How to Help Your Kids Manage Traumatic Events

There have been several national tragedies these last couple of months.

The Sandy Hook School Shootings, the Boston Marathon bombings, the Oklahoma tornado and most recently, the tragic crash landing of Asiana Flight 214 as it arrived at San Francisco International Airport this past Saturday, July 6.

In these and many disasters, children and adolescents experience trauma directly, or in some cases indirectly. 

Patch spoke to child psychiatrist and early life stress expert Dr. Victor Carrion of Stanford's Lucile Packard Children's Hospital about how to help kids who have suffered a traumatic event, particularly in the wake of the crash of Asiana Flight 214.

Patch: How do tragic events affect children?

Victor Carrion: First thing, children that have more exposure to stressful situation are at an increased risk. Exposure is a predictor of who will develop post traumatic syndromes.

Patch: Does tragedy affect children of varying ages differently?

Carrion: It affects different age groups differently. There are other factors that come into question too. How much support is available. Family history, previous trauma, ongoing adversity...those put them at increased risk.

Children's risk can be decreased if they have resilient factors, such as how much support they get when they feel fear and how they can help themselves—self-help.

There are three different age groups—pre-schoolers, school-age, and adolescents

Of course, some responses when something like this happens is normal and expected.

• Pre-schoolers become more clinging, more tearful. They may have some regressive behaviors such as sucking thumb, wetting bed. That should be gone within a month. If they persist there could be a problem.

• In school age, some may complain of headaches, stomach aches, some may not want to go to school. A way to show same clingy behavior

• Adolescents may become more withdrawn, may not want to talk about it. With this plane crash, I do worry about the adolescents because of the exposure.

After a month, if these reactions continue or they start having an impact on how the kids behave in school or with their peers, then take them to get help.

Some people think that younger kids more resilient. It's very important to highlight that there is no data that supports that. The younger you are, the more vulnerable. Because you have no time to develop life experiences and also physiological maturity since the brain is still more sensitive in a younger individual than an older one.

A lot of kids tolerate stress and nothing happens. Fear is a normal reaction to stress when it happens. Some do not develop trauma.

Patch: What other symptoms of trauma else should parents be vigilant for?

Carrion: Distressing dreams can be quite frequent and changes in appetite are all PTSD symptoms, including:

• Re-experiencing of the trauma, most dramatically in flashbacks. Also in intrusive thoughts.

• Avoidance; not wanting to address or talk about it. Some avoidance can be helpful, but if they are avoiding feelings it can put the further at a risk for PTSD;

• Alertness, as in being present when a certain queues are triggered— like being on a plane—can trigger a physiological response. Usually in a dangerous situation you want that to happen. But with PTSD, it happens when there are no triggers.

Patch: What can parents, friends, teachers do to minimize the risk of trauma?

Carrion: It depends on what experience the children have had before and how much they identify with the victim. Particularly if it’s your community, your cultural group. That causes stress, and the larger the feeling of stress, the more a reaction they kids will have.

We all accumulate stress in our body from the amount of stress we experience in life. It's called allostatic load.

The stress may put you at risk, but it also may give you a sense of being taken care of. Like after the Boston Marathon, or Newton , when we as a nation became a community, and we come together; despite our difference that can come together and helped to each other.

Patch: How can you limit exposure when there's so much media especially social media? 

Carrion: For this, I would suggest to break the secret and engage in conversation. Kids will seek information. If you give it to them, they will be less likely to seek it elsewhere.

With adolescents, it may be important to have family meetings, to have conversations about what happened. Engage the adolescents. But as a rule you don’t want to provide more information than is being asked for.

By engaging them, you will limit the amount of social media information they seek. In fact, you could suggest they come to you. With younger kids it’s possible to limit exposure, harder to do with older kids.

Patch: For kids with direct exposure to traumatic stress, how much should they be talking, reliving their experience?

Carrion: It’s important to provide them with the support they need—whether it’s emotional or material, so that the trauma is dealt with. 

Sometimes a quick de-briefing [for investigative purposes] and then forgetting about them, causes more problems. It’s contra-indicative. It is important to talk to them and provide them support and follow-up therapy. 

Patch: Since many of the minor victims travelled by plane, wouldn't they be afraid to get back on another? 

Carrion: Oddly, enough exposure is one of the best types of treatment for post-traumatic stress disorder. It's like if you are afraid of elevators and instead take escalators. The more you take escalators the longer you’ll be afraid of elevators. 

Avoiding planes will make fear of flying greater. The sooner they get back on a plane the better. There will be stress, but that’s when the support comes into play. 

It could be done with gradual exposure, for an hour. Then you go for longer and watch the planes land to see how safe they are.

I am concerned about the physical limitation that some of these individuals have. Now they have to adapt to changes in their lives. 

Patch: How do cultural differences come into play?

Carrion: Everything that I’ve said is a very western way to address trauma. We must find out what other cultures do when this happens. It may be odd for us, but what we have to figure out.

It's important to be more informed and more respectful of cultural difference. Recommend that when they return home, they visit a mental health person from their culture.