We tend to think of trauma and tragedy occurring from disastrous events large enough to make the news such as the Septemer 11, 2001 terrorist attacks on New York City, Washington D.C. and Pennsylvania. There are other types of tragedy, the natural disasters—earthquakes, fires, floods, hurricanes and the unexpected disasters—plane crashes, train derailments, automobile accidents. Yet these large tragedies are only a small percentage of the many tragedies that can affect children's lives. There are also the human random acts of violence—bombings, mass shootings or gang warfare and unfortunately the not so human acts of violence—shootings, stabbings, murder etc. Each year many children and young adults sustain both physical and emotional injuries from tragedies. They may lose friends, teachers, or family members in accidents or tragic events. In today's society exposure to violence can occur in the home or on the streets where children live and play. Research is demonstrating that children who witness violence in their families, schools, or communities are also vulnerable to serious long-term emotional harm.

Children, especially the young, have a sixth sense that enables them to sense an adult's fear and anxiety. As adults struggle to deal with their responses and grief, they must remember that children and adolescents will turn to them for help, answers and guidance. Children learn their responses to loss and how they will cope from their family. Parents and teachers can help children and young adults avoid or overcome emotional reactions that may result following a tragedy by creating and open environment, being there ready to listen and answer questions and providing support. How a parent or other adult react to a child following a loss, death or any traumatic event can aid (or hinder) in his/her recovery process. 

Children and adolescents are at risk to experience fear and anxiety as reactions to tragic events. Following a disaster the child's view of the world as a safe and predictable place is temporarily lost. They may fear that another event is likely to occur and that they or their family will be injured or killed. It helps to remind children that they are safe. Parents, teachers, caregivers, other adult family members can reassure children that they are safe and that the adults around them are doing everything they can to keep the children safe.

Research has shown that children and adults alike who experience catastrophic events either in person or watching on television may demonstrate a wide range of reactions. Much depends of the type of event viewed. Many will experience fear and anxiety. Some may only worry or have bad memories of the event that will fade with emotional support and the passage of time. Others can be more deeply affected and experience long-term problems. The reactions common in children—fear, depression, withdrawal, anger, acting out—can occur immediately following the event, or sometime after the tragedy.

Especially for children fear is a normal reaction to a scary event—real or imaginary; fear is an intense concern or worry caused by real and/or imagined danger. Children with vivid imaginations and sensitive children are even more prone to experiencing intense fear reactions. Children younger than five years old cannot always distinguish fantasy from reality. Media and cinematic depictions of attacks and tragedies can be as frightening as the real events. Limiting media exposure in this age group is important.

Some children will demonstrate fear by developing physical symptoms—stomachaches, headaches, feeling "sick," or complaining of a lump in the throat—some through their behavior—crying, abnormal fussiness or agitation, not necessarily using words. Children may become fearful about being left alone. They may also demonstrate regression and begin acting younger than their age. Common behaviors for a younger child may reappear in an older child including bedwetting, thumb sucking, clinging to parents and fear of strangers. A child may experience problems at bedtime. He/she may start having nightmares, not wanting to sleep alone, becoming more afraid of the dark, falling asleep or remaining asleep. In addition children can experience difficulty thinking and concentrating. They can become easily distracted easily, feel confused and disoriented and often find it difficult to stay focused. Many reactions can be triggered by smells, objects or activities that are associated with the trauma. Frequently a child is unaware of the triggers and of the behavioral changes that occur.

Adolescents in particular are impacted by tragic events. Those who have started demonstrating some independence may shift and want to spend more time with their families. They may also be fatigued, have problems with sleep disturbances and show a lack of interest in favorite activities. It is important to be aware that adolescents may turn to illicit substances—drugs or alcohol as a way of coping with their intense emotions.

For the children who have lost parents in this tragedy we are fortunate to have the resource A Letter to the Youngest Victims of the Terrorist Attack, written by a child survivor of another national tragedy.

Resources:
American Academy of Child and Adolescent Psychiatry. Fast Fact # 8. Children and Grief. Updated November 1998. Available at: http://www.aacap.org/publications/factsfam/grief.htm .
National Mental Health Association. Helping Children Cope With Loss. 2001. Available at: http://www.nmha.org/reassurance/childcoping.cfm .
Doka KJ, ed. Living with Grief: Children, Adolescents, and Loss. Washington D.C.: Hospice Foundation of America, 2000.
American Academy of Child and Adolescent Psychiatry. Fast Fact # 36. Helping Children After a Disaster. Updated March 2000. Available at: http://www.aacap.org/publications/factsfam/disaster.htm .
National Institute of Mental Health. Helping Children and Adolescents Cope with Violence and Disasters. Available at: http://www.nimh.nih.gov/publicat/violence.cfm.