Clinical Reference Systems: Pediatric Advisor 10.0

A catastrophe such as an earthquake, hurricane, tornado, fire, or flood is frightening to children and adults alike. It is important to acknowledge the frightening parts of the disaster when talking with a child about it. Falsely minimizing the danger will not end a child's concerns. Several factors affect a child's response to a disaster.

The way children see and understand their parents' response is very important. Children are aware of their parents' worries most of the time but they are particularly sensitive during a crisis. Parents should admit their concerns to their children. They should also stress their abilities to cope with the situation. It is important to explain the event in words the child can understand.

A child's reaction also depends on how much destruction he or she sees during and after the disaster. If a friend or family member has been killed or seriously injured or if the child's school or home has been severely damaged, there is a greater chance that the child will experience difficulties.

A child's age affects how the child will respond to the disaster. For example, 6-year-olds may show their concerns about a catastrophe by refusing to attend school. Adolescents may minimize their concerns but argue more with parents and show a decline in school performance.

After a disaster, people may develop post-traumatic stress disorder (PTSD), which is psychological damage that can result from experiencing, witnessing, or participating in an overwhelmingly traumatic (frightening) event. Children with this disorder have repeated episodes in which they reexperience the traumatic event. Children often relive the trauma through repetitive play. In young children, distressing dreams of the traumatic event may change into nightmares of monsters, of rescuing others, or of threats to themselves or others.

PTSD rarely appears during the trauma itself. Although its symptoms can occur soon after the event, the disorder often surfaces several months or even years later. Parents should be alert to these changes in their child:

• refusal to return to school and clinging behavior (shadowing the mother or father around the house)
• persistent fears related to the catastrophe, such as fears about being permanently separated from parents
• sleep disturbances, such as nightmares, screaming during sleep, and bedwetting, that last more than several days after the event
• loss of concentration and irritability
• behavior problems such as misbehaving in school or at home in ways that are not typical for the child
• physical complaints such as stomachaches, headaches, or dizziness for which a physical cause cannot be found
• withdrawal from family and friends, listlessness, decreased activity, or preoccupation with the events of the disaster.

Professional advice or treatment for children affected by a disaster--especially for those who have witnessed destruction, injury or death--can help prevent or minimize PTSD. Parents who are concerned about their child should talk about it with their child's physician.