by Donald Rosenblitt, MD
9/20/01

It has been more than a week since the terrorist incidents. Children will need sustained support in the coming weeks. This communication will focus on the needs of children two and one-half through six years of age. With continued help, we can protect young children from feeling excessively unsafe, and teach them the ways in which individuals and communities can constructively respond to worrisome situations.

We must assume that all young children have been affected to some degree, even if they have had minimal exposure to images and information. Children can sense that their parents and others are upset and that anxiety, sadness, and anger are "in the air".

The following protective factors are important at this time.

Young children need family time more than ever. They also need lots of physical and other comfort activities, including extra nighttime comforts. Visiting loved ones, as a family, can be very comforting.

Extra stresses should be minimized, because they can shift the balance from a situation that the child can slowly contain and master, to one that becomes overwhelming. Even situations that have not been previously stressful can become stressful if the child is already feeling unsafe. So, to the extent possible, families should maintain routines; ensure, as possible, adequate rest and sleep for the child; avoid exposure to media with scary content, including many animated videos; minimize babysitters, particularly during the evening; avoid overnight trips or separation from parents - most especially both parents simultaneously; suppress parental discord and keep the house calm; avoid new and challenging experiences, such as introducing play dates that are "a stretch" or overnights at friend's homes; delay trips to over-stimulating settings such as amusement parks; postpone, if medically acceptable, non-routine medical or dental procedures; avoid punishment involving threats or isolation, and, (although the Lucy Daniels Center recognizes that not everyone will agree) avoid physical punishments.

There are additional ways to help children who have seen images and learned facts.

Both parents and children can achieve important continued mastery of their feelings by doing something active, constructive, and helpful. Comforting actions for young children include earning money for a relevant charity (for four to six year olds), saying a family prayer (if prayer is part of the family tradition), planting a flower to remember the victims, or drawing a picture and sending it to the victim's families. Participating in constructive and loving action facilitates a mastery of the current anxiety and helplessness, and supports the development in the child of a belief and hope that destructive forces cannot destroy our abiding goodness, love, and capacity to heal.

Some children will be attempting to master their feelings through solitary or group dramatic play. Props, such as legos, airplanes, fire trucks, or doctor kits can be provided for the child's creative use (without suggestions). Children need to be protected from play that is constructive for another child, but enticing and overwhelming to them. Although play is a fundamental tool that children use to manage and grow, it can occasionally be unhelpful to a child. Indications that the play is probably constructive are that it does not become wild or aggressive; that, after playing, the child seems reasonably settled rather than agitated; and, over a period of a week or two, the play evolves rather than simply repeats. If play does not appear to be helping the child to feel in more control, but seems to just represent a spilling over of terrifying thoughts, parents and teachers should feel free to redirect or limit the play. A grown-up could say, for example, "Yes, some people crashed planes into a building. However, that happened only on one day. Usually planes land on runways. Let's build a runway, and maybe some of your planes could land on runways." If some intermediate step of this sort does not help, parents and teachers should firmly limit unhelpful (scary and hurtful) play to protect the child from him/herself.

Words help children to master emotions, information, and images. Some children will ask repeated questions perhaps wanting many repetitions of the answer, just as adults have needed to talk to different people, often repetitiously. Other children will not continue to ask questions. Some of those children might be satisfied with the answers, some might need a break, some might be unhappy with answers that have not been able to make everything all right, some might be too scared to keep bringing up questions. For a few, (there would be other signs as well) becoming quiet can signal developing problems. Provide gentle opportunities for a child to "pipe in", such as dinner table discussions (unless there is an even younger child who would be overwhelmed).

When a child asks a question about the terrorism, it is important to continue to emphasize, "In our family we are all ok and safe. Everyone we know is safe and well (hopefully this is true). We will keep you safe." Minimalistic explanations are best for the child six years and younger. There is a delicate balance to be struck between protection and not downplaying or distorting realities. Untruthfulness, or covering up, may increase anxiety rather than diminish it.

A common question that children ask is "Why did they do it?" There is no reasonable answer to the unspeakable. One possible way to respond might be: "There are people who have some different ideas than almost everyone else. Sometimes these different ideas are dangerous, the kind that hurt people's bodies badly. The people who took over the airplane had these very mean and bad ideas." Because young children need the support of believing that the forces of good are ultimately stronger than the forces of evil, we can add, "Most people do not have these dangerous ideas. However, a few people can cause a lot of problems. It can seem as if hurting and not caring is stronger than loving and caring. They were stronger on that day and in that place, but look all around our family and everyone we know, and all that our country is doing to help, and see how much love and caring there is in the world."

Another common question is, "Will they do it again?" Young children have difficulty tolerating uncertainty, but we also need to be honest. A possible answer is, "We really think that we will be safe. We will keep you safe, and we will be careful. Everyone in our country is doing everything to try to make sure that it will not happen again. Mommy (or Daddy) and I don't think you have to worry about it."

The vast majority of children six and under in our area of the country will not suffer sustained psychological problems. However, many children will have transient symptoms.

Children may respond with toileting and sleep problems including nightmares; difficulty identifying feelings; generalized anxiety; specific fears, perhaps about fires, robbers, or death; separation anxieties, including worries about the safety of loved ones; whininess, demandingness, or other manifestations of needing parental comfort; cognitive confusion; distractibility, impulsivity, or overactivity; or physical symptoms, such as stomach aches or headaches. Young children occasionally have disturbing thoughts or images that suddenly appear (intrusive thoughts), emotional reactivity to situations that remind them of their worries (triggers), sudden immobility of their body, and a sense of helplessness or passivity.

There are things that parents can do to help children with symptoms. Children with symptoms are communicating that they need more help. As described, parents should offer more comfort and time, avoid stress and any exposure to images. Parents should not worry about allowing regression, such as allowing a child in their bed. If these behaviors become habits, it is because the child is remaining excessively anxious, not because the parents allowed the behavior.

Children with intrusive thoughts or images may worry about what is happening to them, although a young child is unlikely to mention this spontaneously. If your child reports these symptoms, ask if they are worried about their mind. Reassure them that they are having a common reaction that will pass.

Help your child, even as young as three, understand that their symptom is a way of being worried. This gives the child some framework for understanding, gives them hope that they will feel better as they get less worried, and offers understanding of how worries can be expressed in various ways.

A parent's capacity to manage their own reactions will provide the basic security that enables children to go on, because children take on the anxiety of those around them. A young child's ability to deal with a catastrophe depends upon the parents' ability to convey that they are becoming reasonably settled, have a mastery of their anxiety, sadness, and rage, and feel brave. Parents can help a child to the extent that they have been able to help themselves. If a child is experiencing a level of anxiety that seems excessive, this may be a sign that his/her parents should find ways to feel safer themselves.

A small proportion of children will benefit from help from a mental health professional.

Any of the following factors will increase a child's vulnerability to the current events: substantial exposure to images of the catastrophe; history of previous disruptions in the child's sense of safety, such as divorce or trauma including physical, sexual, or emotional abuse; any significant problems in their general emotional development; current family stresses, such as parental unemployment, marital discord, or a loss of a loved one; death in this disaster of someone known by the child or parents; traumatic reactions in the parents to the current events; or, somewhat mysteriously, being female.

Parents should not be unduly concerned by mild to moderate symptoms lasting for three to four weeks that are improving or are stable.

Parents should consider professional help if symptoms are extreme (such as a refusal to leave a parent that continues for several days), or are worsening over the first three or four weeks. If significant symptoms remain after two months despite some improvement, professional consultation is advisable.

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Please email your response to Donald Rosenblitt, MD and/or the Editor of the Pastoral Report.

Don Rosenblitt, MD is the Clinical Director of the Lucy Daniels Center for Early Childhood, a child psychiatrist and a child psychoanalyst, Director of the UNC-Duke Psychoanalytic Training Program, Secretary-elect of the Association for Child Analysis, and past Chair of the Board on Professional Standards of the American Psychoanalytic Association. The CPSP Pastoral Report is appreciative of Don Rosenblitt, MD willingness to allow us to publish his article.

Lucy Daniels for Early Childhood

9003 Weston Parkway Cary, NC 27513

Phone: (919) 677-1459

www.lucydanielscenter.org