Q: "I'm at loss as to what to say to my children."
- A mother on Sept. 11, after the terrorist attacks.
A: Follow your child's lead as questions pop up over the long haul.
"What we've impressed on our mental health staff is that our work starts around week one - and goes on for about 10 years," says Dr. Abraham Bartell, a child and adolescent psychiatrist at Mount Sinai School of Medicine in New York. "There's no question from a psychological perspective that the impact is going to be enormous."
As medical director of Mount Sinai's program to care for children after a trauma, Bartell sought counsel with colleagues all over the world, including from terror-prone Israel, after the attacks. A universal guideline holds true: Listen to your child. You've got to know where he's coming from.
"Children will bring up the attack when they're ready and stop talking about it when they can't handle it anymore," he says.
Psychiatrist John March, an expert on the treatment of post-traumatic stress disorder in children, agrees.
"Instead of asking what should I say to my kids, the better question is, 'What are my kids saying?'" suggests March of Duke University Medical Center. "Every child is in a different place, and it's important to address them where they are."
Kids across the nation connect to the tragedy in their own ways, some simple, some scary:
From a perplexed toddler watching the news: "Where did those buildings go?" He decides he'll have to help "Bob the Builder" rebuild the World Trade Center towers.
From a 12-year-old girl who had recently visited New York: "What's going to happen to all those post cards with the pictures of the buildings?"
A 15-year-old girl from Amador County, Calif., asks: "Could I be drafted?" Her mom, a bereavement counselor for children, was caught off guard but offered what she says should be at the top of each parent's list: "Reassurance, now and for some time to come, that a child's life will remain on track."
Take opportunities when questions arise, but stay on the child's level when answering, March suggests.
"Facts are friendly," he says. "Take reality away completely and there's a vacuum that the child may fill with inaccurate, typically frightening information."
A key role of a parent is to monitor your child's exposure to images on TV, says Bartell, who applies his professional advice to his toddler: "We're trying to maintain continuity of her routine and limit her exposure, even though we're craving to see the news ourselves."
The more a child is exposed to TV, the longer it will take her to settle down and regain her security. If a child is allowed to watch the news, Bartell suggests, a parent needs to be with him - available to clarify events and share reactions.
"In younger kids, safety is a big issue. They wonder, "Will it happen to me?' " he says. "Children need to be told that firefighters, police officers, mommy and daddy are working to keep them safe."
Avoid blanket statements about the safety of the world. Shift the focus to your home, March suggests: "I'm not in danger, and you are not in danger." Talk and reassure him, then get back to your routine: "Now it's time to do your homework, and we'll have dinner at 6 o'clock."
Some clinginess is normal: An 11-year-old boy in Florida suddenly wants to sleep with his parents. A Kentucky girl, 14, pulls her sleeping bag into mom and dad's room to camp out for a couple of nights.
Kids who are more vulnerable: those who had already faced trauma or losses, or had pre-existing depression or anxiety. They are at risk for interpreting the attacks as a signal of personal danger and then having difficulty moving along to see the world as still reasonably safe, March says.
Depending on the scope of what the tragedy means to you - whether you are grieving for lost loved ones or for the nation - your parental guidance over the next few weeks may not be enough. Your child may need professional help.
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