A 9-1-1 for 9/11

Raising Stable Kids in an Unstable World: A Physician's Guide to Dealing With Childhood Stress
by David Ryan Marks, M.D.

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Knowing what to do or say to your children after a traumatic event is not always easy. Let's face it, this territory is new for most of us. Terrorism, threats and safety concerns used to be something that happened to “them” in some faraway country. We are entirely unprepared to deal with this new reality, but deal with it we must, or our children will suffer.

We can help our children through uncertain and chaotic times. As I learned with my young children, you almost certainly can't keep them from finding out about the World Trade Center attacks, anthrax scares, plane crashes or threats of more terrorism. Kids are way too smart for that. In fact, if you try to hide the truth you may do more harm than good. You can, however, shape the way they interpret the information they receive. Parents take on many roles in our child's life; in this case, we become spin doctors.

Kids need time to express their feelings, which is part of the cathartic process after a traumatic event. Younger children, especially those whose vocabulary is not sophisticated enough to deal with a trauma of this proportion (and whose really is?), may be clingy. Let them cling. Sometimes a hug is worth more than a thousand words.

Letting children draw-art therapy-is another form of catharsis that may help children work through their fears. Although I was initially horrified when I saw Jacob's drawings of the disaster, I quickly realized that art was his way of expressing himself without letting down his six-year-old boy, macho, nothing-can-hurt-me, becoming- independent exterior.

Children old enough to speak will probably also need to talk about their feelings. Your response should be age-appropriate for the child. Grade-school children may have questions about the disaster. Use simple, clear language to answer their questions. Don't lie to them or tell them there's nothing to worry about, but don't tell them more than they want to hear. Trying to put your child's feelings into words may also help. Try something like, “It's so sad that all those people died when the buildings fell down,” or “It's normal to be scared after seeing those planes crash.” Don't make light of the situation because your children will see right through you. Also do not make promises you can't keep. If you tell a child, “Don't worry, that won't happen again,” and another terrorist crashes a plane into a building, your child's trust may end up in ruins.

The situation may be reversed in adolescents and teenagers. They may play down their concerns. You should encourage them to talk about their feelings. Older children who repress fear often act out and misbehave. They may also be more susceptible to depression.

One sixteen-year-old girl I heard about was profoundly affected by the events of September 11, but she tried to ignore her fear and insecurity. When her parents tried to talk to her about the attacks, she told them, “I'm fine. I just want things to go back to normal.” She tried to pretend they were. A couple of weeks later, she started complaining of vague aches and pains over her entire body. First her legs hurt, then her arms and back took turns hurting. She also became very tired. Her doctor examined her and took blood tests and X-rays. They were all normal. The doctor's diagnosis: post-traumatic stress disorder. The girl's parents agreed. She is now in counseling to deal with her anxiety.

When I tell parents this story, some of them flinch. As one father asked, “How am I supposed to help my child through this when I can barely comprehend it, much less deal with it myself?”

Avoiding tough issues is not part of the parental job description. If you are having trouble dealing with the traumatic events yourself, communicating that trouble to an older, mature child may be okay. He will instinctively know anyway. However, don't lay all of your psychological burdens on him. Instead, use your feelings to show him that what he is going through is normal, and that healing will be possible over time.8

Some psychologists also suggest you give your child a sense of control over the situation. For example, nightmares and insomnia are quite common during a national crisis. If your child suffers from these symptoms, ask her, “What will make you feel better?” If she asks to sleep with you for a while, let her. Something as simple as reading an extra bedtime story could help. When you involve your children in the healing process, you help them recover the sense that they have some control over their lives.9

As part of being a spin doctor, you should try to monitor the flow of information your child receives. You can't stop children from talking to their friends. Indeed, such communication is often part of the healing process. However, limiting your child's exposure to the media can be a good idea. In the immediate aftermath of the World Trade Center attacks, the twenty-four-hour-a-day television coverage (to which, I must admit, I contributed), and the repeated airing of the gruesome attack footage, nearly sank the entire country into a mass depression. We should not let that happen to our children. Keep young children from watching news broadcasts. I was told about one set of parents who came up with a slick way to do this without calling attention to their concern: they scheduled an activity like story time, or arts and crafts during the news.

My family substitutes other activities instead of watching the news. I don't even want my children watching me on television because so many of my reports these days are about bioterrorism, PTSD, the war, etc. However, my children are young and their lives are still (relatively) controllable. Limiting media exposure for older children and teenagers is harder. The most important thing you can do is monitor the amount and type of their exposure, especially the Internet. If what they are watching, reading or surfing seems to make them more anxious, you may need to step in and impose some limits on their activities. As children grow older, they will like your intervention less. However, your involvement may prevent chronic anxiety and depression.

There are other steps you can take.

• Stick to a routine as much as possible. All humans, especially children, find comfort in routines. They add to a sense of security.

• Do activities that reinforce the idea that one person can make a difference in providing hope and healing. These kinds of activities include raising money to help victims' families or writing letters of support to survivors.

• Make sure your child eats a well-balanced diet and has plenty of opportunity to rest. These factors help children ward off the physical effects of stress.

• Find ways to show your kids you love them.

This book does not pretend to provide all the answers. However, I hope that it can help you help your children cope with the daily stress they will face in the aftermath of the attacks on our country. Some of these stresses are obvious and dramatic-a product of the new world disorder; others are more subtle-a result of the pressures we knowingly or unknowingly place on our children. In either case, stress can build up and have a devastating impact on a child as he or she grows up.

Every generation hopes that their children will live better lives than they did. That's the American way, the dream that continues to beckon to people the world over. September 11 does not change that dream; the events of fall 2001 only make the dream more difficult to achieve. I hope this book will contribute in some small way to keeping that dream alive for all of us parents.

© 2002 Health Communications, Inc.

About the Author

David Ryan Marks, M.D., is an award-winning health reporter for the NBC television stations in Hartford (WVIT) and New York City (WNBC) and has appeared as a medical expert on Today, Good Morning America, MSNBC and the Fox News Channel. He has more than ten years of clinical experience, most recently as medical director of the renowned New England Center for Headache in Stamford, Connecticut. He received his M.D. from the Yale University School of Medicine and a Master of Public Administration degree from New York University.