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Centers for Disease Control and Prevention
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Maintaining a Healthy State of Mind:

For Parents and Caregivers

Children's reactions to acts of terrorism depend on their age and maturity. Their responses also are affected by how close they are to the event, their level of exposure to it through TV and how they see their parents react.

Common reactions
In general, most children have mild, short-lived behavior changes after an act of terrorism.

    For infants to 6-year-olds
    Infants may become more cranky. They may cry more than usual or want to be held and cuddled more. Preschool and kindergarten children may feel helpless, powerless and frightened about being separated from their parent/caregiver. They may return to bed-wetting and have a hard time sleeping.

    For 7- to 10-year-olds
    Older children who know about loss may feel sad, mad or afraid the event will happen again. Peers may share false information that parents or caregivers then would need to correct. They may focus on details of the event and want to talk about it all the time. This may disrupt their concentration and affect how well they do in school.

    For preteens and teenagers
    Some preteens and teenagers respond with risky behaviors. This could include reckless driving, alcohol or drug use. Others may become afraid to leave home. They may cut way back on how much they hang out with their friends. They can feel overwhelmed by their intense emotions and yet be unable to talk about them. Those emotions may lead to increased friction, arguing and even fighting with siblings, parents/caregivers or other adults.

    For special-needs children
    Children who are ventilator-dependent, or are confined to a wheelchair or bed, may have even more pronounced reactions to threatened or actual terrorism. The same is true for youth with other physical or mental limitations. They might display feelings like distress, worry or anger because they have less control over how they get around than other people. They may need extra verbal reassurance, or more explanations, hugs, comfort and other positive physical contact.

Not all children respond these ways. Some might have more severe, longer-lasting reactions that are influenced by the following factors:

  • Direct exposure to the act of terrorism: whether they were evacuated or saw people injured or dying would affect them, as would being injured themselves or feeling their own lives were threatened.
  • Loss: the death or major injury of a family member, close friend or pet.
  • Ongoing stress from the effects of terrorism: this includes being away from home, losing contact with friends and neighbors and losing things that were important to them, like a favorite toy or access to a playground. Their lives are disrupted when they no longer have a usual meeting place or their routines and living conditions change.
  • A prior experience of trauma: including having lived through or observed abuse or a major disaster.

In most children, these behavior changes will fade over time. Children who were directly exposed to the act of terrorism can get upset again and signs of behavior related to the event may return if they see or hear reminders of what happened.

What you can do
When parents and caregivers or other family members deal with the situation calmly and confidently, they can provide the best support for their children, whose reactions are influenced by the behavior they see. They also are sensitive to what they hear and perceive from their parent/caregiver and other important adults in their lives. The better prepared you are, the less distress you are likely to experience. The more control and confidence you feel, the more reassuring you may be during an act of terrorism. This can help children cope.

Beforehand

  • Get informed.
    Ask your local emergency management office or American Red Cross chapter about specific hazards in your area. Learn about the disaster plans where you and your family spend time. This includes schools and daycare facilities. Be familiar with evacuation routes, warning systems and the nearest shelters.

  • Develop a family disaster plan.
    Preparing for an emergency helps the whole family accept the fact that terrorism does happen. It provides a way to select and collect resources to meet basic needs after an act of terrorism. Children, like adults, cope better when they feel prepared and have a greater sense of control over some things in their environment.

    Make sure your children know what to do in different types of emergencies. For example, do they know what they should do if they hear smoke detectors, fire alarms, weather alerts or warning systems like horns or sirens? Decide where to meet if an emergency happens. Choose one location right outside your home. Select another location outside your neighborhood. Ask an out-of-town friend or relative to be your emergency contact. In a terrorist event, family members should call this person and tell them where they are. Make a list of emergency phone and contact numbers. Make sure family members have some change to use a phone, a phone card or access to a phone or cell phone. Include arrangements for your pets in your plan. Practice the plan with your children and pets.

  • Develop a school or day care communication plan.
    It also is important that your children and their teachers and principals are familiar with the plan you have in place. During an emergency they could apply it while they were at school or day care. It would help for them to have your cell phone, work phone, fax and pager numbers as well as your e-mail address and those of any other adults authorized to pick your child(ren) up from school. Make sure those numbers are current and available to school officials who know and can help your child(ren).

  • Assemble a disaster supplies kit.
    Every household should assemble and keep an up-to-date disaster supplies kit. A kit can help your family stay safe and be more comfortable during and after an act of terrorism. Ask your children to think of items they would like it to include. Things like books, games, toys, snack food items that don't spoil quickly and bottled water. If they aren't talking yet, you may need to include stuffed animals, formula, diapers, bottles and pacifiers.

During and after

  • Show understanding.
    Following an act of terrorism, children are most afraid that:
    1. The event will happen again.
    2. Someone close to them will be killed or injured.
    3. They will be left alone or separated from their family.

    You can help them by:

    1. Calmly sharing facts about the event and plans to keep them safe. If a young child asks questions about what happened, answer them simply. Do not go into as much detail as you would for an older child or adult. The amount of information children need and can use varies.
    2. Encouraging them to talk or express what they are feeling through their paintings or drawings.
    3. Listening to their concerns. Show that you understand those concerns and address the issues they raise.
    4. Giving them specific tasks to do. This lets them know they can help out and can restore a sense of control. It also gives them more predictability about their family and community life.
    5. Spending extra time with them.
    6. Re-establishing daily routines for work, school, play, meals and rest.
    7. Understanding that children have a range of reactions to terrorism. This is influenced by their age, maturity and life experience.
    8. Knowing when and how to get help for a child who continues to suffer, takes extreme risks, hurts him- or herself or threatens others.

  • Monitor and limit your family's exposure to the media.
    News coverage of the event can bring out fear, confusion and anxiety among children and adults. This applies to large-scale disasters or terrorist events where lots of property was damaged and lives were lost. Watching images of an event over and over can cause younger children to believe that the event is occurring again and again. Parents and caregivers might want to discuss what is being shown on TV or the Internet about the act of terrorism. Limiting your own exposure to programs that fuel worry also is a good idea.

  • Use support networks.
    Parents and caregivers are almost always the best source of support for their children in difficult times. Thus, it is important for adults to understand their own feelings and to develop coping strategies. One way of doing this is to build and use social support systems that include family, friends, community organizations and agencies, faith-based institutions or other resources. This will help adults feel supported and also will help them manage their reactions better. In turn, they will be less distressed, more in control of their own thoughts and feelings and better able to support their children.

    If a child continues to be very upset by what happened or if their reactions hurt their school work or relationships at home or with friends, they may need extra help. You may want to have them talk with their primary care physician or a mental health provider who specializes in children's needs.

Online resources

For more information about how to cope with terrorism, visit the:

American Red Cross at www.redcross.org/services/disaster/0,1082,0_319_,00.html.

American Psychological Association at http://www.apahelpcenter.org/articles/pdf.php?id=22

Department of Health and Human Services (DHHS), Disasters and Emergencies Index at www.hhs.gov/disasters/index.html.

Department of Veterans Affairs, National Center for Post Traumatic Stress Disorder at www.ncptsd.org.

Substance Abuse Mental Health Services Administration (SAMHSA) at www.mentalhealth.samhsa.gov/dtac/resources.asp.

American Psychological Association (APA) at www.helping.apa.org/daily/tassey.html.

Uniformed Services University Medical School, Center for the Study of Traumatic Stress at www.usuhs.mil/psy/traumaticstress/newcenter.html.

National Institute of Mental Health (NIMH) at www.nimh.nih.gov/healthinformation/index.cfm.

National Mental Health Association at www.nmha.org/reassurance/anniversary/index.cfm.

More information for parents, caregivers and teachers can be found from the-

National Child Traumatic Stress Network at www.nctsnet.org/nccts/nav.do?pid=ctr_prnt#q1

American Academy of Child and Adolescent Psychiatry at www.aacap.org/publications/factsfam/disaster.htm.

American Psychiatric Association at www.psych.org/news_room/press_releases/
talkingtochildrenrewarterror.pdf
.

Federal Emergency Management Agency (FEMA) at www.fema.gov/kids/teacher.htm.

U.S. Department of Education, Office of Special Education and Rehabilitation Services, at www.ed.gov/about/offices/list/osers/osep/gtss.html.

Substance Abuse and Mental Health Services Administration (SAMHSA) at http://www.mentalhealth.samhsa.gov/publications/
allpubs/Ca-0022/default.asp

For more information about emergency preparedness and response, visit the-

Centers for Disease Control and Prevention at www.bt.cdc.gov.

American Red Cross at http://www.redcross.org/prepare/flash/index_2.html.

RAND publication at http://rand.org/publications/MR/MR1731/.

For information about how to create a family plan, visit the-

American Red Cross at http://redcross.org/prepare/makeaplan.html.

U.S. Department of Homeland Security at www.ready.gov/family_plan.html.

This information is provided by the American Red Cross and the Centers for Disease Control and Prevention (CDC).

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Create a Family Disaster Plan
  • Know what to do in case household members are separated in a disaster. Disaster situations are stressful and can create confusion. Keep it simple.
  • Pick two places to meet:
    • Right outside your home in case of a sudden emergency, like a fire.
    • Outside your neighborhood in case you cannot return home or are asked to leave your neighborhood.
  • Pick two out-of-town contacts:
    • A friend or relative who will be your household’s primary contact.
    • A friend or relative who will be your household’s alternative contact.

    Both adults and children should know the primary and alternative contacts’ names, addresses, and home and cell telephone numbers, or carry the information with them. In addition, include these contact numbers on your pet’s identification tags, or use a national pet locator service that someone could call to report finding your pet.

    Separation is particularly likely during the day when adults are at work and children are at school. If household members are separated from one another in a disaster, they should call the primary contact. If the primary contact cannot be reached, they should call the alternative contact. Remember, after a disaster, it is often easier to complete a long-distance connection than a local call.

    Make sure that adults and children know how to tell the contact where they are, how to reach them, and what happened or to leave this essential information in a brief voice mail.

  • Discuss what to do if a family member is injured or ill.
  • Discuss what to do in the rare circumstance that authorities advise you to shelter-in-place.
  • Discuss what to do if authorities advise you to evacuate. [link – to come]
  • Plan how to take care of your pets. Pets (other than service animals) usually are not permitted in public shelters or other places where food is served. Plan where you would take your pets if you had to go to a public shelter where they are not permitted. Many communities are developing emergency animal shelters similar to shelters for people. Contact your local emergency management agency to find out about emergency animal shelters in your community, in the event that you have nowhere else to go and need to go to public shelter with your animals.
  • Post emergency numbers (fire, police, ambulance, etc.) by telephones. You may not have time in an emergency to look up critical numbers.

Note: You can adapt the Family Disaster Plan to any household—couples, related or unrelated individuals, adults without children, adults with children. Even people who live alone should create a Disaster Plan.

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Last Updated 6/7/2005 10:15:00 AM