Providing psychological first aid to infants, children and families in response to disaster

Physical safety is of course paramount in the initial disaster response. But protecting people’s psychological and emotional wellbeing is also critical.

For children, particularly infants and young children, protecting their wellbeing involves helping children feel that they can trust the people around them, and that they have some control over what happens to them. It also includes providing psychosocial support to their parents and other caregivers, so they can notice, respond to and meet children’s physical and emotional needs.

What is psychological first aid?

Psychological first aid (PFA) is a form of psychosocial support designed to reduce the immediate emotional and psychological distress experienced by people who have been affected by a disaster. It focuses on addressing their fundamental needs, including safety, shelter, food and medical care, while also promoting emotional safety, stability and coping strategies. PFA is designed to help individuals with emotional regulation by regaining control over their emotions and cognitive function – which is the foundation for long-term adjustment, healing and recovery.

The five elements of psychosocial support after a disaster

Five essential elements of psychosocial support are found in various models of PFA. They require disaster responders to promote:

• A sense of safety
• Calm
• Connectedness
• Self-efficacy and collective efficacy
• Hope

By creating a safe and secure environment, traumatic stress responses reduce over time, which supports infants’ and children’s physical and emotional wellbeing.

First steps

• Ensure that the infant, child and family are in a safe and comfortable environment and remove or reduce any sources of danger or distress.
• Do not leave an infant or child unsupervised without a caring and trusted familiar adult nearby.
• Provide or arrange for basic needs such as food, water, clothing, shelter and medical care.

Some ways to promote physical and psychological safety for infants, children and families

Reduce or remove exposure to hazards such as debris or unstable structures – if it is safe and within your scope of practice to do so.

Soothe and reassure. Hold and gently rock infants, giving them reassuring smiles and eye contact and speaking to them in a calm and soothing voice. Reassure children by giving them hugs (with their permission) and explaining that they are safe and that the threat has passed if this is the case.

Make them comfortable. Offer blankets, pillows or other items that can provide warmth (or cooling) and comfort. If infants are present, consider their needs for appropriate and safe bedding or privacy and reduced distraction for feeding.

Stick together. Encourage the child and family to stay together when possible. Being with parents can support the physical and psychological safety of children.

Avoid triggers. Help the child and family to identify and avoid any triggers or reminders of the disaster that may cause them distress. Encourage parents to listen to media with headphones or discuss sensitive topics in private so that children are not exposed to information that might be upsetting or misunderstood.

Validate feelings. Validate children’s and parents’ feelings and reactions and normalise their responses where appropriate by saying something like ‘It makes sense that you feel like that after going through such a big event’.

Protect children. Ensure children are protected from harm and remain safe by responding to any concerns, disclosures, allegations or suspicions of harm by following your organisation’s relevant policies and procedures, and working with appropriate child safety or protection services, where relevant.

Check in later. Be thoughtful and observant when talking with a child and their family; notice their ability or willingness to engage with you and respect their wishes if they need more time or decline to speak to you. Offer to return at another time if appropriate.

Who might need some extra support?

Infants. Consider the feeding needs of infants and their parents. The Australian Breastfeeding Association provides fact sheets and other important resources for supporting young families.

Pregnant people and partners. Work with pregnant parents and their supports (partner, parent, friend) to try to reduce their sources of distress. Reassure them that their safety and wellbeing, and that of their unborn child, are a top priority. Where possible, assist parents to access medical care for any pregnancy-related concerns or emergencies.

Special needs. Consider the specific needs of children and families with additional or medical requirements (e.g. neurodivergent, or with a physical or intellectual disability). For example, aim to reduce sensory overload, provide opportunities for sensory supports, and ask parents or children what accommodations or supports they usually have in place.

Anxiety and distress are common responses to threat and adversity. However, if emotional arousal or numbing continues or increases it can interfere with day-to-day functioning. Fostering an environment of reassurance and stability enables effective psychosocial support and can help to reduce anxiety.

Be supportive and reassuring. Offer a listening ear to a parent who is feeling overwhelmed or distressed. Acknowledge losses and challenges – empathise first, and then talk about practical support, while taking care not to minimise or invalidate distress.

Soothing infants and helping children to feel calm can reduce their stress response, which will support their recovery moving forward.

Some ways to promote calm for infants, children and families

Verbal, vocal and visual cues

• Use a friendly and calm tone of voice and slower delivery, and slow down your movements.
• Maintain open and friendly body language by gently smiling with a relaxed face.
• With their parent’s permission, holding and gently rocking infants can soothe them.

Body language

Eye contact can be important when providing support, but sometimes children and adults may not want to maintain eye contact or tolerate a direct gaze.

• Sit beside or on a slight angle to the person, with your arms relaxed at your side or resting on your knees.

Letting it out

• Provide opportunities for the infant, child and family to express their reactions in safe and supported ways, such as talking, crying, playing, writing or drawing.

Calming down

• Help the child and family to use calming techniques to manage their stress.
• Use relaxation techniques, such as ‘box breathing’ (breathe in for the count of five, hold for five, breathe out for five, and hold for another five) or blowing bubbles/balloons to regulate breathing for young children.
• Gentle movement such as swaying with infants, and methods such as the five senses grounding activity or progressive muscle relaxation.

Playing together

• Playing together, with playdough for example, can be calming for both children and adults.

Physical contact (with permission)

• Some children and adults may seek assurance through physical touch, such as a hug, holding hands or leaning on you. Remember it’s important to ask the child (and parent) for permission before picking up and holding or hugging them.
• You might also support parents to provide comfort to infants and children when you notice signs that they are seeking reassurance from family members through physical contact. Common signs include seeking physical affection, being more clingy than usual, wanting to be held, being restless or irritable, crying or having difficulty sleeping.

Psycho-education

Building a developmentally- and age-appropriate understanding of what to expect and what is common or typical can be reassuring for families.

• Offer information on the common signs and symptoms of distress, mental health difficulties and traumatic stress reactions, and how they may affect infant and children’s functioning and wellbeing.

Routines and predictability

Support infants, children and families to maintain some sense of normality or routine.

• You could provide books for parents to read to children as they settle them if that’s part of their usual bedtime routine.
• Try to offer meals at regular times that are appropriate for young children.

Cultural safety

• Ask children and families about ways you can support them in practising their religion, spirituality or cultural practices is culturally competent practice that promotes calm while fostering a sense of comfort, familiarity and resilience.

Ensure privacy and confidentiality

Be aware that people may have their guard down and might share some highly sensitive information with you.

• Reassure adults that you will treat any information they share with confidentiality and respect their right to privacy.

Promoting infants’ and children’s connections with the important adults in their lives helps them feel less alone in navigating the difficult times after a disaster.

If a child has become separated from their parent or family, it’s critical to facilitate or support reunification as quickly as possible – both to reduce the risks to their safety and physical wellbeing and support their psychological wellbeing.

Social connection and support are crucial to help families address practical challenges, and to promote emotional understanding, normalisation of reactions and experiences, as well as sharing of coping strategies.

Some strategies for promoting connectedness

Contact supports

• Help children and families to identify and contact sources of support, such as extended family, friends, neighbours, educators, community groups or faith-based organisations.

Reach out

• Encourage children and families to reach out and seek help from others as needed, and to offer and accept help in return where appropriate.

Play – with peers and parents

• Create opportunities for children to engage with safe, supportive adults and their peers, by supplying drawing and craft supplies, books, a range of toys and play equipment for different age groups, and sensory/activity equipment.
• Encourage parents to play and connect with their children as a way to promote a sense of safety and calm.

Return to school

• When it is safe and appropriate, support children to return to their early learning service and schools where they can connect with educators and other familiar, supportive adults, as well as their peers.

Support service referrals

• With consent of the parents, link children and families with other supports or services based on their individual needs. This could include specialised or long-term support, such as mental health, legal, financial or educational services (see section on ‘Collaborative and integrated support’).

Who might need some extra support?

• Infants. Model ways to engage and soothe infants such as singing, gentle movement and rhythm, warm baths and swaddling.
• Pregnant parents. Arrange for a safe, caring adult to stay with pregnant parents if this is something that would help them feel reassured.
• Solo parents. Offer emotional support as well as practical assistance to individuals who are parenting solo. They may be single, separated from their partner because they are in another location, or possibly bereaved.

Personal space. Also be conscious of, and adjust to, people’s personal space needs. Some children and families may want close proximity and connectedness with each other after a disaster, but others will want lots of space and find engaging with others overwhelming.

Children can feel more confident and resilient when they are given the opportunity to use their strengths in developmentally appropriate ways to help with the recovery of their family or school community.

Children and families who have experienced a disaster may need to have their sense of agency and belief in their ability to cope restored.

Some ways you can support a sense of self-reliance and collective efficacy

Share information

Equipping people with accurate information gives them the confidence to act to protect themselves and their families.

• Provide children and their parents with developmentally and age-appropriate, information on:
  • the nature and effects of the disaster
  • what to expect in the disaster recovery process
  • available resources.
• Be sure to match the information to the child’s ability to understand and cope with what you are saying.
• Remember that not everyone will want to hear or talk about the disaster in the immediate aftermath.

Foster belonging

• Help individuals recognise that they are not alone in their experiences and foster a sense of belonging to support collective efficacy.

Positive reinforcement and praise

Positive reinforcement helps to build confidence and reinforces people’s belief that they can overcome challenges.

• Recognise and praise individuals for their efforts and achievements, no matter how small.
• Encourage infants, children and parents to engage in activities that they can successfully accomplish, even in the aftermath of a disaster. This might include simple tasks like collecting personal belongings, helping with cleanup efforts, or comforting each other.

Listen actively

• Model active listening. This can also encourage parents to hear their children’s views – perhaps for the first time since the disaster event.
• Create space for children to speak about their needs and views about what would support them.

Encourage participation

• Involve children and families in decision-making and problem-solving as much as possible, and in a developmentally appropriate way.
• For example, encourage children’s and families’ active participation in discussions about their immediate needs and help them access relevant supports/services.
• Keep in mind that problem-solving and decision-making skills can be adversely affected when people are distressed after a disaster.

Work together

• Encourage collective brainstorming and problem-solving to address common challenges faced by children, parents and families within the community. By working together to identify solutions and implement action plans, individuals can develop a sense of collective efficacy and confidence in the group.
• Establish activities where children and parents can come together to share their experiences in a supported way and discuss coping strategies. These could be in playgroups, or community ‘town halls’ that include a breakout group or session tailored to children of different ages. This may also facilitate peer support opportunities between children, parents, expectant parents and whole families.

Support resources

• Provide parents with written information on how to access further help or support for their infants, children or families if needed, for later reference and to reduce their mental load.

Individuals who can look to the future with hope and positive expectations after experiencing a disaster are more likely to have better long-term mental health and wellbeing outcomes. When parents and carers model positive expectations it not only alleviates children’s anxiety, but helps them feel more hopeful and able to cope with the challenges ahead.

It is important to foster hope and optimism in ways that do not diminish children’s and families’ experiences of adversity and loss. You can do this by acknowledging and validating the very real challenges and hardships they are facing. It involves offering encouragement and positivity while also allowing space for people to express their feelings of sadness, grief or uncertainty.

Some examples of promoting hope with children and families

Provide reassurance

• For families who may have become separated during the disaster, acknowledge their distress and concern, and actively reassure them that every possible measure is being taken to locate and reunite them with their loved ones as soon as possible.
• Reassure children and parents that their (and their child’s) reactions are common and typical given the circumstances, and with the right support and time people can recover and heal after disasters.

Offer coping strategies

• Engage in discussions about resilience and coping strategies relevant for infants, children and families, emphasising the importance of perseverance and adaptability in difficult times.
• Suggest that a child or parent try practical and positive coping strategies, such as engaging in favourite activities (where possible), seeking social support and using positive self-talk.

Creative coping strategies

• Use storytelling or books – such as the Birdie’s Tree books – to illustrate hopeful narratives and positive outcomes, emphasising resilience and problem-solving skills.
• Encourage imaginative role play where ‘helpers’ support children, families and communities to recover in order to help young children process their emotions and express their feelings in a safe and creative way.
• Engage in activities that promote optimism, such as creating art projects that depict hopeful scenes or planting seeds and watching them grow.

Find strength in culture

• Provide opportunities for children and families to engage in a traditional ritual or prayer ceremony that aligns with their spiritual or cultural beliefs.

Talk about it

• Foster a supportive, validating and non-judgemental environment where children, parents and families feel comfortable discussing their concerns and exploring their hopes for the future.

Reconnect through rest and recreation

• Emphasise the importance of self-care and family connection, and encourage children and families to take breaks, rest and try to undertake activities for enjoyment or fun.

Reflect realistically

• Provide hopeful reflections that help people feel positive that they can recover without denying the reality of post-disaster challenges.

Practise gratitude

• Invite each family member to write down one thing they feel hopeful or grateful for, even amid the challenges of the emergency situation. This could be something as simple as a moment of kindness from a neighbour, a comforting hug from a family member, or a positive outcome they are hoping for.

Celebrate strengths and successes

• Promote optimism by highlighting children and families’ strengths, know-how and past successes, instilling self-confidence in their ability to overcome challenges.

Knowing when to recommend further support is an essential element in supporting the mental health and wellbeing of infants, children and families who have experienced disaster.

Depending on your role, the context of where you are working, and the time available, you may be able to:

• identify the need and assess the readiness of the child and family – including expectant parents – for further or specialised care by being curious and open to their needs and concerns
• discuss the options available and the benefits of seeking support; if you are not aware what services are available, offer to find out (if you can)
• discuss the preferences and choices for any intended support with the child or family.

Referrals

If appropriate:

• offer to refer the child or family to relevant professionals or agencies that can provide the required support, and if possible, help to coordinate the referral process
• provide the child and family with referral contact information and follow-up details.

Wherever possible, refer to services that are responding to the community’s current needs, rather than generic services that might be inexperienced with disaster-related contexts, or unable to provide the necessary or timely support.

Some reasons why your psychosocial support for an infant, child, parent or family may need to come to an end:

• A natural conclusion is reached when the person is no longer in distress or feels they need support.
• The family you are supporting decides to leave the evacuation/relief centre, or perhaps there is a change in their circumstances requiring a different form of support.
• Limitations in the services you can provide due to systemic constraints or threats of danger related to the disaster may prevent ongoing support delivery.
• Personal or professional boundaries, such as competing priorities or impacts on your own wellbeing, could also necessitate the conclusion of your support.

To know when it is time to end your engagement it is important to:

• recognise the limits of the support you can provide
• use your judgement of an individual’s needs, as well as your own needs and capacity.

It is also crucial to know how to end support in an appropriate and respectful way that ensures the people you have been working with feel cared for and not forgotten.

Some ideas for ending support

• Ideally explain why you are leaving and introduce them to an alternative support person who can help.
• If you’ve recommended a practitioner or service, provide the parents or family with contact details in writing, where possible.
• If possible, farewell them in person.

Depending on the constraints of the environment, it may not be possible to use all these strategies in the setting when supporting infants, children and families. It is important to view them as examples of how you can adopt a child-centred and family-focused approach in the support you are providing. Using these examples as a guide, you may wish to consider some other strategies that are appropriate to the context where you can make a difference with infants, children and families affected by disasters.