A general practitioner’s guide to supporting children’s mental health in the long term following a disaster or traumatic event
Emerging Minds, Australia, 2018
- Infants, children and adults are all vulnerable to trauma.
- Healthy parents and a stable routine are the main things infants and children need to be okay after a traumatic event.
- There are many different responses to a disaster, and will be most intense in the first few weeks after a traumatic event.
- Infants and children may experience distress even if they did not experience the event personally.
- Parents will also be dealing with their own grief and loss, and may need increased support to provide stability and routine for their children.
- All infants and children need stability and support in this time.
These guidelines are intended to assist GPs to help families with children in the long term after a natural disaster or traumatic event.
Family doctors are well placed to monitor children’s social and emotional wellbeing and mental health. Following a disaster or traumatic event general practitioners become even more critical in providing regular checks, support and advice to both children and their parents.
Children of all ages can be profoundly affected by natural disasters such as bushfires, floods, cyclones and severe storms or other traumatic events. These events can produce trauma, grief, destruction of children’s sense of safety and security, and loss of their home, school or social networks.
When disasters or traumatic events occur, parents need guidance, information and support to reassure and care for their children as effectively as possible. To help with this support for families, doctors themselves need to be professionally prepared to discuss the issue of disasters or traumatic events with their patient families, and to recognise the ways that these events can affect the psychological health of children and families, particularly immediately after it occurs.
Family doctors are in a unique position to help monitor their patients over time and see how they are doing. Family doctors can play a pivotal role in helping a community recover after a disaster or traumatic event. See the Royal Australian College of General Practitioners’ guide: Managing emergencies in general practice.
Long term reactions to a disaster or traumatic event
The majority of children will see their symptoms decrease gradually over time and eventually resolve; however, for months and sometimes years following a disaster or traumatic event families often continue to experience multiple stresses. Enquiring about the recovery of each family member is important. Parents might report after some months that their infant and children continue to show the effects of the event.
Children’s reactions vary depending on a constellation of factors at the time of the disaster or traumatic event such as the child’s age, temperament, their specific experience of the disaster and the significance of their losses, as well as previous history of trauma and disruption.
Children’s recovery is significantly influenced by:
- the extent of the ongoing disruptions they experience, e.g. not being able to go home, or return to school and usual life-routines, or over-exposure to traumatic images of the disaster or traumatic event
- how well their parents and adult family members can support them
- their access to quality support networks
- their access to a developmentally appropriate explanation of what happened and what is happening.
Some children often express their distress through physical symptoms and these physical symptoms may persist, like experiencing trouble sleeping or unexplained aches and pains. They may also be easily startled, feel anxious, appear withdrawn, show reluctance to do new activities, or engage in excessive repetitive play about the disaster.
Parents need continued support
Continue to assist parents to address priorities and employ achievable strategies that address the issues. It is not uncommon for parents to feel anxiety, helplessness and anger in addition to worrying about their children’s wellbeing. Modelling optimism and encouraging them to see the strengths and coping skills they have and are using will allow them to feel a sense of control about the future.
Support parents with their own needs, trauma and grief. Ensure parents are looking after their own safety and wellbeing and that they understand the connection between their infant or child’s emotions and behaviour.
Provide them with advice and information about children’s needs and how to support them. For instance, infants and children need:
- environments that are predictable, consistent and have reasonable expectations
- regular check-ins and information to know that it can take a long time to feel better after a frightening event
- help to manage fears
- help to label their feelings and identifying them in their body
- help to regulate their emotions
- help to understand their thoughts
- help to prepare for change and transitions
- achievable goals and the steps to get there
- adults to speak to (not always parents, especially if children think talking about the event is upsetting for their parents) about how they are feeling and things they can do to help them
- opportunities to make decisions and help plan for what they are involved in
- engagement with extended family, friends and school community
- music and dance
- fun activities, playing games – expending energy.
Extra support for children
A minority of children will need extra support by a skilled mental health professional who can provide specific assessment and care.
As noted above, infants and children who have experienced adverse childhood events and those with parents who have experienced numerous adverse events need to be especially monitored, as they are more at risk of developing poor health and mental health outcomes.
Infants and children who have not regained developmental milestiones previously achieved, who continue to exhibit heightened distress or withdrawal, sleeping or and eating difficulties, whose symptoms continue to disturb daily life and are not progressing developmentally, are redflags and need special attention. A minority of people, including children, may develop post-traumatic stress disorder (PTSD) from the event.
Self-care for GPs
It is important that you attend to your self-care and that of your family. Putting in place strategies for self-care is essential for doctors working in trauma and post disaster. Some essential tools for this include linking into peer supports, engaging in stress-reduction activities and seeking opportunities to reflect on your experiences with your professional colleagues.
Royal Australian College of General Practitioners, Managing emergencies in general practice: A guide for preparation, response and recovery. East Melbourne, Vic: RACGP, 2017.
Royal Australian College of General Practitioners, Emergency planning and response in general practice. Fact sheet: Mental health in emergencies and disasters. East Melbourne, Vic: RACGP, 2017.
Royal Australian College of General Practitioners. Self-care and mental health resources for general practitioners. East Melbourne, Vic: RACGP, 2017.
About this resource
This resource is based on a resource originally authored by Ruth Wraith OAM;MCPP for the Australian Child and Adolescent Trauma, Loss and Grief Network: www.earlytraumagrief.anu.edu.au.
The document was reviewed and updated in June 2018.