Summary of the main psychological reactions of children and adolescents in disaster and emergency situations
| Reactions within the first 72 hours |
- Agitated state
- Frequent shouting and crying
- Excessive clinging to parents (cannot bear separation)
- They cannot fall asleep or they often wake up
- They overreact to any kind of stimuli and it is difficult to reassure them
|
| Reactions within the first month |
- Sleep disorders
- Loss of appetite
- Excessive clinging to parents
- Apathy
- Regressive behavior
|
| Reactions during the second and third months |
- Sleep disturbance
- Greater tolerance to physical separation
- Unjustified crying
|
| Reactions within the first 72 hours |
- Behavioral changes, passivity, irritability, restlessness
- Excessive fear of any stimuli, especially of those reminiscent of the event
- Spatial disorientation (cannot tell where they are)
- Sleep disturbances: insomnia, waking up in a state of anxiety, etc.
|
| Reactions within the first month |
- Regressive behavior: bed-wetting, baby talk, thumb-sucking
- They cannot bear being alone
- Appetite loss or increase
- Sleep disorders
- Loss of powers of speech or stammering
- Specific fears: of real people or situations (animals or darkness) or of imaginary ones (witches, etc.)
|
| Reactions during the second and third months |
- School or day care center refusal
- Headaches and bodily pain
- Food refusal or excessive eating
- Repetitive play enactment of the traumatic event
|
| Reactions within the first 72 hours |
- Behavioral changes: passivity
- Aggressiveness, irritability
- Confusion (they look puzzled and disorientation)
- Frequent crying
- Regressive behavior
- Language impairments
|
| Reactions within the first month |
- Unjustified fear
- Difficulty keeping still
- Difficulty focusing attention
- Headaches and other somatic complaints
- Repetitive play enactment of the traumatic event
|
| Reactions during the second and third months |
- Difficulty concentrating at school
- School refusal
- They feel guilty or assume the disaster is a consequence of something they have done or thought
- They look withdrawn or shy
- Repetitive play enactment of the traumatic event
|
| Reactions within the first 72 hours |
- Confusion and disorientation
- Withdrawal, refusal to speak
- They look distracted or as if their mind were elsewhere
|
| Reactions within the first month |
- Loss of appetite
- Loss of sleep
- Headaches and bodily pain
- Loss of interest in usual activities
|
| Reactions during the second and third months |
- Rebellious behavior against their family or any kind of authority
- Behavioral problems
- Escaping from home
- School refusal
|
From: PAHO, Practical guide of mental health in disaster situations. Washington D.C., 2006
General recommendations for children and adolescent psychosocial care in a disaster situation
| Recommendations for parents |
- Reassure them
- Be firm about sleeping time
- Stay with them for a while
- Leave a night-light on
- If they wake up fully and are scared (nightmare), reassure them; should they recall the event the following day, talk about the cause of their fears. If they are not fully awake (night terror), do not wake them, since they will not recall the event the following day
|
| Recommendations for teachers |
- Identify the problem (for instance, if you notice the child is exhausted)
|
| Recommendations for parents |
- Reassure them
- Encourage physical contact and cuddle them
- In case of separation, tell them where you are going, and when you are coming back. Have somebody stay with them
|
| Recommendations for teachers |
- Allow parents to be in the classroom for some time, reducing it gradually
|
| Recommendations for parents |
- Avoid punishments and mockery
- Change their clothes and reassure them
- Limit liquids at night
- Take them to the bathroom before they go to bed and during the night
- Show them how pleased you are when they do not wet the bed (tell them to register the days they have not wet the bed in a calendar, etc.)
- Leave a night-light on
|
| Recommendations for teachers |
- Do not allow mockery or rejection from classmates
- Resume school activities as soon as possible
|
| Recommendations for parents |
- Do not punish them (ignore these behaviors)
- Make them focus on something else
|
| Recommendations for teachers |
- Make them focus on something else
- Ignore these behaviors
|
| Recommendations for parents |
- Seek rapid school reintegration
- Do not punish them for their faults; instead, reward any progress
- Seek a return to normal routines at home
- Be firm about a reasonable study schedule
|
| Recommendations for teachers |
- Rapid school reintegration
- Partial parental presence (in the case of the youngest children)
- Special support in case of poor performance: sit the child in the first row; provide individualized attention at the end of school-day, etc.
- Encourage participation
- Reward achievements
- Prevent discrimination
|
| Recommendations for parents |
- Reassure them
- Do not transmit the adults’ anxiety
- Give clear and honest explanations about the past and current situation (avoid making assumptions about an uncertain future)
- Explore management strategies with them (breathing techniques, physical activity, etc.)
|
| Recommendations for teachers |
- Bear in mind that anxiety interferes with attention and concentration and causes restlessness
- Reward positive behaviors: staying seated, following instructions, etc.
- Make periodic evaluations of achievements with them (acknowledgment and reinforcement of positive behaviors) and ignore negative behaviors
|
| Recommendations for parents |
- Help them face fears gradually; be with them
- Set an example as regards self-control
- Do not use either corporal or verbal punishment; the best punishment is indifference or a neutral attitude (still loving)
- Make it clear that aggression to others shall not be allowed
- Declare a truce: ignore the aggression while demanding isolation in a supervised place for a short time —until you are able to control yourself
- Let them know what the desirable and expected behavior is
- Encourage channeling of excessive energy, anxiety and anger through non-harmful strategies
- Reward self-control achievements (hugs, picture cards, stickers, etc.)
|
| Recommendations for teachers |
- Do not allow aggressive behaviors
- Declare a truce
- Explain what the desirable and expected behavior is
- Reward achievements
- Punish through indifference
|
| Recommendations for parents |
- Be patient
- Be firm and object to unacceptable behaviors
- Set clear rules in the family environment
- Encourage communication
|
| Recommendations for teachers |
- Behavior model
- Consider possible external assistance for the family
|
| Recommendations for parents |
- Rule out any medical condition; if necessary, resort to health services
- Establish the relationship between what happens and the symptoms
- Do not allow manipulation through symptoms
|
| Recommendations for teachers |
- Warn parents and facilitate medical aid
|
| Recommendations for parents |
- Let them perceive their own sadness
- Let them express their feelings and memories freely (sadness, anger, guilt) and talk about it in the family group
- Provide company and manifest affection
- Do not conceal reality
- Do not encourage denial; talk about losses and their permanent nature, despite which it is necessary to “carry on”, and try to return to normal life as soon as possible, including individual and collective social activities
- Allow their participation in funeral rites (burial, religious services in case of death, etc.)
- Counteract possible feelings of anger and guilt explaining the real circumstances of the loss (or death)
- Allow adolescents to deal with mourning before they assume new responsibilities
|
| Recommendations for teachers |
- Inform classmates before the child starts attending classes. Briefly explain what normal reactions the child will have
- Provide emotional support
- Facilitate spaces to talk with the child individually, but do not focus all your attention on him/her
- Encourage participation in regular educational and recreational activities
- Check the child’s evolution and identify red flags (growing sadness, death or suicidal thoughts, etc.)
- Contact parents and coordinate actions
|
From: PAHO, Practical guide of mental health in disaster situations. Washington D.C., 2006