9. How do I know if my child needs professional help?
Dr. Boris Birmaher, University of Pittsburgh:
First, you have to talk to your child about what happened and prompt them to talk about their feelings and worries. Let them know that you are also concerned, but the situation is under control and the government is taking the necessary steps to prevent tragedies like this from happening again.
Let them know parents are there for them. It is also important, that these issues be discussed at school. Some schools have been avoiding talking about what happened. Kids have been watching the TV and pictures on the Web and newspapers and need clarification of what is going on.
It is normal for a kid, in particular young children, to have nightmares, be afraid and apprehensive the first days. However, if a child continues to have anxiety, sadness, problems with concentration or behavioral problems and these symptoms are affecting their functioning at school and home, parents should consult a professional.
Children who lost relatives or close friends are at higher risk to develop emotional problems and need more reassurance and support. If they develop persistent symptoms of anxiety, depression, or nightmares they need to be seen by a professional.
10. How do I answer my child's question, "What happened to the people in the planes and the buildings?"
Carmel Mahan, child life manager, University of Maryland Children's Hospital:
Be honest and not evasive, as avoidance will only increase children's anxiety. Ask the child what he or she thinks happened, and gauge your reply to the level of information the child conveys to you. For example, your 3-year-old might say, "The building blew up, and the people tried to run away." A 15-year-old may say, "My friend told me who did this to us, and we should go and bomb them."
A very simple explanation is warranted for the young child, but the teenager may need to discuss issues of freedom, tolerance, politics and government related to this tragedy.
11. Could talking about the event upset my child more?
Daniel A. Kupper, assistant clinical professor of psychology and psychiatry, UCLA:
Talking upsets only if it reinforces the fear and helplessness engendered by the terrorist attack. If it emphasizes recovery, problem solving, all feelings experienced including acknowledgement of fear, anger or understanding then it is definitely helpful according to our experience and research.
This fear and helplessness can also be communicated nonverbally.
12. Is it better for me not to talk about what's happened if my children are not interested?
Dr. Lewis R. First, professor and chairman, department of pediatrics, University of Vermont College of Medicine:
If your children are in elementary school or older, they are going to hear about this from other classmates, and what they hear may not be at all accurate. Therefore, it is best if you talk about this with your children before they hear from others, so they understand that there is still a secure sense of safety and normalcy in their lives.
Not telling children who are old enough to understand that a tragedy has occurred will only make them think that you are hiding it from them. This may create new fears like the fact that this might happen to them, that someone they love might be hurt or killed next, that the family will get separated or the children will be left alone — none of these things being healthy thoughts for your kids.
Thus, it is best to take the cues and questions from your children. If your children have no questions, then at least acknowledge what has happened, expressing your feelings about it to them while conveying a continued sense of the family structure being as safe as it can be and family activities continuing as normally as they were before all of this happened.
13. How can I get my children to communicate to me what they're feeling?
Dr. Kenneth Fletcher, associate professor of psychiatry, University of Massachusetts School of Medicine:
Let them make drawings or write stories. Let them get their feelings out. And above all, hold them, pet them, kiss them, comfort them. Tell them that everyone has similar feelings, although the world can sometimes be a scary place, it is still a safe place for the most part. Let them talk about their feelings, help them correct any kinds of thinking that's distorted, for example: Are we all going to die? Are they going to blow up our town?
Older kids, adolescents, should write out their feelings, write out a story about it, anything that helps them express their feelings about it in a safe, controlled way.
Parents also need to worry about being traumatized themselves. And then the added burden of telling their children sometimes makes them more confused and stressed. It's important to give them physical comfort. Spend a little more time with them. If they don't want to talk about it, then don't force them to.
14. How important is reassurance (about working, flying, etc. at a time like this)?
Daniel A. Kupper, assistant clinical professor of psychology and psychiatry, UCLA:
Reassurance is natural and good, but not as effective as open and honest discussion about thoughts and feelings regarding working, flying, death, or the future, especially for teenagers.
15. What can I do to make my child feel safe?
Dr. Bradley M. Pechter, child, adolescent and adult psychiatrist, assistant professor of psychiatry, Northwestern Memorial Hospital, Warren Wright Adolescent Center:
Spend time with your child and reassure them of your love and devotion to their safety. Point out to them that these sorts of things are actually very rare and that most people are still very safe and unhurt. At all ages, spend time with your child and listen to their concerns.
Children often surprise us with their thinking, and this is one of their charms. You may be surprised where they are at with their thinking about the subject.
Lastly, be certain to take care of yourself and model good coping skills. It is perfectly reasonable to be angry, sad or anxious but don't let that impair your judgment, making yourself frightening to the child, unavailable or promoting prejudices.
16. If I have kids of different ages or who are responding differently, how do I talk to them?
Dr. Daniel Creson, professor of psychiatry and behavioral sciences, University of Texas, Houston, Medical School:
Children need accurate information, but they need information in an age-appropriate way. That is to say the words and concepts need to make sense to them. Without adequate information, children of all ages will fill in the missing pieces with their imaginations, and this can be very problematic.
In addition, they need comfort, but not at the risk of inappropriate, if well meaning overprotection. The resiliency of children is truly amazing.
Be there, listen, provide reassurance, and speak with respectful candor.
17. How do I initiate a conversation with my child, and how can I facilitate understanding of what my child is thinking?
Dr. Paula K. Rauch, chief, Child Psychiatry Consultation Service; director, PACT: Parenting At Challenging Times; MGH Cancer Center Parenting Program:
First you have to understand what a child of any age has heard, seen, and integrated from these tragic events. Without that information as a baseline, it is hard to begin any meaningful conversation.
Once the parent has some information about what the child "knows" the process of understanding that better and then correcting misinformation or answering questions can begin. It is essential to help children articulate their "real" questions, which the parent cannot know without asking more questions.
"What got you wondering about that?" "That's a really interesting question, how did you think of it?" It is easy for parents, especially when stressed, to jump to answer questions too quickly and not really know what true concern underlies the child's initial question.
For teenagers, ask what he or she is hearing from friends, teachers and the media. Ask what is the hardest part of the tragedy for the teen to understand or deal with or what is most upsetting. Does the child feel he is hearing too much or too little about these events—from family, from the school, or from the media.
Ask how he or she sees others coping. Ask if there is anyone the teen is worrying about. Often teens will talk more freely about the struggles of a friend. After this discussion of another child, the parent may be able to follow up with questions about the teen's own feelings.
18. Is there anything that I can do to help my child reestablish a sense of control?
Aaron T. Ebata, department of human and community development, University of Illinois at Urbana-Champaign:
There are three things parents can do:
1. Re-establish meaningful relationships, roles, and routines (regular activities).
There will be a sense of normalcy if "life can go on" — or at least parts of life that may have not been affected. Most important are activities the kids are involved in, hobbies and interests, spending time with peers, and daily family rituals and routines. These "3Rs" (relationships, roles, and routines) provide kids with a sense of stability and the resources that they may need to cope with feelings of grief, anxiety, or fear that they may be experiencing. There may be kids whose lives are disrupted so that life will be forever changed — but it is still important to then begin establishing new roles or routines. Creating some kind of ritual of honor or remembrance to lost loved ones may be important in this effort.
2. Help children extract or create meaning out of the tragedy. 3. Help children to act, or engage them in making a meaningful contribution to the relief effort or to efforts that will promote peace or the welfare of others. Help or encourage them to do something, however big or small, to help in the relief effort (e.g., donating money, giving blood, signing up for some volunteer effort in your community), or work on some effort that will help make your neighborhood, school, town, or state a safe and caring place.
19. Is there such a thing as a child too young to talk to about this?
Judith A. Myers-Walls, associate professor and extension specialist, child development and family studies, Purdue University:
Children as young as 2 years of age will have some exposure to this event and may have some reaction. Actually, it is possible that even younger children will see the images on TV, and very young children will sense the stress and concern in the parents. So children may be impacted by it at any age.
Extremely young children — that is, those who are not yet verbal — will not be comforted by words as much as by action. Those children need hugs, closeness, and quiet activities.
They also need parents to laugh and play with them. If parents can maintain a normal routine for the very young children, those children will benefit. When it is not possible for parents to do normal things or follow a normal schedule, it helps to keep some familiar items (a blanket, a stuffed animal, a pacifier) close by.
Young children who are able to use language do not need speeches and long explanations. It is important for parents to help them with their reactions to the event, though. It may be best for parents of preschool children to listen to the children first. Find out what they know or think. Ask them if they have questions.
Tell them that they do not need to talk about it, but they may. If parents try to protect children from the information and never talk about it, the children may believe that it is not OK to talk.
Consider using drawings or puppets with some young children. They may not be able to put their feelings into words, but they can put them in pictures. The parents may learn a lot about the children that way.
20. How do I answer my preschooler's question, "Are my mommy and daddy safe?"
Stephen S. Leff, clinical psychologist, department of pediatrics, The Children's Hospital of Philadelphia; assistant professor, University of Pennsylvania School of Medicine:
If at all possible, we need to give young children much reassurance and support during this difficult time. Explaining that something bad happened far away from the child is important, because very young children are egocentric, and may not understand that what they see on TV will not also happen to them. We need to assure the young child that they are now safe, their family is safe, and their country is strong.
21.Should I worry if I find my children playing "games" that seem like re-enactments of the attack, for example, "bomb the building" or some other thinly disguised version of what happened?
Dr. Glen R. Elliott, director of Children's Center, University of California, San Francisco:
Play is the way children work through issues in life, but "traumatic play" sometimes emerges that seems not to be helpful. The biggest clue is how the children are feeling while in "play."
If they become grim, intense, or angry and seem to play the same scene over and over, that suggests they are stuck with the issues at hand. Interestingly, adults often can help by engaging with them in the play and looking at ways to come up with other endings and happier outcomes.
If the child seems unable to allow any change in the way the game is played and cannot stop playing it, professional help may be useful.
22. Do I need to worry if my child suddenly starts behaving in ways that he or she used to act at a younger age, for example, wetting the bed, thumb sucking, or not wanting to sleep alone?
Dr. Glen R. Elliott, director of Children's Center, University of California, San Francisco:
It's quite common for all of us to turn back to early behaviors when under stress. Keeping that in mind as a parent and explaining it that way to the child can be an enormous relief. For behaviors such as bed wetting, simply explaining what's happening and adjusting to it probably is enough.
For behavior that is more clearly self-soothing, it's fine to make an explicit agreement that an old behavior is "OK" for a few days, until things settle down. Most of these behaviors go away on their own as soon as the child has had a chance to recover from the stress.
23. How do I answer my adolescent's question, "Will this lead to a world war?"
Stephen S. Leff, clinical psychologist, department of pediatrics, The Children's Hospital of Philadelphia; assistant professor, University of Pennsylvania School of Medicine:
Our country has to respond to terrorism in a united and powerful way. We need to help others around the world realize that there are many people out there who will not tolerate acts of hatred and violence. Thus, sometimes to be strong, we need to take a strong stance.
Many countries around the world need to work together to declare a war against terrorism. However, you will still get up every morning, go to school, and do the usual things. And I also will get up every morning and go to work. Our country will do what it has to do to counter this terrible event, and we will be fine.
24. How can I help my child cope with a shattered sense of national security?
Daniel A. Kupper, assistant clinical professor of psychology and psychiatry, UCLA:
