Talking to Children About Tragedy

Feb. 25, 2010— -- An experienced trainer at SeaWorld was pulled off a poolside platform by a killer whale Wednesday and was either thrashed to death or drowned as spectators were rushed out of the stands where they had gathered to watch the trained marine mammal perform, a SeaWorld official said.

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SeaWorld can have up to 1,000 visitors on any given day, many of them children, according to its Web site.

So what should parents say to their children if they have witnessed such a traumatic event? The ABC News Medical Unit asked Rahil D. Briggs, Psy.D., pediatric psychologist and director of Healthy Steps at The Comprehensive Family Care Center (CFCC) at Montefiore, to give parents advice on how to talk to their children about the incident.

Children of different ages will respond differently, Briggs said. Since she is an infant and toddler psychologist, she said she answered the questions with children from infants to 5 years old in mind.

Question: How should a parent address with their child what they have witnessed in order to help them deal with seeing this traumatic event?

Briggs: Parents themselves may be quite upset, understandably, after this incident. It is important to attempt to be calm and convey acceptance while talking with a child who has witnessed a traumatic event, such that the child will feel able to ask myriad questions and talk about the event whenever it is on his or her mind. Parents can share that they were scared, too, but should attempt to convey that the child is safe, secure, and the parent will remain an effective caregiver. If parents themselves experience recurring thoughts, difficulty sleeping, excessive tearfulness, etc., they may benefit from seeking professional help. Children will do much better if they feel that their parents are still in control, and will attempt to limit any exposure to harm or fearful events.

Parents should gently ask their children if they are thinking about the incident, without pressing the issue too insistently. Do not assume that, because your child is young and not yet bringing up the topic themselves, they don't remember it. If children have questions, provide honest and brief answers, in a developmentally appropriate fashion. Parents can help children to construct cohesive narratives regarding the incident, as children will very often attempt to patch together the bits and pieces that they understand/remember. Although there may be a desire to watch news coverage of the incident, parents should seriously limit their children watching such coverage, as it can be traumatizing. Stick to routines. In the aftermath of such an unexpected trauma, the day-to-day routines of family life are important, and may help to restore some sense of normalcy. Allow a bit of extra time for cuddling, for bedtime routines, transitions, etc. If a child is in school, communicate with teachers regarding the incident, as they can help be an extra set of eyes, noting any concerns.

Question: What might be some of the signs in the weeks and months to come that a child could be experiencing the lingering effects of having witnessed something this traumatic?

Briggs: For infants, babies, and non-verbal toddlers, parents may see increased irritability, startle responses, separation anxiety, crying, sleep disturbance, changes in feeding habits, and overall regression (for example, a child who was previously toilet trained may begin soiling his diapers). It is also important to note that while babies cannot verbalize their memories of traumatic events, we often see the remnants of the incident in their play and conversations as toddlers and older children.

For verbal toddlers and preschool age children, all of the above concerns are relevant. In addition, these children may repeatedly ask about the incident, either directly or in a more "round about" fashion (for example, asking about a pet goldfish, or swimming at the pool). Parents may see representations of the incident in children's play, as they may draw fish, whales, oceans, swimming pools, bodies, etc. Children may suddenly refuse to separate from parents in order to go to school, may have difficulty concentrating while in school, may tantrum, may show decreased exploration and play, and may become curious and fearful about death and separation in general.

Post-traumatic play: play that represents a reenactment of some aspects of trauma

Traumatic event outside play, such as drawing pictures related to the event.

Repeated nightmare.

Distress at exposure to reminders of the trauma.

Episodes with objective features of a flashback or dissociation: a child makes dolls fight after hearing a siren because it reminds the child of the ambulance that arrived after the argument between the child's parents.

Numbing of responsiveness:

Increased social withdrawal.

Restricted range of affect.

Temporary loss of previously acquired developmental skills.

A decrease or constriction in play compared to the child's pattern before the traumatic event.

Increased Arousal:

Night terrors: child starts from sleep with a panicky scream and shows some signs such as rapid breathing, racing pulse, and sweating.

Difficulty going to sleep.

Hypervigilance.

Exaggerated startle response.

Symptoms not present before the traumatic event:

Aggression toward peers, adults or animals.

Separation anxiety.

Fear of toileting alone.

Fear of the dark.

Other new fears.

Pessimism or self-defeating behavior.

Sexual and aggressive behaviors inappropriate for a child's age.

Other new symptoms.

(Source: the DC:0-3R, the diagnostic classification system for infants and toddlers,published by Zero to Three. Full title: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised)

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