Course The Emotional Impact of Disaster on Children and Families

How can Pediatricians Detect Conditions, Intervene and Help Reduce the Emotional Impact of Disaster on Children and Adolescents?

Pediatricians can have a significant role in the assessment of the emotional impact of disasters on children and adolescents. Pediatricians can advise families, teachers, and the community on ways to minimize the emotional consequences of the disaster, help families cope and assist humanitarian workers to do their work in ways that it conducive to child mental health and wellbeing.

The pediatrician is a very significant figure for parents who have entrusted the care of their child to this physician. The pediatrician is also an important link in the child-family-school-community chain. Part of the pediatrician’s role is to encourage communication between families, schools, and leaders in the community, and to develop a joint plan that aims to reduce or avoid longterm emotional consequences, and return children to a sense of routine and security. The first aspect pediatricians should address is a plan for their own security and the security of their family. Lack of planning and intense worry about one’s own and family’s security will undermine the ability to assist others.

Pre-disaster Intervention

Ensure that the emotional needs of children are adequately considered and addressed as part of the anticipatory planning of disasters.

Understanding the physical and emotional needs of children throughout their different developmental stages is important and pediatricians can assist in all phases of planning to create a plan that addresses the psychosocial aspects of children and families.

With this knowledge, one can advise parents, teachers, police officers, firefighters, and others on some of the basic elements needed to prevent or reduce the expected emotional impact on children, and to identify children at high risk or an intense and immediate emotional disturbance and chronic mental health problems.

Pediatricians can give advice on the emotional needs of children at each developmental stage, and can assist in community collaboration. One way to prepare the community is by giving talks, distributing leaflets or other informational material, and educating the local media.

A pediatrician can also assist in the planning for the placement of available resources and structure of the rescue teams in pediatric hospitals, shelters, and emergency rooms.

Pediatricians should also work together with school personnel in the preparation of programs aimed at helping teachers deal with distressed children. It is important to train teachers and personnel in charge about the specific emotional needs and typical reactions to a disaster.

The pediatrician should talk with parents about the reactions they might expect from their children according to their developmental stage (see Section III). Implementation of this kind of anticipatory planning is especially crucial in those communities considered to be at high risk for being exposed to earthquakes, hurricanes, floods, and other natural disasters. A good and feasible way of to help communities and professionals prepare for helping others is to organize workshops in Psychological First Aid. There are various training materials and manuals. The World Health Organization has made generic materials, and Save the Children have made specific materials for child focused Psychological First Aid. In the United States the The National Child Traumatic Stress Network and the National Center for PTSD have made a comprehensive set of training materials for Psychological First Aid.

During the Disaster

Pediatricians should help community leaders identify the existing resources to deal with the disaster and make sure that those resources are distributed equitably. It is important to participate in disaster related call centers and educate the mass media in order to educate broader segments of the population. It is also crucial to become integrated into an organized relief and recovery program. It should be kept in mind that children spend many hours at school, and disasters often occur while they are there. Hence, if teachers and school personnel are trained to identify the most frequent emotional manifestations of students and know how to deal with them, the school can provide an adequate place for children and adolescents to feel safe and confident enough to express their concerns and carry on activities appropriate for their age. This will likely reduce the emotional impact and its consequences.

After the Disaster

It is important for pediatricians to be avail able for consultation to families, schools, and the community in recognizing the different long-term emotional reactions that appear among the childhood/adolescent population.

Once the event is over and the threat has abated, they should give emotional support and guidance to families, especially the parents. Consider referring parents for support when needed, since the parents are the main vehicle by which children recover. They should listen and advise parents on how to respond to their child’s emotional distress. Clarifying normal reactions and those reactions that are more concerning can be very helpful to parents. If intact, the pediatrician’s office should remain a safe place for children and families to feel comfortable, and free to ask for guidance and support. It is ideal to have an adequate place where meetings with the whole family can be held. Encourage dialogue between parents and their children that can be modeled by the pediatrician.

The pediatrician should continue to provide emotional support and facilitate communication among family members. He/she should help rebuild a normal routine so children can regain a sense of security. He/she should be alert to those children with special needs, e.g. those who have been direct witnesses of the disaster, children with previous diseases, or orphans. It is imperative to follow up on children in order to establish the need for specialist referral.

The role of the pediatrician also includes being an advisor to school personnel, helping to screen children for impairing symptoms, and being available for further assessment with treatment or referral of children who have more severe or chronic symptoms.

In addition to providing information that the observed emotional disturbance is transitory, the pediatrician should also counsel families, educators, and the media, that a certain percentage of children will develop long-term symptomatology and impairment benefiting from treatment.

The pediatrician should also be aware of the criteria for a child or adolescent referral to a mental health professional, a specialist, or community-based treatment. Many pediatricians believe it is their responsibility to screen for emotional distress and make referrals after trauma and disaster. Formal screening of all individual can be very helpful and is more suitable than informal screening or routine surveillance (http:/massgeneral.org/schoolpsychiatry/checklists_table.asp).

The identification of mental health disturbance can be complicated by an individual’s reluctance to discuss symptoms, and ongoing fears for safety, and by shame and guilt associated with the trauma. It may be difficult for medical providers to inquire about symptoms since they may be affected by the disaster and are uncomfortable with the subject. Those who believe it is not their responsibility or lack suitable training or confidence can still provide suitable anticipatory guidance and counseling, and can identify those vulnerable individuals most at risk for persistent or severe emotional impact. In this regard, special attention should be paid to children who have been direct witnesses of terrorist attacks or slaughter or who have suffered significant losses.