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Helping Children Cope Following Trauma

When a child is admitted to the hospital after a serious injury or an emergency medical situation, everyone in the family is affected: the patient, parents and other adult caregivers, and brothers and sisters. Other children that may be affected include classmates and friends, particularly if they witnessed the accident or medical emergency. All children involved need support in order to find ways to cope and make sense of the event.

What Children Need

  • Contact with a parent or other close caregiver as soon as possible
  • Simple, age –appropriate, honest explanations of what happened and what is happening, with frequent updates
  • Reassurance and physical comfort
  • Consistency in routine and limits
  • Opportunities to talk about or play through their experiences

Talking about your child’s injury to your other children may be particularly difficult when the injury is life-threatening and the future is uncertain. How do you tell them your best understanding of what may happen when you don’t know? It is important to tell them that their brother or sister is injured (include the name of the injury) and your best understanding of what may happen. Many parents have found the following words helpful:

“We’re really, really worried… the doctors and nurses are doing everything they can to take care of your brother. We hope that…”

For some parents, it may be easier to say: “The doctors and nurses are very worried…they are doing everything possible to take care of your sister…they hope that…”

General Responses of Children to Traumatic Events

  • Behavioral Responses: changes in activity level (greater levels of activity or withdrawal from activities); aggression; fear; difficulty sleeping, nightmares, changes in eating; avoidant behaviors; regressive behaviors (returning to thumb-sucking, loss of toilet training, clinging, wanting to be held); attention-seeking behaviors (deliberate misbehaving or breaking rules); changes in school performance (falling grades, new behavior problems at school)
  • Emotional Responses: anxiety, irritability, guilt or shame, anger, grief, fear of separation from parents or primary caretakers, worry about physical health
  • Cognitive Responses: confusion, difficulty concentrating, persistent thoughts of the trauma, belief or fear that another traumatic event will occur, belief in omens and prediction, development of trauma-specific and general fears, increased sensitivity to additional stresses.
  • Physiologic Responses: tendency to startle easily, increased nervous tension, physical symptoms (stomach-ache, head-ache)

Things Children Often Wonder or Worry About But May Not Ask

Will my brother get better? Is he going to die? ​Explain honestly your best understanding of what may happen. If death is a possibility, you can be truthful with your children while holding on to hope. If death is likely, you may find it very difficult to say that out loud, and you may worry that talking about death will be upsetting to your children. Again, gentle truth is beneficial.

Suggestions for what to say include:

  • Will the injury get better? “The doctors and nurses are doing everything possible to help your brother. Sometimes, though, a person’s body is too hurt to get better or to work anymore. This is what the doctors believe is happening with your brother’s body – even with everything that everyone is doing to help your brother, his body is too hurt to live.”
  • Is it my fault? Did it happen because of something I did, didn’t do, or even thought? Learn from children what they believe caused their sibling’s injury, then address any potential basis for unnecessary guilt. Ask, “What makes you think that?” Explain, “Lots of children think that, but it rarely happens that way.” Give concrete examples: “If you wished this object to fall, could you make it happen?”
  • Could it happen to me, too? Reassure them that this will not happen to them, if that is accurate. If the patient was involved in a trauma, ask what can be done to prevent that sort of accident.
  • Who will take care of me during this time? Plan and explain to your children how their lives will remain the same and what will be different – who will take care of them, where they will stay, what their routine will be. Recommendations: maintain routine as much as possible, stay at home if possible – bring alternate caregivers to stay with them in the home.
  • Don’t you care about me? Children may feel anger and/or a sense of abandonment with separation from parents during stressful times. Ask “How has it been for you while we spend time at the hospital?” Acknowledge and accept their feelings. “If you were in the hospital, where do you think we would be? What do you think we would do?

Positive Strategies for Helping Children

  • Provide additional soothing activities (physical comfort, rocking, an extra story before bed, backrubs, a nightlight)
  • Expect temporary regression
  • Listen to children’s retelling of events – expect their need to repeat the story over time
  • Respect your children’s fears and give them time to cope with fears
  • Avoid re-exposure to frightening situations or reminders of the trauma
  • Maintain sleeping and eating routines as well as general household and family routines
  • Reassure children that strong or scary feelings are normal and will lessen over time
  • Facilitate opportunities for children to make choices and have some control over their daily lives
  • Provide opportunities and appropriate play materials for trauma-related play
  • Avoid introducing new or challenging experiences for children during the first weeks following a traumatic event.
  • Be alert to children’s misunderstandings of events, especially those of guilt responsibility, or magical thinking

Possible Effects of Traumatic Events in Childhood

  • Repeated memories of the event
  • Repeated behavioral reenactments during play
  • Development of specific fears related to the trauma
  • Changed attitudes or beliefs about people, life, the future

Preparing Children for Coping with Repeated or Intrusive Memories

Explain that many children remember parts of the event for days, weeks, or months after the accident or emergency and that this is okay. Sometimes, even when they are busy doing what they enjoy, a picture or image of the event can come into their minds. This is normal and it happens to lots of kids. Parents should help their child focus on the present, using their senses of touch, sight, sound, smell, even taste to orient him or her to the “here and now”. Reassure your children that they are safe now and that they are not alone.

Plan with the children what they will do when they have these memories, especially if it is upsetting or interferes with their activities. If they are at home when these memories occur, your children may choose to talk to you about it, call a friend, or get involved in a physical activity (shooting baskets, even hitting a pillow) – any appropriate activity that helps them concentrate on being in the present can help relieve distressing memories. At school, it is important to identify one of several adults who are accessible to your child and with whom they feel comfortable. Explain the situation to the teachers and other adults your child identifies with and discuss plans for helping your child cope when they have trouble paying attention in class or concentrate on work due to replaying memories or images. Let teachers know what coping strategies your child uses at home and plan together how the strategies can be utilized in school.

Reenactments During Play

Play often allows children to work through their experiences and to make sense of their world. In this sense, reenactment of the traumatic event through play can be a healthy way for children to express feelings and work through thoughts related to the event. It also may give adults insight into how a child is understanding or making sense of the experience.

  • Pretend play/Dramatic play - Using dolls, animals, action figures, even cars and trucks, children can play about their experiences. Adults can learn what is on children’s minds by watching and by participating. Play with cars can become play about the mommy car, the daddy car, the baby car, and the big brother car. To learn the most from your children, guide the play gently – perhaps setting the characters (“you be the mommy and daddy dolls and I’ll be the baby and sister dolls”) and setting the scene (“the mommy and baby dolls are at the hospital; what do you think is happening there?”). Using questions can further extend the play – “what does he say?” “What’s she thinking/feeling now?”. Usually children take over the play and begin to direct all of the characters. If you sense that your child is reluctant or wants to do different play, give him or her the freedom and control to move on.
  • Drawing - Children often use drawing and other forms of art for emotional expression. Encouraging children to talk about their drawings or artwork can be eye opening for adults. Open-ended questions (such as, “What is happening in this picture – what is this person thinking or feeling?” or “Tell me the story of this picture”) can help you learn about your child’s inner world. For example, parents sometimes become alerted to a child’s perception that he or she was somehow responsible for the accident or emergency. With this information, parents can appropriately address this common concern. Consider what play materials can be added to your child’s collection to provide richer opportunities for this “working-through” play. A child who has witnessed or been involved in a car accident will likely benefit from play materials that include cars, an ambulance, and police car. If the child or someone close to them was hospitalized following the accident, including doctor and nurse dolls, a hospital bed and other appropriate “props” can be helpful.

Sometimes reenactment play does not bring relief. This is usually the case when: the reenactment play becomes very repetitive, the child has difficulty transitioning to other types of play, and/or the child shows no sense of enjoyment or satisfaction during or at the end of play. When reenactment play shows no benefit, many parents have found it helpful to contact a professional with expertise in children’s stress and coping.

Development of Specific Fears Related to the Trauma

Many children worry that another traumatic event may occur or develop fears specific to aspects of the traumatic event in which they were involved – the sound of ambulances, getting too close to a window, being in a car again, the sound or sight of fire, for example. They may become afraid of specific locations, things or human behaviors. Sometimes, adults can help children make emergency plans to help them feel more secure: what to do if there is a fire in the house, how to avoid falls, or what to do if someone is having trouble breathing. Other ways to help children feel secure in their world include maintaining a consistent routine and letting them know if the routine changes. Reassuring children and encouraging them to actively participate in problem solving can also be helpful.

Changed Attitudes or Beliefs about People, Life and the Future

Children’s attitudes and beliefs are often challenged when they face a traumatic event. The idea that the world is a safe place may not fit with their understanding after a traumatic experience, for example. Parents and other caregivers can assist children in coping with such a change in their understanding of the world in a variety of ways: by using the recommendations in the above paragraph; by sharing their own beliefs with their children, incorporating a faith or spiritual perspective in understanding life; and by recognizing and accepting the confused feelings that may come with losing a sense of security.

Positive changes in beliefs and attitudes are also possible. Some children and teenagers have said that experiencing a traumatic event has increased their faith in people, in God, and in their own strength to face difficult times.

When to Seek Professional Help

If you notice that your child is experiencing several signs of stress that continue to occur over time (beyond six weeks), contact a professional with expertise in children’s stress and coping. Some parents have heard the term “post-traumatic stress” before and recognize that children may experience such stress following a traumatic event, particularly if they witnessed the event or were injured themselves. A professional is most qualified to determine if a child is experiencing symptoms of post-traumatic stress and will be able to decide the appropriate level of care and support. Your child’s primary physician may be able to assist you with a referral to a counselor in your area.

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