SARBC

Victoria, BC
Canada

A five-year-old girl pushes a toy truck slowly down the middle of the floor of the kindergarten class, when suddenly she picks it up and flings it against the wall. There's a loud crash, the truck falls back to the floor, and bounces several times before landing on it roof. Two of its wheels roll across the floor. Meanwhile, the noise has attracted the attention of two other children who quickly approach the "accident site," one pushing a tow truck and the other an ambulance.

The three children proceed to rescue the imaginary driver who is deftly removed from the wreckage, placed in the awaiting ambulance and sent off to the nearest hospital.

No teacher steps in to admonish the five-year-old for breaking school property. On the contrary, the teachers encourage this behaviour as a way of helping the youngsters work out their feelings after a tornado swept through their town, leaving 12 people dead and hundreds of others homeless.

Children are permitted to make their own interpretations during play activities, but teachers are available for conversation if the children want to talk.

This is just one of many ways to help children cope with the aftermath of disaster. Techniques also vary depending on the age group. But, how do you recognize when a child needs help? This isn't always easy as young children frequently express themselves in non-verbal ways. Dealing with an anxious child can be especially difficult if the parents have just gone through the same disaster. Their first reaction when seven-year-old Jimmy begins to act like a two-year-old (he's clinging to them and screaming) may be one of exasperation, as they too are filled with anxiety and trying desperately to arrange for basics such as food, clothing and shelter. To ignore Jimmy's clinging and screaming now would be a mistake, as the behaviour is likely to persist until he gets the reassurance he needs. His worst fears have been awakened by the disaster -- he fears that if his parents go away, he might never see them again.

What Jimmy needs now is to be cuddled and reassured that his parents are not going to leave him. He will derive further reassurance if allowed to accompany his parents as they proceed with recovery activities, including shopping and cleanup chores.

Jimmy's reactions of anxiety and fear are normal responses to danger and occur during the days and weeks following a disaster. In addition to being afraid of separation from his family, he may be afraid of injury, death, or of a similar disaster recurring. These fears are very real to him and should not be ignored by parents and care-givers.

His secure, nurturing world shattered, it is not surprising that Jimmy is not behaving as usual. Instead of a regular routine with familiar faces and friends, preparing for school and sleeping in his own bed, he finds himself sleeping on a cot in temporary accommodation, in a new neighbourhood.

After a disaster some youngsters may revert to childish behaviours such as bed-wetting, thumb-sucking, and holding onto a security blanket. All of these habits are ways that children find to comfort themselves when they are tired, upset or sick. Other children might display an inordinate fear of strangers. Parents should not be alarmed by their child's regressive behaviour as it is usually of short duration. They can help by not fussing, punishing, nagging, or making fun of the child. It is also helpful to acknowledge and encourage appropriate behaviour through praise. Parents should spend extra time with their child, making him or her feel special and loved. Indeed, the intensity and duration of the child's reactions decrease more rapidly when families show they understand.

Bedtime problems are the most frequently reported difficulties encountered by parents following a disaster. Children may refuse to go to bed alone and may insist on sleeping with their parents, or having someone present in their room. They may suddenly be terrified of the dark or of animals. Once asleep, they may have terrible nightmares during which they relive the disaster, then wake up crying and screaming.

Nightmares can help a child to vent anxieties and conflicts, understand, and work through strong emotional experiences related to; threats to life, death of a close relative or pet, and separation from parents. Nightmares are an extension of normal dreaming and a natural part of a child's development. However, young children cannot always readily distinguish fantasy from reality and sleeping from being awake. For a child, the frightening creatures and events in the nightmare may seem as large or as real as life.

Parents can also help by providing opportunities for the child to exercise and play vigorously. Such activities will help the child work off excess tension and energy and contribute to an uninterrupted night's sleep.

A warm bath, quiet play, telling a story, singing a quiet song, providing a cuddly toy all contribute to the sense of security, comfort, and well-being so effective in preventing nightmares. This time alone with the mother and father is often a time when children can share anxieties and fears. These intimate contacts relieve the child of anxiety and lull him or her into a pleasant sleep.

It may be helpful to turn on a night-light in the room or in the hall and leave the child's door open.

If your child wakes up frightened, go and comfort him or her immediately. When you go in, try not to turn on bright lights or talk in a loud voice. Acknowledge the fear: "Your must have had a very scary dream." Listen without interruption to what your child has to say about his or her dream. Do not deny the existence of fear by saying, "There's nothing to be afraid of"; rather, be accepting, understanding, and help the child express the fear and gain greater control over it. To calm your child it is essential to help establish what is real and what is fantasy. By allowing the child to describe the nightmare, you will have an opportunity to determine which fears are real or imaginary. When the child has told you about the nightmare, acknowledge and validate the experience by saying: "It must have seemed real to you," or " that sounds like a very scary experience, I don't blame you for hiding ... crying ... screaming ... running away ... " Reassure the child that you are near and that he or she is safe. If possible, stay until your child falls asleep.

Some bedtime problems can be met by greater understanding and flexibility on the part of the parent. Allowing your child to sleep in your bedroom on a mattress or in a crib or moving him or her into another child's room temporarily might be of some help. A time limit should be agreed upon by both parents and child and adhered to firmly.

If your child seems to be having an increasing number of nightmares or they seem very upsetting, talk the problem over with your doctor, public health nurse, or mental health worker.

Fears and anxieties also predominate in the reactions of children of elementary school age (6 - 11). Such fears show their increasing awareness of real danger to themselves as well as their family, and friends. Imaginary fears that seem unrelated to the disaster may also appear.

As with the pre-school group, regressive behaviour such as bedwetting, clinging, and nightmares may also appear, some marked in degree. Weather fears such as a fear of thunder, lightning, heavy rain, high winds and snow -- all conditions associated with a previous disaster (flood, fire, tornado, blizzard) -- may trigger fears that the disaster will recur.

Other problems may manifest themselves by irritability, disobedience, depression, headaches, visual or hearing problems. Loss of prized possessions, especially pets, seems to hold special meaning.

Parents can act as role models. Although parents may be experiencing strong disaster-related fears and anxieties themselves it is important that they demonstrate strength and control to their children who will feel more secure and reassured. However, it will not harm the child to let him or her know that you are afraid. As a matter of fact, it is good to put these feelings into words. For example, statements such as, "It's a scary feeling when ... it rains hard ... thunders ... wind blows ..." are helpful and should be used. This sharing will encourage the child to talk about feelings or fears and help reduce the child's anxiety as well as the adult's. (Adults often think mistakenly that talking to a child about traumatic experiences will only keep painful memories alive and harm the child.) The child may then express some fears that are not real and the parents will have a opportunity to explore these fears and reassure the child. Accurate information will also reduce anxiety so it is important to explain what happened during the disaster and what will happen.

The school environment and the increasingly important role of peers lend another dimension to the behaviours already described. Children may refuse to go to school, have behaviour problems in school, and experience difficulty concentrating.

It is important for children to attend school since it is the centre of life with peers. It's the major source of activity, guidance, direction, and structure for the child. When a youngster avoids school, it may generally be assumed that a serious problem exists. One of the reasons for not going to school may be fear of leaving the family and being separated from loved ones. The fear may actually be a reflection of the family's insecurity about the child's absence from the home. Some high-achievers may be afraid of failing and, once they have missed some time at school, may be worried about returning. The low performers may find that the chaos of disaster makes it even more difficult for them to concentrate. School authorities and parents should be flexible in the ways they encourage youngsters to attend school.

It is important to note that children are very sensitive to their parents' problems following a disaster and may not want to burden them with their own. They often open up more easily to someone outside the home whom they trust such as teachers, counsellors and peers.

It is not unusual for a disaster to trigger children's questions about death and dying. Underlying many of these questions is the fear of losing a parent.

Tell children about the death of a loved one. Some parents feel uncomfortable talking about death to their children either because of their own fear of death or because they are so preoccupied with their own grief that they fail to consider their child's. Others want to protect their children from pain and sadness even to the point of not wanting to tell them about a death in the family. However, it may well be that one of the best kinds of protection we can give children is to respect their right to grieve by sharing with them what happened in a simple, honest, and age-appropriate manner. Children should then be given the opportunity to ask questions or respond as they feel.

Children may need additional time to adjust in their own way to the loss and let the parents know what questions they have.

Include children in the funeral rituals. This is especially important as young children do not understand what death is all about. They need parents to talk about it with them and include them in the funeral and mourning rituals. Excluding a child from the opportunity to see the body or participate in the rituals of farewell may add to the difficulty in comprehending and resolving what has happened. Exclusion may also bring a sense of rejection and result in children misinterpreting what is going on and lead to anxiety. We need to remember that when there are unanswered questions (or unspoken ones), children will find their own explanations. Often these fantasies are more frightening than reality. It is therefore important for parents to label and identify the finality of death in order to dispel fantasies.

Provide family reassurance and support. When a mother or father dies, most children are fearful of what will happen to them should the remaining parent die. They may need gentle repeated reassurance that although their parent or relative has died and will not return, other family members will stay and look after them. It is essential, therefore, that all efforts be made to prevent any breakup of the family unit after the bereavement.

Answer questions about where the deceased has gone. Children's questions are often a problem for parents. Parents need to be true to their individual faith and beliefs as well as to family traditions but, at the same time, remain sensitive to their children's real concerns. Many of our words can be frightening or confusing.

Sometimes it is more helpful to answer a child's questions about the whereabouts of the deceased with such answers as "No one knows for sure but I believe ...". For some people saying "You know, I wonder about that too," is a special kind of honesty and a kind that children understand.

Children can feel angry about death -- just as we can. "How could he do this to me?" or "Didn't she know how much I needed her?" are feelings that children and adults alike often want to scream out loud. People of all ages need the freedom to shake their fists at the sky and shout "Why me?" Help for a child can often come from your helping him or her know that lots of people feel that way when someone close to them dies. One can also help by providing physical outlets for the anger, such as strenuous physical sports or games. Playing with sand, water or playdough is another outlet as it allows children to devise games to express their anger and soothe themselves.

Children can also feel guilty. They may believe "if only I had behaved better, she wouldn't have died." Younger children may even think that they "turned on the tornado" or that playing with a candle made the "world burn." According to H.B. Sharapan, young children do tend to think that their thoughts and wishes have magical power -- that wishing someone dead could cause that person to die. Guilt can also come from specific regrets most of us have when a loved one dies, regrets for things we said or did, or for things we did not say or do.

Children are no different, and we help each other when we talk about these feelings together. For example, that we often express anger at people we love the most, that loving people understand that and forgive us. We need to be equally forgiving to ourselves. Children need reassurance that the death of a parent or family member was not their fault, that it was caused by an accident or illness. It is comforting to be told that there are some things we cannot control, such as parents getting sick or having an accident or dying.

¹ U.S. Department of Health and Human Services. National Institute of Mental Health. Manual for Child Health Workers in Major Disasters, by N.L. Farberow and N.S. Gordon. Washington, D.C., Superintendent of Documents. U.S. Government Printing Office, 1981.

² Talking with Young Children about Death, by H. B. Sharapan. Family Communications Inc., Pittsburg, Pa., U.S.A.

Raymond Lafond is a Social Work Consultant in Emergency Services, Medical Services Branch, Health and Welfare Canada. This article appeared in the Jan-March 1989 issue of Emergency Preparedness Digest. Reprinted in SARNEWS by permission. (Although this appeared years ago, it still seems to be thoughtful and valid, doesn't it?)