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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

February 2013

Talking to children about tragedy in the primary care setting 

Random acts of violence can have devastating emotional effects on children, as well as adults. A traumatic event—whether in the child’s community or viewed on news coverage—can shatter a child’s basic assumptions about themselves and the world. The following advice from mental health experts may help guide clinicians in identifying youngsters who are distressed by a traumatic event and soothing their fears.

Traumatic events are experienced and handled differently by children, based on age, ethnicity, culture, developmental level, and previous exposure to trauma. The recent shootings in Newtown, Connecticut, may naturally cause children to worry that something similar may happen to them. It can also cause them to fear a part of their normal routine, such as going to school. Children who hear reports of shootings, natural disasters, and acts of terrorism may view their world as threatening and confusing. While reactions to traumatic events may fade over time, new events and anniversaries can cause the trauma to resurface or create new feelings and worries.

The National Institute of Mental Health provides a fact sheet to help understand how children react to trauma based on age:

  • Children age 5 and younger— appearing afraid (whimpering or trembling); clinging to a parent; crying or screaming; moving aimlessly or becoming immobile; thumb sucking; bedwetting; developing a fear of the dark
  • Children age 6 to 11—becoming isolated; being withdrawn around friends, family and teachers; experiencing nightmares; exhibiting depression, irritability, disruptive behavior, or outbursts of anger; inability to concentrate; refusing to go to school; complaining of physical problems; developing unfounded fears; expressing guilt or feeling numb emotionally; declining school performance.
  • Adolescents age 12 to 17—having flashbacks or avoiding reminders of the event; using drugs, alcohol, or tobacco; partaking in anti-social behaviors; expressing physical complaints; experiencing sleep problems; becoming isolated or confused; experiencing depression or having suicidal thoughts.

Primary care providers should be alert for these signs. If you notice symptoms, explore with your patients and their parents whether the source of the child’s distress is exposure to a traumatic event.

Talking with children about their concerns can help put confusing information into a reasonable context.  If parents have questions about the best way to talk to their kids about local or national tragedies, you may want to share a flyer developed by the National Association of School Psychologists. It offers helpful tips and talking points. A few examples include:

  • Reassure children that they are safe. Listen to and validate their feelings. But also reinforce that schools typically are very safe.
  • Provide developmentally appropriate explanations. Young children benefit from simple information, including reassurance of safety in both home and school. Older children often have strong opinions and may want to share their thoughts about preventing violence.
  • Stick with a normal routine. Because routines can reassure children, it’s important to return to or develop regular sleeping, eating, and exercising schedules.
  • Review safety procedures. Help children identify safety procedures and safeguards at home and school.

In assessing the patient or family, you may find that they need outside assistance in dealing with a traumatic event. If this is the case, United Behavioral Health can help.

How United Behavioral Health can help your patients—For complex clinical situations, United Behavioral Health (UBH) is available to provide consultative assistance. Practitioners can call the UBH Physicians Consultation Service at (800) 292-2922. To refer a patient for behavioral health services and to facilitate the coordination of care, call UBH at
(888) 777-4742.

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