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Signs of Trauma in Children

What to watch for in the weeks and months after an upsetting event 

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In the wake of a disturbing event or tragic loss in the lives of children, we know parents and teachers will do their best to help kids cope with their grief and anxiety in a healthy way. We have provided some tips on how best to engage kids in a calm and supportive dialog about their feelings—it's certainly not easy to do, but it can make a big difference to kids.

Still, some children are more at risk than others for suffering long-term effects from an upsetting event, including those who have lost close friends or classmates and those who might have learned about the event or loss in a particularly emotional and upsetting way.

How a child experiences an event and how it's handled by those around him have an effect on how traumatizing it can be, notes Child Mind Institute trauma expert Dr. Jerry Bubrick. When families come upon news accidentally, parents can be caught off guard and respond in a highly emotional way that can impact children. Television coverage and shocking newspaper headlines can also amplify the impact of a disturbing event or loss.

So even as you try to soothe and comfort children, it is important to recognize the signs of unhealthy coping that would suggest a visit with a professional might be needed. In extreme cases, children can develop post-traumatic stress disorder, but even less extreme PTSD-like symptoms can interfere with a child's life and happiness. Here are some signs to look for and things to keep in mind in the months, and even the year, ahead.

Normal Grief

"Everyone grieves at a different pace," Dr. Bubrick says, and an immediate reaction—or lack of one—is not really an indicator of how a child will cope with the loss. "If a child seems to be coping well now, they might still have a poor reaction later," he says. "Or it could also just be a sign that they're handling it well." So while we want to help our children as much as possible immediately after the event, a lasting and hurtful response usually won't be evident until 3 or 6 months later.

Increased Thinking About Death and Safety

 One common sign of PTSD or a PTSD-like reaction is what Dr. Bubrick calls a "hyper-focus on mortality or death." And while some kids become notably morbid and fascinated by death, others will develop an obsession with their own safety and the safety of those close to them. In the case of a fire or another disaster, their thoughts might return with disturbing regularity to the possibility of a fire in their own home, or of the earthquake or flood happening where they live.

Problems With Sleeping, Eating, Anger, and Attention

Some of the symptoms of trauma in children (and adults) closely mimic depression, including too much or too little sleep, loss of appetite or overeating, unexplained irritability and anger, and problems focusing on projects, school work, and conversation. Sometimes the symptoms appear more like an anxiety disorder—obsessive or pervasive worry, difficulty separating from parents.

Triggers

 A year after a tragic event, we tend to look back, take stock, and memorialize those whose lives were lost. But as Dr. Bubrick observes, there are other anniversaries connected to children's lives that could have unexpected consequences for them—the birthdays of friends or classmates who died, for instance. Children "could be basically OK between now and then, maybe with some rocky periods," he says. "And then around the time of the birthday, they could have more symptoms. It's a trigger."

School Refusal

When an event is connected to school, such as the loss of classmates or violence at school itself, an unhealthy reaction could take the form of avoiding school. As Dr. Bubrick points out, school is "where the most reminders of the kids' deaths will be." While episodes of depression, heightened anxiety, trouble sleeping, and a fixation on the accident may be transient, avoiding school is a clear sign that something is wrong. "For the most part, everyone is going to experience some form of those things, altogether or in pieces," says Dr. Bubrick. "But if, over time, it's not really lifting and it's continuing, it may result in school refusal altogether. At that point we definitely know we need help."

You should also know that stress and trauma can manifest differently in girls and boys. Although this is by no means definitive, boys often react more quickly and with more irritation and anger, while girls can have delayed reactions that are more internal.

Updated: February 11, 2013

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