Children's Mental Health Needs Must Be Addressed In A Crisis

Mental Health and Crisis

As the nation begins recovery and rebuilding efforts following Hurricane Katrina, it is imperative to consider both the physical and emotional needs of children, according to the American Academy of Pediatrics (AAP). Children who have been displaced by the flood face many losses such as the loss of home, familiar surroundings, a supportive school or daycare community, peers, prized possessions, and potentially, loved ones.

Studies conducted after the events of September 11 showed that mental health needs among children were widespread and persistent, but often went unrecognized, and in the vast majority of cases, untreated. Because of children's developmental limitations, they are often unable to express their needs directly or clearly. They rely on adults to help them identify and express their concerns, to help them access supportive services, to model appropriate coping behaviors, and to provide a supportive environment so they can begin to understand and adjust to the crisis.

The AAP urges parents and caregivers to remember that if children receive support, they may emerge from a crisis more capable and resilient. Without such support, though, children are more likely to have difficulty adjusting, and risk long-term problems.

"Over the next several weeks and months, many children will need to begin the process of grieving the loss of loved ones that did not survive the flood," says David Schonfeld, MD, FAAP, a behavioral and developmental pediatrician and AAP spokesperson. "Identification of remains, funerals, and memorial services will confront thousands of grieving families with painful decisions about how best to involve children - questions we cannot wait to answer. We must begin immediately to help these children understand and begin to adjust to these losses." Dr. Schonfeld says it is hard for adults to acknowledge that young children can feel profound pain as they grieve the loss of a family member - but it is much harder for a child or adolescent to grieve in isolation and without adult support.

Pediatricians, in collaboration with psychologists and other mental health professionals, can aid parents and other caregivers in communicating with children in ways that help them understand and begin to adjust to the impact of the disaster. According to AAP President Carol Berkowitz, MD, FAAP, "Pediatricians need to be able to identify when emotional distress is at the root of physical complaints. They should screen their patients for adjustment problems, perform timely and effective triage when mental health problems are identified, provide brief supportive interventions, and make appropriate referrals for mental health support and counseling as indicated."

Dr. Berkowitz points out that even when it is not a time of crisis, children in the United States are most likely to receive treatment from primary care physicians for symptoms associated with mental disorders. In times of disaster, pediatricians become even more critical in providing such services.

For those families directly involved in the disaster, one of the major losses will be the absence of community and the informal support networks that they rely on to deal with day-to-day challenges. Those networks, including schools for children, become vitally important at times of crisis.

Children who weren't directly involved in the flood may still feel a profound impact. And those children who are dealing with other stressors in their lives may be particularly sensitized as coverage in the media of the deaths of others are reminders of personal losses. Just like adults, many children will feel sad for the loss of others. Disasters are a reminder that terrible things can, and do, occur, which may make children more concerned about their own safety, as well as those they care about. It's important for parents and others to reassure children about their safety and the safety of their families without making promises that are difficult to keep.

"We should tell people that even otherwise emotionally healthy individuals may experience significant emotional reactions in the aftermath of disaster," says Dr. Schonfeld. "These responses may benefit from counseling. It is not whether or not counseling is 'needed', but instead whether or not it may be of benefit. Our obligation is to provide supportive services to children who may benefit."

The AAP has a listing on its Web site of resources that address the physical and emotional needs of children. Visit http://www.aap.org - CHICAGO