A mother hugs her daughter following a shooting at the Sandy Hook Elementary School in Newtown, Conn. / Melanie Stengel, AP
As kids return to school today, many will bring questions and anxiety about the deaths of 20 other young children in Connecticut on Friday.
Going to school for the first time since the shooting "is going to be a huge reminder for children," says Priscilla Dass-Brailsford, an associate professor of psychology at Georgetown University Medical Center.
Yet maintaining routines such as school schedules is important for kids, and can help reassure them that their schools are safe, Dass-Brailsford says.
Psychologists say parents and teachers should be sensitive to children's questions, and attentive to any behavior changes that could signal excess worry or stress.
"Tune in to your own child and listen closely, says Glenn Saxe, chairman of the Department of Child and Adolescent Psychiatry at the NYU Langone Medical Center and director of the Child Study Center at NYU Langone.
Saxe says children will fear that this could happen at any school. They may speak up about it or just sit silently worrying that a place that "should be one of safety and learning has become a place where a terrible thing can happen."
Tell your child clear answers to their concerns and assure them as much as possible. Stress, Saxe says, that "We do everything we can to make sure you are safe." Other tips:
Project a sense of calm. Kids often take their cues from their parents. If parents seem calm and confident, children will feel safe and more secure, Dass-Brailsford says. Parents who feel stressed, or even angry, should refrain from venting in front of kids, who are adept at reading their parents' emotions, and overhear far more than many parents realize.
Stay together. "This is a time when children need to be with their families," Saxe says.
Turn off the TV. Stuart Goldman, a professor of psychiatry at Harvard Medical School and Children's Hospital Boston, advises parents of small children to "put up as much of a firewall as they can" to prevent kids from hearing about the tragedy.
"This isn't a good time to be running the six o'clock news during dinner," Goldman says. "Watch DVDs tonight, instead of TV, so you don't risk having someone interrupt the show with breaking news about the shooting."
Studies suggest that kids who watch more media coverage of shootings or other violent events are more traumatized than other kids, says David Schonfeld, a spokesman for the American Academy of Pediatrics who has worked with mass shooting survivors in Aurora, Colo. and other places.
Of course, kids aren't exposed to news only from TV anymore. Watching tragic events unfold in real time, through breaking tweets or Facebook posts, can create tremendous anxiety, making both adults and children feel as if they are experiencing the trauma themselves, Schonfeld says.
"This a huge tear in the tapestry of everyday life," says Cheri Lovre, of the Oregon-based Crisis Management Institute, who worked with New York City schools after 9/11. "The scar will be there forever, but we all have scars. The difference is whether it will be an open wound. "Young children don't have a sense of history and context for this. They won't know it is not an ongoing event."
As many as 30% of children who witness a traumatic event, such as a shooting, develop post traumatic stress disorder, an enduring problem that requires professional help, Goldman says. Other survivors may experience shorter-term anxiety, nightmares and flashbacks, but eventually recover on their own.
It's critical to "rebuild trust in the school," Lovre says. That will require highly scripted re-entry programs that consult parents and children about their concerns and fears before the school doors reopen.
The Newtown community faces both trauma and grief and they can't be dealt with simultaneously. Grief counseling opens up emotions and reminds people of their vulnerability, Lovre says, so it is best to deal first with the trauma.
An obvious show of force, such as uniformed patrols, police cars, barricades and metal detectors, may not accomplish this. Lovre says children themselves will tell you, if asked, what they need to feel safe.
"They may say they really want to see more moms in the hall or moms in the classroom. Children need to see that adults have taken control of the situation."
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