Supporting the mental health of infants, children and families after disasters

Key messages

• Australia is facing an escalation in both the frequency and severity of disasters, with increasing risk of experiencing multiple disasters concurrently or consecutively.
• Disasters can have profound effects on mental health and wellbeing. Infants and children are at higher risk of mental health difficulties, among other challenges, following a disaster.
• Recognising and addressing the specific needs of infants and children is crucial for facilitating recovery, resilience and healing.
• Responsive, timely provision of psychosocial care tailored to the needs of infants and children is a critical component of disaster recovery. This includes practical, emotional and social support to minimise mental health impacts and promote community cohesion.
• Supporting parents post-disaster is critical for nurturing children’s mental health and wellbeing. This requires collaborative efforts to provide parents with resources and assistance in navigating parental responsibilities and emotional stress.
• There are five essential elements for providing effective, timely care and support to individuals in distress following a disaster or potentially traumatic event.
• Supporting infants, children and families after a disaster requires practitioners to be responsive and adaptable as they navigate a dynamic and challenging landscape characterised by displacement, disrupted infrastructure and heightened emotional distress.
• Using guiding approaches for supporting infants, children and families after disaster can support practitioners to tailor their practice to the diverse needs and strengths of infants, children and families.

Who is this resource for?

This practice paper was developed to assist practitioners who are supporting, or could support, infants, children and families following a disaster.

This includes practitioners and workers, leaders and volunteers in:

• health services
• social and community services
• education
• first response and emergency services
• government agencies and services
• non-government organisations; and
• community-led initiatives.

For ease of reading, we refer to individuals in all these roles as ‘practitioners’.

Definitions

The terms ‘children’, ‘parents’ and ‘practitioners’ are used throughout this resource and we define them in the following ways.

Children: includes newborn infants, babies and children up to 12 years old.

Parents: the biological, adoptive, foster and kinship carers of a child, as well as individuals who have chosen to take up primary or shared responsibility in raising that child.

Practitioners: all individuals with a role that involves or might involve supporting infants, children, parents and/or families in the context of a disaster of any kind.

In Australia disasters related to natural hazards, such as extreme weather-related events, are becoming more frequent and severe. Emergencies and disasters resulting from other hazards, such as terrorism, toxic waste, violence and epidemics, have also affected and could continue to impact Australian communities. Communities are increasingly likely to experience multiple disasters, either concurrently (around the same time) or consecutively (one shortly after another).

Disasters can affect many parts of life, like health, relationships and environment. The potential impacts of disaster exposure, whether direct or indirect, on mental health and wellbeing are well recognised (Whaley et al., 2020). While the often traumatic experience of a disaster can ultimately lead to growth and positive impacts for some people, other population groups – including infants and children – have a greater risk of mental health difficulties after a disaster (Phoenix Australia, 2020).

With the responsive support of caring adults, infants and children who experience a disaster are more likely to recover and adapt well. As such, a critical element of disaster response strategy is providing timely psychosocial care that matches the needs of the affected community.

Psychosocial care encompasses many different interventions (strategies) intended to help people regain or achieve healthy levels of psychological and social functioning, and reduce their likelihood of mental health difficulties. It involves providing practical support to address:

• resource and logistical challenges after a disaster
• emotional and psychological support; and
• social support to minimise impacts on family relationships, and promote support networks as well as community connectedness and cohesion.

Providing support that considers the child’s ecology helps prevent disruption to the development and mental health of infants and children who have experienced a disaster. Understanding the child’s ecology involves recognising the interactions between their individual characteristics, such as:

• age
• development and temperament
• familial and social relationships
• environments where they live, learn and play
• broader community dynamics.

These factors collectively shape a child’s experiences and responses to disasters, so it is important to consider a range of psychosocial support strategies that encompass all aspects of their ecology.

A coordinated, comprehensive approach to identifying and meeting psychosocial needs can support infants’ and children’s positive mental health, resilience and recovery after a disaster by boosting protective factors and addressing adversity. Adverse psychosocial impacts can be prevented or minimised by providing timely access to mental health support, psychosocial interventions, social services and community-based initiatives that reduce distress, and promote wellbeing, social connectedness and adaptive coping strategies.

Disasters can have significant and wide-ranging impacts on people’s livelihoods, community infrastructure and economics, as well as their natural and social environments.

Disaster recovery is the process of ‘coming to terms with the impacts of disaster, and managing the disruptions and changes caused’ (Australian Disaster Resilience Knowledge Hub, n.d.). Sometimes this is also referred to as the phase ‘after’ disaster. Recovery includes restoration of built, environmental and economic elements, as well as social wellbeing. Recovery can provide an opportunity to ‘build back better’, by enhancing social and natural environments, infrastructure, economies and services, to reduce disaster risk in the future and create a more resilient community (Australian Disaster Resilience Knowledge Hub, n.d.).

The terms ‘recovery’ and ‘resilience’ can have different meanings in the context of disaster management. For the purpose of this paper, recovery is defined as a process experienced by individuals and communities affected by disasters.

Recognising recovery as a phase in emergency management arrangements can help to acknowledge and describe the roles, responsibilities and functions of the people and agencies who are involved in recovery, including those who are impacted.

National Principles for Disaster Recovery

Anyone working with infants, children or families after a disaster should be aware of the National Principles for Disaster Recovery. The principles can be used to guide the recovery efforts, approach, planning and decision-making of communities, governments and recovery agencies.

The principles are:

• Understand the context
• Recognise the complexity
• Use community-led approaches
• Coordinate all approaches
• Communicate effectively
• Recognise and build capacity.

While no two disasters are the same, and individuals and communities have unique experiences, these principles can guide your practice after a disaster in any context. For example, the principle ‘use community-led approaches’ notes that recovery should (among other things) assist and enable individuals, families and the community to actively participate in their own recovery; and recognise that individuals and the community may need different levels of support at various times.

Read more about these disaster recovery principles on the Australian Disaster Resilience knowledge hub:

The Australian Government’s National Disaster Mental Health and Wellbeing Framework adapts these principles to the context of mental health service provision and provides examples of what they mean in practice. For example, the principle ‘use community-led approaches’ is exemplified by flexible and responsive mental health and wellbeing services that are adapted to local and emerging conditions, while being integrated within the businesses and services people use.

Intervening early in a child’s life or when a problem is just beginning can significantly reduce the impact of potentially traumatic experiences, such as a disaster, on infants’ and children’s mental health and wellbeing. Psychosocial support can reduce the risk that a disaster will impact physical and psychological health and safety, development, learning, sleep, relationships and other areas of daily life. It not only benefits infants and children in the short term – it can create a solid foundation for healthy outcomes later in life.

Disasters (of all types) are not equal in their impacts. Infants and children are among the population groups at greater risk of physical and psychological harm during and after a disaster (Marshall et al., 2020) due to:

• their earlier stage of physical, cognitive and emotional development – making them less experienced and equipped to deal with the physical and psychological stress of a disaster
• their reliance on adults for protection as well as support to cope and ‘make meaning’ of disaster events (noting that adults closest to the child are often also impacted by the disaster, which can affect their capacity to meet children’s needs)
• the disruptions a disaster causes in communities, such as loss of housing and access to education, health services and spaces for sport and play, which can disrupt optimal development of infants and children; and
• being overlooked in recovery efforts, in part due to the incorrect belief that infants and children are too young to understand or be negatively impacted by disasters.

A disaster experience can disrupt child development, wellbeing and functioning

When people are exposed to stresses and threats (such as those caused by disasters) physiological and psychological responses are activated. Physiological stress responses such as ‘fight’, ‘flight’, ‘freeze’ or ‘fawn’ are an important way that people adapt to survive when under threat or feeling unsafe (Mohammadi et al., 2024).

However, if the stress response continues once the threat has passed, it can disrupt infants’ and children’s development, functioning, and potentially their mental health. Experiencing stressors and adversities that outweigh the protective factors in an infant’s or child’s life or their current coping resources – like a strong parent–child relationship and access to support – can negatively impact the development of their physical, neurological and emotional systems.

Exposure to a disaster, whether direct or indirect, can adversely impact multiple aspects of a child’s daily life. Every child’s post-disaster reactions are unique, and depend not only on their exposure, but also individual risk and protective factors such as:

• pre-existing individual challenges or difficulties, such as child mental health or medical conditions, disability, or concerns related to development of physical, social, emotional, behavioural, cognitive (thinking) and communication skills
• pre-existing family adversities (e.g. children exposed to family and domestic violence, poverty, parental substance use, or parental physical and mental illness)
• parents’ capacity to provide care and support
• their family’s access to resources such as housing, money and social support; and
• the degree of damage and disruption to their environments (built, natural, social and systems).

Temporary regression (i.e. moving backwards) in skills, behaviour and development is also typical in infants and children who have experienced severe stress, or an adverse or potentially traumatic event (Lai et al., 2020).

Some of the ways disasters may impact children of different ages and stages of development include:

Infants and toddlers: commonly regress in some developmental milestones following a disaster. They might experience sleep or feeding problems; increased irritability and extreme distress when separated from a parent or primary carer; or regress in physical skills such as sitting, crawling or walking.

Preschoolers: often become very ‘clingy’ with parents or other primary caregivers and might regress in toileting or sleep. They may become withdrawn and not enjoy or engage in things they used to love.

Primary school-aged children: commonly experience anxiety and sleep problems, complain of bodily aches and pains, and may exhibit regressive behaviours like wanting to be dressed or fed by an adult. Changes in appetite or sleep (not wanting to go to bed at night, difficulties staying asleep or nightmares) are common. Not wanting to go to school or be separated from family and having difficulties at school (e.g. struggling to concentrate) is also common.

While infants’ and children’s reactions may be observed through changes in their behaviour and other forms of communication, it is also important to know that their psychological distress may not be obvious, even to the adults closest to them. Children’s reactions can also change over time. They may appear to be recovering and adapting well immediately and shortly after the disaster, but show signs of coping difficulties months or even years later.

Learn more about what shapes infants’ and children’s reactions and responses to disasters, and the potential impacts on their mental health in the following resource:

Children with an accumulation of stress and adversity are at greater risk

It is important to understand that disasters are a potentially traumatic event. With support, most children adapt and recover well (McDonald et al., 2019).

The risk of a traumatic stress response is greater for infants and children who have experienced multiple adversities prior to a disaster. These might include family and domestic violence, poverty, parental substance use, parental physical or mental illness, and previous disasters. Children who experience further adversity following a disaster – such as the loss of a family home, financial stress or a parental relationship breakdown – are also at higher risk of mental health difficulties.

Providing support that meets the individual needs of an infant, child, parent or whole family can reduce the risk of adverse outcomes resulting from the disaster and/or because of it. Providing timely support matched to a family’s needs can reduce the potential for lifelong negative impacts on a child’s development, mental health and wellbeing (Kenardy et al., 2011; Le Brocque et al., 2017).

Due to the broad range of possible individual experiences and reactions to disaster, different types of support may be needed. This means that a variety of people and services have a role in providing psychosocial support to infants, children and their families after a disaster.

The National Disaster Mental Health and Wellbeing Framework promotes a pyramid of mental health and psychosocial support in emergencies, with different components of care and types of interventions delivered by people with varying levels of experience and specialisation.

At the tip of the pyramid is mental health care provided by mental healthcare specialists and services. Below that, focused, non-specialised support including psychological first aid and counselling can be provided by community workers and primary healthcare providers. At the foundation level, practitioners from various sectors, as well as community members and volunteers, can provide practical support, as well as emotional support and reassurance (see Figure 1).

Figure 1. Adapted from the UN IASC Intervention pyramid for mental health and psychosocial support in emergencies

The psychosocial support needed by most families after a disaster includes:

• practical relief and support
• emotional support
• help with problem-solving and navigating services; and
• support to strengthen family connectedness and resilience.

This practice paper is part of a series that offers guidance and strategies for practitioners who are providing psychosocial support to infants, children and families after disasters. The roles, knowledge and experience of these practitioners vary greatly, for example:

• mental health specialists may provide psychological therapy for individuals with acute needs
• GPs might offer basic mental health support
• school psychologists and school counsellors might provide psychological first aid and counselling to students and families.

The importance of a collaborative partnership approach

By working together, communities and services can improve their effectiveness in supporting affected populations while ensuring that resources are directed where they are most needed.

The shared responsibility of disaster recovery efforts to support infants, children and families requires collaboration by various sectors and organisations – including government agencies, non-government organisations, healthcare services, and education and early learning services – plus partnerships with individuals and families in the affected communities.

Engaging and empowering children and families

Recognising children’s rights, as informed by the UN Convention on the Rights of the Child, means enabling children to be active participants and contributors in their own healing and recovery processes. A collaborative partnership approach to providing mental health and psychosocial support to children involves engaging and empowering children and their parents in decision-making (Royal Far West & UNICEF Australia, 2021).

A culturally sensitive response

Collaboration promotes culturally sensitive and respectful disaster response efforts by acknowledging the diverse requirements and preferences of families regarding psychosocial support (World Health Organization, 2022). Interventions are more effective if tailored to families’ needs, strengths, know-how, resources and circumstances (Australian Government, 2019).

A collaborative approach enhances community trust and disaster response effectiveness, while promoting resilience and bolstering community capacity to prepare for and recover from future disasters.

There are many different approaches and services needed to support disaster recovery and resilience at the individual and community level. Key among them is psychosocial support.

Psychosocial support involves providing assistance and care to address the psychological, emotional, social and behavioural needs of individuals, families and communities. It also encompasses spiritual and cultural dimensions. It is designed to help individuals navigate and cope with the challenges and disruptions they may face as a result of the disaster, including stress, trauma, loss and displacement.

As shown in the pyramid model on the previous page, psychosocial support after disasters involves a range of approaches and services to help people regain or increase their capacity and capability to adapt and cope in the short and long term. Effective psychosocial support considers and enhances an individual’s ecology, which includes their environment and relationships (Triggell, 2023).

The National Disaster Mental Health and Wellbeing Framework describes five key ‘components of care’ that make up an integrated approach to mental health and wellbeing before, during and after disasters:

• psychosocial prevention and preparedness
• practical support and advocacy
• community and family support
• focused non-specialised support; and
• specialised services (Australian Government, 2019).

An integrated and stepped approach ensures different types of support are available to respond to an infant’s, child’s, parent’s or family’s needs, which are likely to change over time. This includes support to restore functioning and adapt to the potentially adverse circumstances after disaster, as well as preparing for future disasters.

To learn more about disaster preparedness with infants and children in mind, read the following practice paper.

Psychosocial support for infants, children and families

The experiences and psychosocial needs of infants and children after a disaster will differ from those of adults and require child-centred responses. Each child’s responses and needs will be unique, influenced by many factors including:

• characteristics, and their experience, of the hazard or disaster
• their age, development, temperament, and individual strengths and vulnerabilities
• access to support during and after the disaster
• how parents and other adults around them respond
• disruptions to their daily life
• pre-existing adversities (individual or family); and
• post-disaster adversities and family challenges (Fothergill & Peek, 2015; Triggell, 2023).

Accordingly, support for infants and children must be comprehensive and consider these different factors. A range of interventions and services must be offered to address the range of physical, emotional, cognitive and social needs of infants and children, acknowledging that these will change over time.

During and following a disaster, infants and children (and adults) typically experience temporary distress that lessens with support from parents and others, but for some, emotional and behavioural reactions persist. These reactions may intensify or develop into mental health difficulties. Others may initially appear unaffected, but then display signs of mental health difficulties and/or traumatic stress responses later.

Infants’ and young children’s early reactions are often physiological (e.g. loss of appetite, trouble sleeping, regressions in toileting). Emotional and behavioural reactions, such as irrational fears and anxieties, sometimes come up immediately after disaster, but often are expressed later – even weeks, months or years later. Children’s reactions are often intermittent or episodic in nature, meaning they come and go over time. This can be surprising and unsettling for their parents and other adults around them.

Support infants and children by providing psychosocial care to parents

During times of crisis, such as a disaster, parents can provide a consistent source of comfort and reassurance that is crucial for supporting the mental health of infants and children. However, after a disaster, parents may need support to be able to notice and be responsive to children’s needs (Cobham et al., 2016).

After a disaster, parents find themselves juggling numerous demands. Along with undertaking practical tasks and responsibilities, they are also likely to be navigating their own difficult emotions and high levels of stress in response to the disaster. This can mean their attention is split across many competing priorities, inadvertently affecting their capacity to be responsive to the needs of their children.

Extended family, friends, community networks and services play an important role in supporting parents so they can nurture and care for their children. Remember that ‘it takes a village to raise a child’ – and this also applies to supporting their safety and mental health before, during and after disasters.

Supporting parents in their caregiving role acknowledges the importance of the secure attachment bonds and responsive nurturing that protect children from the negative impacts of stress and trauma. Parents can benefit from having the information and support required to nurture their children’s mental health and wellbeing. This includes help with practical tasks and responsibilities, enabling parents to invest time in connecting with and supporting their children, as well as prioritising their own wellbeing.

Even in the most challenging situations, parents will often seek out or welcome support so they can better understand:

• their own stress response, and how to manage it; and
• their children’s responses, and how to meet their needs.

Practical and community support are important aspects of psychosocial support (Hobfoll et al, 2007).

After a disaster, families and individuals often encounter practical challenges that make an already daunting situation more complicated.

Practical support for families after a disaster involves taking various actions to ease immediate needs and challenges, while enabling daily activities in the short term and recovery in the long term. It includes:

• providing immediate aid such as temporary shelter, food, water and medical supplies
• assistance with clean-up efforts, debris removal and restoration of infrastructure, which help reduce health and safety hazards and support a return to a ‘new normal’; and
• helping families navigate bureaucratic processes for claiming insurance and accessing financial assistance, plus coordinating with relief organisations to ease the burden of administrative tasks and facilitate access to essential recovery resources.

Practical support lessens some of the burden and worry contributing to parents’ emotional distress and overwhelm. Meeting immediate needs for shelter, water, food, medication and supplies needed for infants and young children (such as formula and nappies) helps restore a sense of security for families in the chaos and uncertainty of the disaster aftermath. Reducing stresses on parents means they have more time and capacity to focus on their own emotional needs, and as a result, identify and respond to the needs of their children.

Support addresses practical challenges and helps provide access to the resources needed to assist affected families regain stability and rebuild their lives. Providing temporary accommodation, helping families regain or replace belongings, and supporting children and parents to return to daily routines (e.g. by facilitating re-opening of schools or early learning services) are examples of practical community actions that support the emotional wellbeing of children and families.

In addition, supporting families to access tools, resources (including financial) and assistance they need helps develop their sense of control and agency, which can have a positive impact on the resilience and coping abilities of both parents and their children. Research suggests that children and families who have skills in using available resources and supports are more likely to experience positive outcomes (Fothergill & Peek, 2015).

The five essential elements of psychosocial support

There are five essential elements that are widely recognised as foundational principles for providing psychosocial support to people in distress after a disaster (Hobfoll et al., 2007; 2021). They were developed through expert consensus, and informed by international research, empirical evidence and practice experience, to guide care and support for individuals during and after a disaster or other potentially traumatic event.

Along with examples of how these principles support infants and children after a disaster, the five essential elements of psychosocial support are:

These elements can be used to positively guide the approach of all practitioners; you don’t have to be a mental health specialist.

Supporting infants, children and families in the aftermath of a disaster demands a responsive and adaptable approach. The constantly changing landscape of the aftermath of a disaster will present you with unique challenges. Disruptions to infrastructure, the displacement of families, and the heightened emotional distress of whole communities creates an environment where common practices may no longer apply.

You’ll be required to navigate through uncertainty and chaos, often while facing logistical hurdles and resource limitations. Additionally, the urgency to address immediate needs while also planning for long-term recovery adds complexity to the already demanding task of providing effective support. In such circumstances, you must remain flexible, innovative and adaptable, ready to shift away from traditional approaches. To meet the evolving needs of those impacted by the disaster, you can draw upon the following key guiding approaches for providing child-centred, family-focused support.

In the event of a disaster, any practitioner can offer various types of psychosocial support; it’s not necessary to be a trained mental health worker or therapist. However, the inclusion of psychosocial support as part of emergency management operations may determine who can deliver certain interventions or types of support. Consider the following issues:

With the increasing frequency and severity of disasters in Australia, the need for disaster recovery strategies that focus on meeting the unique needs of infants, children and families has become more urgent.

Responsive and tailored support from adults is crucial in facilitating the recovery and adaptation of infants and children who experience a disaster. Integrating child-centred and family-focused approaches that are guided by the principles of psychosocial support into disaster recovery efforts will support long-term healing and resilience for infants, children and families.

Acknowledgements

This guide draws on research, practice insights, and the lived experience of our child and family partners. We would like to thank the professionals and families who played an integral role in shaping this resource.

To learn more about supporting the mental health of infants, children and families before, during and after disasters, you may wish to read these practice papers next:

Learn more about infant and child mental health with the following Emerging Minds resources:

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