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A general practitioner’s guide to supporting children’s mental health in the short term following a disaster or traumatic event

Emerging Minds, Australia, 2018

Related to Bereavement, loss and grief, Natural disasters, Responding to traumatic events, Trauma

Resource Summary

Key points

  • Infants, children and adults are all vulnerable to trauma.
  • Supportive parents and a stable routine are the main things infants and children need in their recovery after a traumatic event.
  • There are many different responses to a disaster, and these 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 short term after a natural disaster or traumatic event.

Children of all ages can be profoundly affected by natural disasters such as bushfires, floods, cyclones and severe storms other traumatic events. These events can produce trauma, grief, destruction of children’s sense of safety and security, and loss of their home or school/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 with their patient families, and to recognise the ways that these events can affect the psychological health of children and families, particularly immediately after a disaster or traumatic event 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.

Reactions to expect in the short term after a disaster or traumatic event

It is normal for nearly everyone to experience some form of psychological difficulty after a significant or traumatic event. Reactions following a traumatic event are intense and usually at their worst during the first few weeks when upheaval and change in life-patterns is often overwhelming.
For most people, these feelings fade over time, though they may come and go for a much longer period, and also return when reminded of the event.
Some of the psychological difficulties people can experience at this stage include:
  • intense emotions that can change rapidly from fear, to anger, to sadness
  • a sense of being overwhelmed and uncertainty about what to do next
  • worry, anxiety, and fear
  • despair or hopelessness
  • feeling burdened by responsibility
  • anger, sadness and even numbness.
People may also commonly experience:
  • intrusive thoughts and memories, such as negative thoughts or images, that won’t go away
  • nightmares or flashbacks regarding their experience of the disaster.
These psychological difficulties and feelings can be very disturbing for both adults and children; however, they are part of a natural psychological process of dealing with traumatic experiences and memories.
For most people, these psychological and emotional difficulties will reduce and disappear over time, but some adults and children they may persist for months after the event, or become worse over time. These adults or children may need a referral to a psychologist or mental health social worker to help them further process the trauma.

Children’s reactions

Children’s reactions after a disaster can differ, depending on:
  1. age (younger children may be more vulnerable)
  2. specific experiences of the disaster, which may have included:
    • death of parents or family members
    • loss of significant others
    • damage or destruction of home, neighbourhood, school or community
    • loss of loved pets and possessions
  3. extent of the ongoing disruptions after the disaster (e.g. not being able to go home, or return to school and usual life-routines, or over-exposure to traumatic TV images of the disaster or traumatic event).
Children may have ongoing fears regarding safety, security and separation from parents. These fears may present as follows:
  • Young children:
    •  regression
    • clinging
    • sleep difficulties.
  • Older children:
    • bravado
    • withdrawal
    • emotional problems
    • behavioural problems
    • sleep difficulties.
  • Adolescents:
    • acting out
    • caregiving
    • arousal
    • depression
    • drug use
    • sleep difficulties.
Children may experience grief at the losses that have occurred and show sadness, withdrawn behaviours, seek comfort from other family members, cling to attachment objects, ask questions repetitively. Children’s reactions may also include:
  • Young children:
    • may not understand the finality of death
    • may feel abandoned.
  • Older children:
    • may ‘attach’ to others
    • seek security
    • experience guilt.
  • Adolescents:
    • may show a range of grieving emotions or denial
    • anger
    • guilt
    • pseudo maturity.
Children may develop trauma syndromes e.g. PTSD:
  • become distressed, sleep difficulties, irritability, lack of concentration
  • display a lack of emotion, avoidance, withdrawal
  • re-experience the disaster, including some repetitive play
  • developmental regression.
Children may develop traumatic grief: This is a mixture of trauma and grief and is common in such circumstances.
Children are vulnerable to multiple stressors: Children particularly vulnerable when there are multiple stressors.
Children may be quiet, good and compliant early after the disaster, until they regain some sense of a secure world, and only later show the impact (even six months or more afterwards).
Common symptoms of a disaster or traumatic event impacting on children include:
  • increased fearfulness about any threat
  • becoming clingy and displaying regressed behaviours
  • becoming fearful of separation
  • sleep difficulties
  • general bodily complaints including stomach pains and headaches
  • difficulties concentrating at school
  • becoming withdrawn, sad, and in some cases, depressed
  • displaying aggression and acting out.
Disasters and traumatic events may impact on development through the severity of the children’s experience, their reactions, and the degree to which they are able to be supported adequately.

Advising parents or other caregivers on how to help their children

Parents and other caregivers are pivotal in the recovery of the child. Working with the parent or other caregivers to provide a safe, secure, supportive environment is essential.
If children were separated from parents at the time of the event, then the parents’ reactions, both immediately and subsequently, will be important for the child, as will be how much parents, even in their own distress, can support and respond to the child afterwards.
The broader family and social network are key resources, as is the community and school support systems.
Helping children involves also helping parents, or other caregivers close to the child:
  1. Support them with their own needs, trauma and grief.
  2. Provide them with advice about children’s needs and how to support them. For instance, children need reassurance that they:
    • are loved
    • will be safe and secure
    • can share, or speak about, any of their feelings
    • can ask questions that will be answered simply and honestly
    • will be comforted and looked after now and in the future.
Helping children involves supporting their resilience by recognising and promoting their:
  • positive, hopeful and optimistic responses
  • connectedness to others and their social skills
  • capacity for recognising and expressing their own feelings
  • capacity to focus and problem solve as appropriate to their developmental levels sense of self.

Self-care for GPs

Experiencing a disaster or traumatic event personally and/or being a family doctor in a community that has recently experienced such an event can be overwhelming. 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.

 

Useful links

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.

Headspace, How To Support Your Child After a Natural Disaster

 

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.
This document was reviewed and updated in June 2018.

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