Caring for Children in Troubled Times

By Barbara J. Anderson, PhD, Professor of Pediatrics, Baylor College of Medicine

In my 25-year practice as a pediatric psychologist, I learned a lot about traumatic stress in children from an 8-year-old patient with type 1 diabetes named Silas. Silas was attending a summer day camp near his home in Boston, when one day he saw lightning strike a tent at the camp, which caused minor injuries to the children and adult counselor inside. Silas was very verbal and vividly expressed his feelings of fear. In our sessions, he spoke of worrying every time the sky turns dark before a rain storm. His anxiety spread to his diabetes. To an extreme degree, he insisted on carrying all his supplies in a fanny pack with him at all times because he feared sudden swings in his blood sugar levels. He was even afraid to ride the bus because he worried that the bus driver would not know what to do in case he had a diabetes-related emergency.

I thought Silas could, in time, overcome his fears if he could articulate them. Children can be remarkably resilient when we listen to them. We spent our sessions writing a story about a child who had seen lightning strike. Silas also drew pictures of lightning and chose the art medium to depict some of his difficult experiences with diabetes. After three months of expressing his fears through storytelling and art, Silas was ready to move on and flourish.

The hidden toll of disasters like Katrina may lie in the minds and hearts of children. When a disaster strikes, children typically exhibit loss of trust and fear that what happened once may happen again. Even secondhand exposure to disaster on TV can be traumatic for them. And if trauma is left untreated, it could lead to serious behavioral problems in the future.

We can help our children cope by reassuring them that they are safe. We can also encourage them to express their feelings and assure them that it is normal to feel upset. We must listen to them and watch for signs of distress in order to respond effectively.

In the case of a child with diabetes, the situation is aggravated, because besides emotional stress, there is an accompanying physical reaction to stress–swings in blood sugar levels. Here is some guidance for supporting children with diabetes in times of stress.

Reassure your child that she is safe: Assure your child that you are doing everything you can to keep her safe and get your lives back on track.

Look at your child’s reactions: Expect immediate regression or lapses in your child’s level of functioning and behavior, including self-care. Expect some decrease in your own level of functioning: You and/or your child may be less attentive, more forgetful, distractible, impulsive, depressed, or angry. Other signs of stress include excessive crying, fearfulness, separation anxiety, school avoidance, insomnia, or lack of appetite. This is all normal emotional fallout after surviving a disaster.

Encourage your child to express his feelings: Ask age-appropriate questions about how your child is feeling. “You look sad. Are you missing our old neighborhood? What are you worried about?” Some children cope with trauma by asking lots of questions; others by asking the same question over and over again. Encourage younger children to represent their experiences by painting or drawing. Older children may find that taking action–raising money, helping others–will help them overcome feelings of powerlessness.

Empathize with your child: Share your own feelings with your child in age-appropriate ways. Expressing feelings is an important part in the healing process.

Re-establish daily routines: Structure helps to re-ground your family and child, especially at a time when there are many distractions from your child’s diabetes care. Try to return to stable going-to-bed and wake-up times for all family members. Making concrete plans with your child–what she will do next or who she can write to about her experience–will help your child develop the emotional muscles to regain a sense of normalcy.

Focus on your child’s self-care: Focus on the behavior that produced high numbers on your child’s blood glucose meter, rather than on the numbers alone.

Organize a family-team effort: It’s important to make your child’s diabetes management a family-team effort. Once you have secured the adequate diabetes supplies and identified where the supplies are kept, decide who will be responsible for each of the many tasks in your child’s diabetes care routine. If your child is in a new school, secure school educational materials from your diabetes team or an organization like JDRF to give to school staff. An organized approach to your child’s diabetes care can help your child regain some sense of control.

Stay involved: Be involved with what your child watches on TV and limit the family’s overall exposure to media coverage of the disaster. If signs and behavioral symptoms of stress in your child (or yourself) continue beyond a two to three-week period, seek professional mental health counseling for your child and/or family.