A general practitioner’s guide to supporting children’s mental health immediately following a disaster or traumatic event

These guidelines assist GPs to help families immediately following a disaster or traumatic event.

Children of all ages can be profoundly affected by natural disasters such as bushfires, floods, cyclones, and severe storms or other traumatic events. These events can produce trauma, grief, destruction of children’s sense of safety and security, and loss of their home, school or social networks.
When disasters or traumatic events occur, parents need guidance, information and support to reassure and care for their children as effectively as possible. To help with this support for families, doctors themselves need to be professionally prepared to discuss the issue of disasters with their patient families, and to recognise the ways that disasters can affect the psychological health of children and families, particularly immediately after a disaster occurs.

Family doctors are in a unique position to help monitor their patients over time and see how they are doing. They can play a pivotal role in helping a community recover after a disaster or traumatic event.

The immediate aftermath of a disaster or traumatic event can be devastating for all members of the community. Infants and children are often overwhelmed and their immediate reaction may be to freeze, physically and/or emotionally, or scream and cry inconsolably. They will be confused and struggle to make sense of what is happening. They are likely to be deeply afraid and highly anxious looking for a secure figure and constant assurance.

They may experience intense physical and psychological reaction such as:

• nausea
• heart palpitations
• loss of bowel and bladder control
• increased babbling and hyperarousal
• increased fearfulness about any threat
• becoming clingy and fearing separation
• displaying signs of developmental regression
• sleep difficulties
• general bodily complaints e.g. stomach pains, headaches
• difficulties concentrating at school
• becoming withdrawn, sad and, in some cases, depressed
• displaying aggression.

Children’s reactions after a disaster can differ, depending on:

• age (younger children may be more vulnerable)
• child’s specific experiences of the disaster which may have included:
  • death of parents or family members
  • loss of significant others
  • damage/destruction of home, neighbourhood, school or community
  • loss of loved pets and possessions
• extent of ongoing disruptions after the disaster (e.g. unable to return home, to school, usual life-routines, and over-exposure to traumatic images of the event).

To mitigate the impact of the disaster, children need the familiarity of their parents and other caregivers, and to be provided with protection, safety and comfort as soon as possible to help them feel soothed and safe. Infant and children’s basic health needs including shelter, clean water, warmth, healthy food and rest need to be provided as soon as possible.

In the immediate aftermath of the event encourage parents or caregivers to:

• Remove the child and themselves as much as possible from the sight, sounds, smells and circumstances of the incident. Look for a quiet and settled place with other people around.
• Talk to their child and reassure them that they are safe (while being as honest as possible).
• Try to avoid exposure to distressed people, other people’s conversations about their experience and media reporting of the incident
• Comfort their child with the normal comforting actions the child is used to such as singing lullaby’s, cuddling, holding, stroking, holding hands and sitting together. Quiet conversation and singing can also help to reassure them that they will be ok
• Accept the child’s responses, reactions and feelings. Don’t tell them to ‘be good’ to ‘stop being silly’, or to ‘be brave’
• Change their expectations about age appropriate behaviour and the expression of emotions
• Allow the child to talk and say what needs to be said. Let them cry, but do not force them to talk. Calming and quiet conversation will help a child to settle and feel safe.
• Answer any questions factually, clearly and concisely without unnecessary detail. If the parent does not have information its ok to say so
• Not make promises which may not be able to be kept or make statements that may not be accurate.
• Connecting with siblings and other family.

Regaining a sense of emotional safety and physical safety will help stabilise the infant and child.

Working with the parent or other caregivers to provide a safe secure, supportive environment is essential. If children were separated from parents at the time of the event, then the parents’ reactions, both immediately and subsequently, will be important for the child, as will be how much parents, even in their own distress, can support and respond to the child afterwards. The broader family and social network are key resources at this time as is the community and child care/ preschool support systems.

Helping children involves also helping parents, or other caregivers close to the child:

1. Support them with their own needs, trauma and grief. Ensure that they are looking after their own safety and wellbeing.
2. Provide them with advice about their children’s needs and how to support them. For instance, infants and children need reassurance:
   • that they are loved
   • that they will be safe and secure
   • that they can share, or speak about, any of their feelings
   • that they can ask questions that will be answered simply and honestly
   • that they will be comforted and looked after now and in the future
   • that their reactions are normal and will pass in time
   • about what has happened and what will happen next.
3. Remind parents that it is important to:
   • Avoid unnecessary separations over the next few weeks.
   • Be mindful of the child’s needs and reactions and be responsive to them.
   • Help the child to manage any physical reactions such as using slow and steady breathing when they are tense, breathing rapidly or fidgeting.
   • Connect the child with something familiar – a person, a place, an object – as soon as possible. Familiarity and routine help to establish and maintain recovery.
   • Encourage play, listen to music and have fun.

Helping children involves supporting their resilience by recognising and promoting their:

• positive, hopeful and optimistic responses
• connectedness to others and their social skills
• capacity for recognising and expressing their own feelings
• capacity to focus and problem solve as appropriate to their developmental levels sense of self.

Experiencing a disaster personally and/or being a family doctor in a community that has recently experienced a disaster can be overwhelming. It is important that you attend to your self-care and that of your family.

Putting in place strategies for self-care is essential for doctors working in trauma and post disaster. Some essential tools for this include linking into peer supports, engaging in stress-reduction activities and seeking opportunities to reflect on your experiences with your professional colleagues.

Useful links

Royal Australian College of General Practitioners, Managing emergencies in general practice: A guide for preparation, response and recovery. East Melbourne, Vic: RACGP, 2017.

Royal Australian College of General Practitioners, Emergency planning and response in general practice. Fact sheet: Mental health in emergencies and disasters. East Melbourne, Vic: RACGP, 2017.

Royal Australian College of General Practitioners. Self-care and mental health resources for general practitioners. East Melbourne, Vic: RACGP, 2017.

Headspace, How to support your child after a natural disaster.

About this resource
This resource is based on a resource originally authored by Ruth Wraith OAM; MCPP
for the Australian Child and Adolescent Trauma, Loss and Grief Network: www.earlytraumagrief.anu.edu.au.
This document was reviewed and updated in June 2018.