Pediatric Disaster Behavioral Health (PDBH) Toolbox

Children's reactions to disaster are shaped by developmental stage, exposure level, and pre-existing factors. Understanding these dimensions is critical to response planning.

• Developmental and Individual Factors
  • Children's ability to process threat and express distress varies by age and developmental level.
  • Pre-existing factors—such as trauma history, neurodevelopmental differences (e.g., autism), or complex medical conditions—can increase vulnerability.
  • Cultural and language considerations may impact how distress is experienced and communicated.
    
• Primary and Secondary Impacts
  • Impacts may include physical injury, traumatic exposure (e.g., witnessing death or destruction), disruption of routine, and separation from caregivers.
  • Medical procedures and lasting pain following injury (medical trauma) may add additional psychological trauma.
• Distress and Behavioral Health Risks
  • Acute stress reactions—such as insomnia, somatic complaints, or anxiety—are common and often resolve without intervention. Resilience is a common, long-term outcome for many after disasters.
  • In events like CBRNE incidents, psychological effects may far exceed physical injuries and generate a surge of care-seeking behavior.
  • Some children will develop more severe or persisting mental and behavioral health disorders, such as PTSD, depression, or anxiety.
  • In prolonged recovery phases, rates of behavioral health conditions and suicidality may increase due to persistent stress and resource strain.
  • Behavioral health impacts may not be immediately impairing but can escalate over time. These delayed effects should be planned for in disaster cycles