Trauma in Children During the COVID-19 Pandemic
IN THIS ARTICLE OUR EXPERTS
Child Study Center
Hassenfeld Children’s Hospital at NYU Langone
CONDITIONS Traumatic Stress in Children
DEPARTMENTS & INSTITUTES
Department of Child & Adolescent Psychiatry
Across the nation, everyone is being exposed to and reacting to the confusing, stressful, and sometimes frightening situation of the 2019 coronavirus disease (COVID-19) pandemic in different ways. But are we, and our children, being traumatized by the pandemic? Childhood trauma often involves a negative reaction, called traumatic stress, following an overwhelming, upsetting, or frightening experience—called a traumatic event—that challenges a child’s ability to cope. “Traumatic events are typically situations that are out of our control, beyond our usual experience, and cause us to feel as though our lives or the lives of others may be in danger,” says Adam D. Brown, PsyD, clinical assistant professor in the Department of Child and Adolescent Psychiatry at NYU Langone and member of its Child Study Center. Together with the Department of Child and Adolescent Psychiatry’s WonderLab, Dr. Brown answers questions parents may have about childhood trauma during COVID-19. Can a Pandemic Be a Traumatic Event? “The COVID-19 pandemic certainly is an unusual, unexpected event that is causing many to worry and even panic,” Dr. Brown says. “Many children are seeing and hearing frightening news on television. Some have family members or other people they know who are sick or may have died. Our experience can vary greatly, based on not only different levels of exposure, but also on what is going on around the child.” For instance, Dr. Brown says, if a child’s caregivers are relatively calm and reassuring, this can be a protective factor. If, on the other hand, caregivers are overwhelmed with their own worry, panic, or grief, it can be hard to provide the reassurance children need. The way a child reacts may therefore be strongly influenced by how others around them are reacting. “Some level of worry, confusion, or sadness at this time is to be expected,” Dr. Brown adds. “We need to look at what specific emotional and behavioral reactions might indicate traumatic stress, rather than post-traumatic stress, as the current stressors are ongoing.” What Are Some Typical Reactions a Child May Have? “Children’s reactions following a traumatic event will vary depending on their age, developmental level, degree of social support, and coping skills, among other factors,” Dr. Brown says. “Some children show signs of traumatic stress in response to stressful events, while others do not.” Dr. Brown explains the following typical reactions that young children—ages 10 and under—may exhibit after a traumatic event. Unwanted Thoughts or Images “Your child may replay certain thoughts or images in their mind or have an increase in nightmares—which may or may not be clearly related to the traumatic events,” Dr. Brown says. “Children often describe feeling unable to control these thoughts or images. Some children may draw, write, talk, or play about the events repeatedly.” Negative Feelings “Your child may struggle with a range of negative feelings including sadness, hopelessness, irritability and anger, or numbness,” Dr. Brown says. “Some children may become overwhelmed by their feelings and act silly or younger than their age. Others may become anxious, especially when separated from caregivers. Your child may display behaviors they had previously outgrown, such as becoming clingier, bedwetting, separation anxiety, or having sleep difficulties.” Avoidance of Reminders and Problems with Attention “Your child may avoid, or become agitated or distressed if unable to avoid, people, places, and things that remind them of what happened, or what is happening,” Dr. Brown says. “Your child may also have a hard time concentrating on schoolwork or other activities, seem more forgetful, or seem like they are daydreaming.” Arousal and Reactivity Symptoms “Your child may startle more easily or feel like there is danger or a threat present,” Dr. Brown says. “Your child may have an increase in stomachaches, headaches, or other bodily aches and complaints, or have a change in appetite. Your child may also have difficulty falling or staying asleep.” When Should Parents Consider Professional Help for Their Child? “Research has shown that while some children exhibit signs of stress in reaction to traumatic events, these symptoms will likely resolve within a few days or weeks, while some may have a more lasting impact.” Dr. Brown says. If your child’s symptoms do not decrease in two to four weeks after the event, it may be good to see a child or adolescent psychiatrist or psychologist, he says. “Of course, this is hard to assess during a prolonged event such as a pandemic, so if in doubt consult with a professional.” Other situations that may warrant a visit with a mental health specialist include the following:
If your family is unable to meet the needs of your child, including if you or other caregivers are struggling because of the traumatic events and want or need support.
If your child’s symptoms are severe or significantly interfere with their daily routines, their ability to socialize, or do schoolwork.
If your child has been previously exposed to trauma, previously diagnosed with a mental health disorder, or struggles with anxiety or other mood problems. These children are more vulnerable for developing ongoing traumatic stress problems.
If your child has experienced loss or grief, this may warrant additional support even if the situation does not appear traumatizing.
“As a parent, you know your child best, and you should reach out to a professional if you have concerns about your child’s reactions, or your ability to help your child,” says Dr. Brown. “Try to find a provider with knowledge of trauma and evidence-based or evidence-informed treatments for treating traumatic stress.” Many child psychologists and psychiatrists, including those at NYU Langone, are providing virtual evaluations and treatment during this time. How Can Parents Help Their Child Cope? To help children process their feelings during this unprecedented time, parents should provide developmentally appropriate information. “Depending on their age and developmental level, your child is likely to have some information—but this information may be incomplete or inaccurate,” Dr. Brown says. “Ask your child what they have heard and whether they have questions. Provide concrete explanations and use child-friendly language, while avoiding euphuisms, such as ‘grandma went away,’ as they may confuse your child.” Be prepared that your child may ask you the same question or bring up the same concern repeatedly, he says. “Try to give a brief, but honest response.” Parents should also be mindful about talking about the pandemic with others when their child is present. Limiting media exposure can also be helpful, Dr. Brown says, as it can be overwhelming and confusing for young children to be repeatedly exposed to images or information. “Create opportunities to check in with your child,” Dr. Brown says. “You do not have to have a formal sit down conversation but can casually check-in while doing other things, or at dinner or bedtime.” Children likely have concerns about their safety and the health and safety of those close to them. “Provide concrete reassurance about what you are doing in the present and immediate future to keep them safe,” Dr. Brown says. “Masks and gloves may be frightening, so make sure children understand these are to keep us all safe.” Teenagers may want to have more information and may need to talk more. “Alternatively, they may act as though nothing is bothering them and may say they do not want to talk,” Dr. Brown says. “Give them space, but also keep a close eye on how they are coping, and create opportunities for discussion.” How Can Parents Help Their Child Manage Their Feelings? Children may feel a range of emotions following a traumatic event, and some are more able than others to identify how they are feeling. “You can help your child by labeling their feelings and providing validation,” Dr. Brown says. “For example, you could say, ‘It makes perfect sense that you are feeling worried. Lots of people are getting sick, but we are doing everything we can to stay safe and healthy.’” Young children often use play, storytelling, or drawing to express their fears and wishes, Dr. Brown says. This is a healthy and adaptive way for the child to try to make sense of what is happening around them. But they may also blame themselves, even if the events are out of their control, or have other inaccurate thoughts about what happened, Dr. Brown adds. “Help your child come up with more helpful thoughts and coping statements, such as ‘I did the best I could.’” Help your child identify activities to soothe themselves, such as spending time with the family pet, watching a show, listening to music, or playing a favorite game. If your child has difficulty calming down, “you can give them simple strategies such as deep breathing, thinking about a happy memory, or using a stress ball,” Dr. Brown says. Consistency can also help your child manage their emotions in uncertain times. “Maintain consistency and familiarity whenever possible with virtual school time and family routines,” Dr. Brown says. “If that is not possible, tell your child about what changes they can expect.” Kids are tuned into their parents’ reactions, and it is important to model healthy expression of emotion. “You can briefly share how you are feeling and how you mange difficult feelings,” Dr. Brown says. “It is helpful to let your children know if you are sad or worried while reassuring them you are there for them no matter what. If you feel overwhelmed by your own reactions, seek consultation or help from others or a mental health provider.” In order to best support your children, you must take care of yourself, too. “Make sure you get the sleep and exercise you need. You can use the same self-soothing strategies that you are helping your children practice,” Dr. Brown says. “Find ways to get support from family and friends and if you are involved in a spiritual group or community organization, stay connected during this difficult time.” More Resources for Parents Dr. Brown suggests these online resources for parents:
National Child Traumatic Stress Network: Parent and Caregiver Guide to Helping Families Cope with the 2019 Coronavirus Disease
Stop, Breathe, and Think Kids: Stop, Breathe, and Think app
NYU Langone’s Stress, Trauma, and Resilience Service
Trauma-Focused Cognitive Behavioral Therapy: Triangle of Life app