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When Bad Things Happen, How do we Talk to our Kids?

Mark Diamond, M.D.

A life insurance commercial appeared on TV. A father and his young son were watching and the boy asked "What is life insurance?" The father had a stricken look upon his face as he realized that he had to explain the concepts of life and death to his son.

Over the past few years, we have been bombarded by a series of horrible, tragic events. The Asian tsunami, hurricanes Katrina and Rita, the massive earthquakes in Pakistan and the ongoing conflict in Iraq have brought us graphic images of massive destruction and death. It is certainly difficult to emotionally cope with the enormity of these events for adults. How then, do young children handle such situations? How traumatic are these images to our children? Are there long-term psychological consequences?

All children experience unpleasant stressful reactions. Most are brief and quickly forgotten. When these reactions continue to cause problems, Post Traumatic Stress Disorder may occur. This condition usually involves a situation in which severe injury or a life-threatening event has taken place. It may be at home, where child, sexual, or spousal abuse may be witnessed. Community events include drive-by shootings or serious accidents. Natural disasters as mentioned above also increase the risk of PTSD.

As many as 5 million children per year are exposed to such events in United States. One to three percent of children show signs of PTSD. In some studies, as many as 80 percent of children exposed develop PTSD. So what is to be done?

The first step is to identify the problem. Children with PTSD often have a long list of symptoms. Following the trauma, a child may have episodes of agitated behavior punctuated with fear, helplessness, anger or denial. Younger children often will participate in play activities in which the traumatic event is dramatized. Nightmares increase as the event is subconsciously relived.

Obsession with death is common. "Are you going to die, Mom?" is a question we might hear. Favorite activities disappear for no reason. Extremely emotional reactions such as rage manifest themselves. Sleep disorders, such as difficulty falling or staying asleep begin to occur. Lack of concentration is common, so a message from the teacher that the child is daydreaming in class and her work is slipping comes home. Increased alertness to the world around them is a subtle sign. This presents as an increased number of fears to things that adults perceive as minor. Immature behavior, such as thumb sucking or wanting to be carried, is common.

Of course these signs can be present with many conditions, but certainly can represent the results of serious psychological stress. PTSD may last from weeks to years if left untreated.

Edward's mom reported that he recently expressed worry about an uncle serving in Iraq. He asked whether "bad guys" were pointing guns at his uncle, or whether he would be killed. Within a week, Edward was having difficulty falling asleep as well as frequent nightmares. Thumb sucking was a new habit. His mom called and asked for advice.

Telling the truth about these horrifying situations is critical. Dr. Foster Hutchinson of Vista Behavioral Health believes that the graphic images and details available from the media should be screened, if possible, from young children, but otherwise the truth is essential.

Lying or serious distortion only leads to more stress. Each of us must discuss the concepts of life and death, often using our religious, ethical or philosophical beliefs. These provide a framework that can be adjusted to the level of understanding of the child, to provide a more comprehensive picture of what is happening.

Why do these things happen? This is a question our children ask and we must ask ourselves. Often the answer is a truthful "I do not know." However, we must reassure our children that, together, we will make every effort to provide a safe environment. Are there guarantees? Of course not. But we do the best we can.

Dr. Robert Noll, chairman of Children's Hospital Child Development Unit in Pittsburgh, PA postulates that most children have the ability to take a dramatic event and emotionally numb themselves from the pain. In essence, they disassociate the trauma from reality. Unfortunately not all children are able to do this, thus PTSD.

Treatment involves identification that a problem exists. Once recognized, professional help may be necessary to determine the cause and then to effect a cure. There is no "right" way to treat PTSD, so therapy must be individualized.

We live in an complex and sometimes sad world. Our children cannot grow up in isolation, but with a supportive family and community they can learn to cope with unpleasant aspects of the real world.

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