological effect on the child can be the same as if the child was at the scene of the event itself.

We must protect children by limiting their exposure to these images. If the child is three or four years old -- and there is no chance of them hearing about a recent tragic incident -- then there is no need to discuss it with them. You only need to talk about it if you think your child will hear about it.

Long-term, what are the potential psychological impacts to children who witness or hear about traumatic events?

Carrion: For some children -- if they are not treated via an assessment and psychosocial therapy -- their academic and social life will be impacted. Difficulty paying attention, managing emotional responses and problems with memory are common symptoms that children may experience. We call the ability to organize, make decisions and manage emotional responses “executive function,” and this skill set could be impaired if a child witnesses or hears about a violent event. Post-traumatic stress disorder is a particular danger for children who live in volatile environments. They will develop the disorder more quickly if a tragedy occurs near them.

Another effect of a traumatic event is that children feel very much out of control. Parents can help their children get a sense of control by allowing them to engage with community or school activities that are designed to provide a relief effort for the affected area.

What are some of the early warning signs of childhood trauma for parents to look out for?

Carrion: Irritability, a greater susceptibility to crying, and difficulty with sleep are among the symptoms that should raise a red flag if they persist longer than a month. Younger children may become clingier and experience nightmares and distressing or bad dreams. Children may regress in some behaviors -- such as bedwetting or sucking their thumb -- and you may hear them complaining more about a stomachache or headache. Some children, when they get older, may withdraw and become more isolated, and may potentially stop enjoying things that they used to.

Are children who are under a certain age more vulnerable to psychological impact than a teenager would be?

Carrion: We know that the younger the child -- for example, a preschooler would be more vulnerable than a school-age child -- the more they are at risk. Physiologically, their minds are more fragile. Adolescence is a critical period, just like early childhood; they are still vulnerable as well. People used to think that children -- by virtue of being children -- are more resilient, but there is no medical basis for that in neuroscience or psychological research.

What is your recommendation for parents on how they should talk to their children about disturbing events and images they witness or hear about?

Carrion: Encourage discussion with your children, but do not force it. Let your kids know that the conversation is welcome but that if the child doesn’t want to, don’t make them. Don’t force bravery; let them know that it’s ok to be fearful or angry or sad, that it’s okay for them to have their reaction. In addition -- according to their developmental level -- children will respond to traumatic events differently, so the way to approach a discussion with a child varies as well.

With very young children, communicating the news through art or through play can be very effective because children communicate well in this way, and they may be able to communicate some anxiety they have about the incident. It’s also very important to assure young children of their safety. If that is one of their concerns, then it is important to give the message, “You are protected. You are safe.”

With adolescents, it important to give them some space so that they can reflect -- but at the same time
-- we want to make sure that they feel protected and feel safe, and that conversation is open if they want to discuss what happened.

In the event you notice warning signs in your children’s behavior, I would recommend taking them to their pediatrician or mental health specialist to obtain a consultation.

To learn more about Victor Carrion, MD, and his research interests, click here.