Psychological first aid with infants and children: Practice guidance (part two)

Practitioners delivering PFA may be required to understand and operate within disaster response and recovery arrangements. When emergency management arrangements are required, there is a lead agency coordinating services at the local, regional, state or national level, depending on support needs. In some cases, especially during large-scale disasters, coordination may involve collaboration between multiple jurisdictions, requiring you to be flexible and adaptable. You may also be required to identify yourself as a practitioner providing PFA by wearing a badge or specific clothing.

• Australian Emergency Management Arrangements Handbook (Australian Institute for Disaster Resilience)

Delivery of any psychosocial support, including PFA, should occur within the scope of your expertise, experience and designated role – especially when working with children. Additionally, adhering to professional standards or guidelines, policies or procedures set by relevant professional associations or your employer is crucial to ensure the high quality and ethical delivery of PFA.

Organisations or agencies responsible for coordinating psychosocial support in disaster contexts may require you to undergo specific training or certification before providing PFA. Training may be mandated to ensure that you have the necessary knowledge and skills to provide effective support and to meet organisational standards or regulatory requirements.

Regardless of your qualifications or experience you can learn how to offer PFA. Accessing an orientation or training program is essential to develop your knowledge and skills to provide PFA in a safe and effective way. Training in PFA can increase understanding of common psychological reactions to disasters and ways to prioritise safety and wellbeing, while demonstrating cultural sensitivity. Training, along with supervision and practice support, builds confidence and competence, fosters adherence to ethical principles, and promotes continual improvement in response strategies.

As PFA is not standardised, training programs may not include a focus on supporting infants, children and families. Learning more about infant and child mental health will help ensure you have the knowledge, skills and resources to provide effective, safe and supportive PFA tailored to the unique needs of infants and children who have experienced disasters or potentially traumatic events. Follow the links at the end of this resource to learn more about infant and child mental health.

Ideally, child-centred PFA professional development would support you to:

• understand the unique developmental needs of children, enabling you to provide age-appropriate support tailored to children’s psychological and emotional responses to potentially traumatic events, such as disasters
• use specific techniques for engaging and communicating with children in distress, including active listening and providing reassurance
• recognise early signs of distress or trauma responses in infants and children, and seek access to specialised support services to reduce the risk of negative impacts on their mental health
• adhere to best practices and ethical considerations, minimising the risk of inadvertently causing harm
• consider the specific needs of infants and children by reflecting on factors such as developmental stage, cultural background and past experiences, promoting more inclusive and culturally competent support; and
• manage the emotional challenges of effectively supporting distressed children and develop strategies to support your own wellbeing when providing psychosocial support.

Understanding developmental stages, including age-appropriate behaviours and reactions after a disaster. This enables you to meet children where they are developmentally, and identify signs of distress, enhancing the effectiveness of tailored PFA.

Infants and toddlers may not have the verbal skills to articulate their emotions and instead express them through behaviour. Older children may have a better grasp of language but may still struggle to explain how they feel. Understanding children’s developmental stages will help guide you in providing relevant and understandable support, increasing the likelihood of engagement and participation.

Be aware of traumatic stress responses that may be seen in children after a potentially traumatic experience. These typically include increased clinginess, difficulty sleeping, heightened irritability, or regression in developmental milestones such as toilet training or language development. Because infants and young children may have limited verbal abilities, it’s important to be attuned to, and ensure parents are aware of, subtle cues and changes in behaviour that may indicate underlying emotional distress.

In addition to being at different developmental stages, family factors may influence the unique strengths and vulnerabilities of children, and their parents, during the immediate aftermath of disasters. For instance, young children may rely more on parents for safety and security, while older children may seek peer support and autonomy. Be aware and curious about the child and their family’s strengths, skills, know-how and resources, and build on these.

Disasters can be significantly more stressful for parents and children when a family member has an illness, disability or additional needs. This is due to the heightened challenges they face in maintaining a supportive environment and routine care, and managing sensory sensitivities or medical requirements in a disaster/post-disaster context. Identifying families experiencing such challenges early is important for delivering targeted support. This may involve help accessing special foods, resources to accommodate sensory sensitivities or essential medications.

Tailor communication and support so it aligns with where a child is developmentally. This involves using various strategies to enhance engagement, such as:

• simplifying language to match the child’s comprehension level
• using visual aids like picture cards or storybooks, age-appropriate toys or play equipment; and
• incorporating play or creative activities to encourage emotional expression and engagement.

Birdie’s Tree books and Hard Times cards have been designed to engage infants and children experiencing disaster-related distress. By being flexible and creative in finding ways to communicate and connect with both the infant or child and their family, you can establish rapport, build trust, and create a sense of safety that supports healing and resilience-building.

Listen to children’s voices and perspectives when offering PFA. This helps create safe opportunities for them to express their thoughts, feelings and concerns. It is important to view children as active participants rather than passive recipients of care and support. Actively listening to children and acknowledging their experiences helps them articulate their needs, thereby giving them a voice in the recovery process.

For non-verbal infants or children, attention to their behaviour and non-verbal cues is key to understanding their feelings and preferences. It can also provide parents with an opportunity to consider their children’s perspectives post-disaster – which they may not have had the chance to do in the chaotic environment of a disaster.

Consider cultural and contextual influences that may shape children’s understanding of and responses to disasters. It is important to be sensitive to and respectful of the beliefs, values, and preferences of children and families from diverse cultures. Culturally competent PFA also includes being aware of and responsive to any challenges families may face due to discrimination, racism and other systemic barriers. You can ensure your interactions align with children’s and families’ cultural practices by respectfully asking them about preferences and needs.

By creating a safe and secure environment, traumatic stress responses reduce over time, which supports infants’ and children’s physical and emotional wellbeing.

Your first priority is to ensure that the infant, child and family are in a safe and comfortable environment and remove or reduce any sources of danger or distress. Do not leave an infant or child unsupervised without a caring and trusted familiar adult nearby. Provide or arrange for basic needs such as food, water, clothing, shelter and medical care.

To promote a sense of physical and psychological safety and comfort for infants, children and families you might also try the following:

• Reduce or remove exposure to hazards such as debris or unstable structures – if it is safe and within your scope of practice to do so.
• Soothe distressed infants.
• Reassure children that they are safe and that the threat has passed if this is the case.
• Offer blankets, pillows or other items that can provide warmth (or cooling) and comfort. If infants are present, consider their needs for appropriate and safe bedding or privacy and reduced distraction for feeding.
• Encourage the child and family to stay together when possible. Being with parents can support the physical and psychological safety of children.
• Consider the feeding needs of infants and their parents. The Australian Breastfeeding Association provides fact sheets and other important resources for supporting young families.
• Work with pregnant parents and their supports (partner, parent, friend) to try to reduce their sources of distress. Reassure them that their safety and wellbeing, and that of their unborn child, are a top priority. Where possible, assist parents to access medical care for any pregnancy-related concerns or emergencies.
• Help the child and family to identify and avoid any triggers or reminders of the disaster that may cause them distress. Encourage parents to listen to media with headphones or discuss sensitive topics in private so that children are not exposed to information that might be upsetting or misunderstood.

‘If we can limit kids’ exposure to news reports, social media and the sorts of things that gives graphic images or distressing content it helps ensure emotional safety.’
– Adrienne, single mother of three, reflecting on the 2011 Brisbane floods

• Consider the specific needs of children and families with additional or medical requirements (e.g. neurodivergent, or with a physical or intellectual disability). For example, aim to reduce sensory overload, provide opportunities for sensory supports, and ask parents or children what accommodations or supports they usually have in place.
• Validate children’s and parents’ feelings and reactions and normalise their responses where appropriate by saying something like ‘It makes sense that you feel like that after going through such a big event’.
• Ensure children are protected from harm and remain safe by responding to any concerns, disclosures, allegations or suspicions of harm by following your organisation’s relevant policies and procedures, and working with appropriate child safety or protection services, where relevant.

Be thoughtful and observant when talking with a child and their family; notice their ability or willingness to engage with you and respect their wishes if they need more time or decline to speak to you. Offer to return at another time if appropriate.

Anxiety and distress are common responses to threat and adversity. However, if emotional arousal or numbing continues or increases it can interfere with day-to-day functioning. Fostering an environment of reassurance and stability enables effective psychosocial support and can help to reduce anxiety.

‘A Red Cross volunteer gave my five-year-old son and seven-year-old daughter a knitted teddy bear (each). Those bears are still with us today, seven years later, and hold special value for my children. I’m not sure exactly what it did for them, but I know it meant a lot to them at a time when everything around them was confusing and scary.’
– Heather, mother of three, reflecting on their experience of bushfires and recovery

Be supportive and reassuring. Offer a listening ear to a parent who is feeling overwhelmed or distressed. Acknowledge losses and challenges – empathise first, and then talk about practical support, while taking care not to minimise or invalidate distress.

Soothing infants and helping children to feel calm can reduce their stress response, which will support their recovery moving forward.

Some ways to promote calm for infants, children and parents

• Use verbal, vocal and visual cues for calmness. For example, use a friendly and calm tone of voice and slower delivery, and slow down your movements. Maintain open and friendly body language by gently smiling with a relaxed face. Infants may be soothed by you holding and gently rocking them (with their parent’s permission).
• Eye contact can be important when providing support, but sometimes children and adults may not want to maintain eye contact or tolerate a direct gaze. Sit beside or on a slight angle to the person, with your arms relaxed at your side or resting on your knees.
• Provide opportunities for the infant, child and family to express their reactions in safe and supported ways, such as talking, crying, playing, writing or drawing.
• Help the child and family to use calming techniques to manage their stress. Use relaxation techniques, such as ‘box breathing’ (breathe in for the count of five, hold for five, breathe out for five, and hold for another five) or blowing bubbles/balloons to regulate breathing for young children. Gentle movement such as swaying with infants, and methods such as the five senses grounding activity or progressive muscle relaxation.
• Playing together, with playdough for example, can be calming for both children and adults.
• Some children and adults may seek assurance through physical touch, such as a hug, holding hands or leaning on you. Remember it’s important to ask the child (and parent) for permission before picking up and holding or hugging them.
• Offer to explain the common signs and symptoms of distress, mental health difficulties and traumatic stress reactions, and how they may affect children’s and families’ functioning and wellbeing. Building a developmentally- and age-appropriate understanding of what to expect and what is common or typical can be reassuring for families.
• Support infants, children and families to maintain some sense of normality or routine as much as possible. For example, provide books for parents to read to children as they settle them if that’s part of their usual bedtime routine, or try to offer meals at regular times that are appropriate for young children.
• Asking children and families about ways you can support them in practising their religion, spirituality or cultural practices is culturally competent practice that promotes calm while fostering a sense of comfort, familiarity and resilience.
• You might also support parents to provide comfort to infants and children when you notice signs that they are seeking reassurance from family members through physical contact. Common signs include seeking physical affection, being more clingy than usual, wanting to be held, being restless or irritable, crying or having difficulty sleeping.
• Be aware that people may have their guard down and might share some highly sensitive information with you; reassure them that you will treat this with confidentiality and respect their right to privacy.

Promoting infants’ and children’s connections with the important adults in their lives helps them feel less alone in navigating the difficult times after a disaster. If a child has become separated from their parent or family, it’s critical to facilitate or support reunification as quickly as possible – both to reduce the risks to their safety and physical wellbeing and support their psychological wellbeing.

Social connection and support are crucial to help families address practical challenges, and to promote emotional understanding, normalisation of reactions and experiences, as well as sharing of coping strategies.

Some strategies for promoting connectedness

• Help children and families to identify and contact sources of support, such as extended family, friends, neighbours, educators, community groups or faith-based organisations.
• Encourage children and families to reach out and seek help from others as needed, and to offer and accept help in return where appropriate.
• Create opportunities for children to engage with safe, supportive adults and their peers, by supplying drawing and craft supplies, books, a range of toys and play equipment for different age groups, and sensory/activity equipment.
• Encourage parents to play and connect with their children as a way to promote a sense of safety and calm.
• Model ways to engage and soothe infants such as singing, gentle movement and rhythm, warm baths and swaddling.
• Arrange for a safe, caring adult to stay with pregnant parents if this is something that would help them feel reassured.
• Offer emotional support as well as practical assistance to individuals who are parenting solo. They may be single, separated from their partner because they are in another location, or possibly bereaved.
• When it is safe and appropriate, support children to return to their early learning service and schools where they can connect with educators and other familiar, supportive adults, as well as their peers.
• With consent of the parents, link children and families with other supports or services based on their individual needs. This could include specialised or long-term support, such as mental health, legal, financial or educational services (see section on ‘Collaborative and integrated support’).

Also be conscious of, and adjust to, people’s personal space needs. Some children and families may want close proximity and connectedness with each other after a disaster, but others will want lots of space and find engaging with others overwhelming.

Children can feel more confident and resilient when they are given the opportunity to use their strengths in developmentally appropriate ways to help with the recovery of their family or school community.

Children and families who have experienced a disaster may need to have their sense of agency and belief in their ability to cope restored.

Some ways you can support a sense of self-reliance and collective efficacy

• Provide children and their parents with developmentally and age-appropriate, information on:
  • the nature and effects of the disaster
  • what to expect in the disaster recovery process; and
  • available resources.
• Help individuals recognise that they are not alone in their experiences and foster a sense of belonging to support collective efficacy.
• Equipping people with accurate information givens them the confidence to act to protect themselves and their families. Be sure to match the information to the child’s ability to understand and cope with what you are saying. And, know that not everyone will want to hear or talk about the disaster in the immediate aftermath.
• Recognise and praise individuals for their efforts and achievements, no matter how small. Positive reinforcement helps to build confidence and reinforces the belief that they can overcome challenges.
• Encourage infants, children and parents to engage in activities that they can successfully accomplish, even in the aftermath of a disaster. This might include simple tasks like collecting personal belongings, helping with cleanup efforts, or comforting each other.
• Create space for children to speak about their needs and views about what would support them. Model active listening. This can also encourage parents to hear their children’s views – perhaps for the first time since the disaster event.
• Involve children and families in decision-making and problem-solving as much as possible, and in a developmentally appropriate way. For example, encourage children’s and families’ active participation in discussions about their immediate needs and help them access relevant supports/services. However, keep in mind that problem-solving and decision-making skills can be adversely affected when people are distressed after a disaster.
• Encourage collective brainstorming and problem-solving to address common challenges faced by children, parents and families within the community. By working together to identify solutions and implement action plans, individuals can develop a sense of collective efficacy and confidence in the group.
• Establish activities where children and parents can come together to share their experiences in a supported way and discuss coping strategies. These could be playgroups, or community ‘town halls’ that include a breakout group or session tailored to children of different ages, for example. This may also facilitate peer support opportunities between children, parents, expectant parents and whole families.

Provide parents with written information on how to access further help or support for their infants, children or families if needed, for later reference and to reduce their mental load.

Individuals who can look to the future with hope and positive expectations after experiencing a disaster are more likely to have more favourable long-term mental health and wellbeing outcomes. When parents and carers model positive expectations it not only alleviates children’s anxiety, but helps them feel more hopeful and able to cope with the challenges ahead.

It is important to foster hope and optimism in ways that do not diminish children’s and families’ experiences of adversity and loss. You can do this by acknowledging and validating the very real challenges and hardships they are facing. It involves offering encouragement and positivity while also allowing space for people to express their feelings of sadness, grief or uncertainty.

Some examples of promoting hope with children and families

• Provide hopeful reflections that help people feel positive that they can recover without denying the reality of post-disaster challenges.
• For families who may have become separated during the disaster, acknowledge their distress and concern, and actively reassure them that every possible measure is being taken to locate and reunite them with their loved ones as soon as possible.
• Reassure children and parents that their (and their child’s) reactions are common and typical given the circumstances, and with the right support and time most people recover and heal after disasters.
• Engage in discussions about resilience and coping strategies relevant for infants, children and families, emphasising the importance of perseverance and adaptability in difficult times.
• Suggest that a child or parent try practical and positive coping strategies, such as engaging in favourite activities (where possible), seeking social support and using positive self-talk.
• Use storytelling or books – such as the Birdie’s Tree books – to illustrate hopeful narratives and positive outcomes, emphasising resilience and problem-solving skills.

‘One of the beautiful things about those storybooks is that they tell stories of someone who’s had a similar experience to the child, or Little Frog, but that people came and they helped clean up and they helped rebuild, and that life was restored. Those simple little stories help to give a really little person some hope that things, while they’re not OK now, will be OK eventually.’
– Mother of two, reflecting on her family’s experience of bushfires and recovery

• Encourage imaginative role play where ‘helpers’ support children, families and communities to recover in order to help young children process their emotions and express their feelings in a safe and creative way.
• Foster a supportive, validating and non-judgemental environment where children, parents and families feel comfortable discussing their concerns and exploring their hopes for the future.
• Provide opportunities for children and families to engage in a traditional ritual or prayer ceremony that aligns with their spiritual or cultural beliefs.
• Promote optimism by highlighting children and families’ strengths, know-how and past successes, instilling self-confidence in their ability to overcome challenges.
• Engage in activities that promote optimism, such as creating art projects that depict hopeful scenes or planting seeds and watching them grow.
• Emphasise the importance of self-care and family connection, and encourage children and families to take breaks, rest and try to undertake activities for enjoyment or fun.
• Invite each family member to write down one thing they feel hopeful or grateful for, even amid the challenges of the emergency situation. This could be something as simple as a moment of kindness from a neighbour, a comforting hug from a family member, or a positive outcome they are hoping for.