Cope with Trauma in a New Era
September 11, 2001, ushered in a new era in the United States. Our sense of safety, security, and even complacency is gone, as infants, toddlers, and their families have experienced the untimely, violent death of parents on scale that never before occurred so close to home. The long-term impact on young children of expo-sure to such violence and experience of early loss is still unknown. There is much to learn, as well, about protective factors that contribute to the resilience of children and families. As a consequence of September 11th and its aftermath, our perspectives on how young children and families cope with trauma may need to change.
Principles to Guide Practice
Infants and toddlers depend on trusted adults to protect them and make sense out of their world, especially when children have been exposed to potentially traumatic events. Parents, teachers, and other adults whom young children turn to and trust must be able to listen to the children in their care, contain their concerns, and help them feel safe. Adults must realize that in infants and toddlers, new fears may result as well as loss of trust in adults. Previously happy, carefree children may become more clingy, being afraid to leave or be left by their parents or caregivers. They may question every time the parent goes out whether they will return or leave them. While they may have achieved developmental milestones that include being able to explore their environment independently and be left alone reasonably comfortably, with trauma, they maintop want to be left alone at all. Patience is crucial in explaining to the child that everything will be all right and that they will be safe. However, as much as one wishes to protect a young child, it is difficult to hide the anxiety aroused by terrorist attacks and continuing warnings of danger. If parents are traumatized—or even anxious—themselves, it is important for them to reach out to family, friends, and others to get the sup-port that the need so that they can help their children.
Children’s reactions to potentially traumatic experiences may be difficult to predict. Since September11th, some parents have told us about behaviors and emotions noted in their children that worry them. Others have expressed concern that their children did not talk about the event even when they knew they had seen the pictures on television and overhead conversations of adults. Further, parents who themselves were anxious wondered if they should talk with their children about the event, and if they did, what they should say. We know that children’s reactions to trauma like many other events will be greatly influenced by those of their parents. Reactions also vary based on the child’s age, degree of exposure, proximity to the event, and their relationships with the people who are affected, which also includes their closeness to the traumatized adult. What should parents or other trusted adults say to children? While of course it depends on the age of the child, there is no doubt children’s imaginations can run wild! So it is important to help ground them in a reality that they can understand.
For a 1-year-old, it is most important to be reassuring. They will likely not know about or under-stand what has happened. But they will react to the tension, stress, anxiety, and fear of the trusted adult. Hold them and hug them and tell them everything is going to be all right. While the traumatized parent may not always feel that “every-thing will be all right” it is crucial to provide the infant with that sense of security.
A 2-year-old will understand more that something terrible has happened, that people have been hurt, and that people are anxious and sad. Since children of this age tend to feel very powerful, they may even think they have done something to “cause” this awful thing to happen. Their imaginations maybe conjure up images that are worse than the actual reality. They need to be told some of the details in simple language and then again reassured that they are safe and protected with their parents.
In the third year of life, young children will understand more of what has happened and may have some trouble telling the difference between what is real and what they usually see on television. It is very important to try to keep protecting these children from seeing too many images of the event as it will only be frightening and very difficult to integrate in a young mind. Indeed, many adults have had difficulty integrating the event in their minds. These children will likely repeat the event in their play and in their drawing, perhaps over and over trying to master it. Let them do it, but if they seem to be stuck in their play, feel free to suggest a different ending or even a different theme to the story.
Exposure to trauma can lead to symptoms, even without direct exposure. The traumatic event can remind a child (or an adult) of an earlier trauma. If children have symptoms that do not go away within 2 months, parents should seek professional consultation. A limited consultation may help provide the information and reassurance that the parent needs. However, if the symptoms have not dissipated, without help and intervention it is unlikely they will go away over time. Therefore, education is needed for parents through pediatricians, emergency rooms, and clinics. Training is needed for child care providers and others who come in contact with children. Considering the loss and trauma that has occurred within the communities of law enforcement and fire fighters (where “being strong” is highly valued), education and support to these groups is also very important.
Parents and other trusted caregivers can do many things to help children feel safe. In uncertain times, as well as amidst the stresses of ordinary life, the most important things parents can do include listening to the child, following their lead, allowing them to show their fears, and helping them identify their feelings. Maintaining a regular day-to-day schedule offers the comfort of structure. Although many people are and will continue to suffer following the terrorist attack and subsequent events, adults need to feel that it is all right to continue to enjoy life and to help children retain at least some of the carefree and fun feelings of being a child.
There is much more uncertainty about the future for children in the United States now than before September 11th. We can only hope that the enduring effects of trauma on young children who are sustained and nurtured in safe and secure environments will dissipate over time. Indeed, many children are resilient and, as Selma Fraiberg told us so sensitively about work with infants and toddlers, “It is a little bit like having God on your side.” At the same time, with the events of September 11th, and the subsequent terrorist threats, there will be many continuing “triggers” and potential re-traumatizing events. Thus, as caring adults as well as therapists, we must keep our “windows and doors open” so that caregivers of infants and toddlers who have been traumatized can be provided with the ongoing support structure that they will need.
Joy D. Osofsky, Ph.D., Louisiana State University Health Sciences Center, New Orleans, Louisiana
Excerpted from “Helping Young Children and Families Cope with Trauma in a New Era”, Zero to Three Journal, December 2001/January 2002 (Vol. 22:3)