Helping children cope with mass violence

Incidents of mass violence, where several people are injured or killed, can affect the entire community – children and adults alike. Here, a CHOC pediatric psychologist offers insight into behaviors and reactions parents might expect from their children – as well as themselves – and strategies to help.

Coping with violence is very stressful, says Dr. Heather Huszti, CHOC’s chief psychologist. Depending on the incident’s proximity, a parent or child may be directly impacted or know someone who was directly affected. Confusion abounds, and it may be difficult to understand what happened or make sense of it.

Common reactions to mass violence in the community

A child or adult may feel afraid or unsafe

Fearing for safety is a common reaction after incidents of mass violence, whether a person was directly impacted or not. If the people impacted were in places your family frequents or were doing things you do, that can contribute to the fear.

They might struggle with normal routines and feelings

Even if your child doesn’t mention it, they may be experiencing these reactions after an incident of mass violence:

  • They might have trouble concentrating and paying attention at school or work, and may be less productive.
  • They may have difficulty falling or staying asleep, or experience nightmares.
  • Physically, they may have headaches, stomachaches, a racing heart or a change in appetite.
  • They may feel misunderstood or distant from friends or family, and not care about things that used to matter or were important to them.
  • Feelings may run the gamut: sadness, anger, confusion and fear. They may also feel jumpy or irritable, or that they must stay on alert for danger at all times.
  • Thoughts, images or visions of the mass violence event may feel constant to them, and they may be constantly reminded of the violence by sights, sounds, people or places.
  • Additional grief reactions – different for everyone – should be expected if they lost a loved one in the incident.

They may react with behaviors that seem younger than their age

When children are stressed, their behavior can shift back to earlier developmental milestones.  For instance, a child may talk in a more baby-like way or may forget how to do a skill they recently mastered like tying their shoe. This can be a normal response to a tragic event and with support and comfort, they should return to normal shortly (generally within a week).

Concern for family and loved ones may increase

Worrying about friends and family is common, but it could likely intensify or change after mass violence. You or your child may become more aware of the impact of these events on relatives with special needs, or a friend of a specific race, ethnicity or religion. They may grow more protective or anxious about their well-being.

Everyday challenges may seem harder

Experiencing mass violence may magnify typical day-to-day challenges like tests at school, work deadlines, or conflicts with siblings. These problems may seem relatively small compared to mass violence, but this new experience can intensify them and make it harder to cope – especially if you or your child has experienced a traumatic event previously.

Identify issues may prompt stronger emotions

If the incident targeted or impacted a group of people you or your child identifies with, it’s likely your emotions will be even stronger. Others may not understand the discrimination you or your child may have experienced before, during or after the event, and this may lead to feelings of increased threat, fear or danger.

A search for meaning may begin

Understanding why mass violence happened or what systems failed to protect you can be very difficult. Additionally, in incidents of targeted violence, searching for meaning following hate is extremely challenging. This can challenge trust in other people, your usual worldview and more.  There are books specifically for children to help them start to build this meaning. Thinking about volunteering or helping the community in some way can be helpful for children.

How to help children and others after mass violence

Limit media and social media exposure

Avoid the temptation to stay glued to your phone or television. Media and social media coverage is constant following mass violence, but watching it over and over can compound the trauma. Be mindful of children’s exposure to media as well – even if they aren’t in the room, they may overhear news reports. Older children may have their own access to computers and social media. If watching TV or being on your phone helps with coping, try turning on a movie, watching a channel without news alerts, or playing a game.

Answer your children’s questions with age appropriate information

Not all children will have questions after a mass violence event, but if they do ask you questions, try to use simple language that fits with your child’s developmental level. Children may ask if you are safe and you can reassure them that you are and that they too are safe. You can also help put this in perspective: While this is a tragic event and we are very sad, it is also something that is rare. For children, when they see something repeatedly or hear people talk about it over and over, they may think it is happening more widely and frequently than it is.

Stick to routines and healthy habits

Children benefit from routine always, but that will be especially so following a traumatic event like mass violence. Having a daily schedule of eating healthy and regular snacks and meals, exercising, and getting a full night’s rest is more important now than ever.

Remember to have some fun

Give yourself and your family permission to have some fun. It’s OK to disengage from tragedy. Try every day to do something you or your child really enjoys, like taking a bike ride, making a craft, playing or listening to music, or spending time with pets. This will help take your mind off the violence, enhance routine and structure, and infuse more joy into your lives. In addition, family time can be immensely healing for children, so just spending fun time together can help children regain their emotional balance.

Connect with others

Even during times of social distancing, try to find ways to ensure you and your child can connect with family, friends and other people who make you feel more relaxed. Try sending a text message or email, setting up a family Zoom session, meeting at the park for a distanced chat, or make a date for a phone call.

Go easy on yourself

Parents should give themselves some grace – during this time, you might feel like your parenting isn’t meeting your expectations. That’s OK. Ask for parenting support if you need a break.

Seek help

No one should suffer alone following mass violence. Adults shouldn’t hesitate to reach out an EAP program at work, call a hotline, or seek support from a mental health provider. In general, children are very resilient, but in some cases they may need some extra support. It’s always good to seek help early. If your child’s symptoms persist for more than two weeks, you might want to explore other supportive options. Your child’s pediatrician can help make a referral for mental health support too.

Call 9-1-1 or 1-855-OC-LINKS (625-4657) if you or your child is in danger of hurting themselves or others.

Text HOME to 741-741 for free 24/7 text support for people in crisis.

Call 1-800-273-TALK (8255) to reach the National Suicide Prevention Lifeline.

Stay Informed about Mental Health

CHOC Children’s has made the commitment to take a leadership role in meeting the need for more mental health services in Orange County. Sign up today to keep informed about this important initiative and to receive tips and education from mental health experts.
 
 
 

Tips for coping with political stress

By Dr. Sarah Ruiz and Dr. Ava Casados, pediatric psychologists at CHOC

Political events can be stressful and evoke upsetting emotions. A recent survey by the American Psychological Association found that 68% are stressed by the current political climate. With an increasing amount of demands on our time, especially in light of the COVID-19 pandemic, it can be easy to keep shuffling along and focus on crossing things off our never-ending to-do list, rather than dealing with our stress.

We understand that it can be hard for parents and caregivers to figure out how best to care for children in their lives during their own times of stress. For many people going through times of stress, it may be even harder to prioritize self-care instead of focusing on caring for others in our lives. When that stress starts to make it hard for you to focus on work, sleep soundly or to be mentally present with loved ones, those are signs that it’s time for you to give yourself a break.

It is important to remember to take time to care for yourself as you do others. By practicing a little self-care, you can make sure your emotional and physical “gas tank” is getting refilled so that you have the power to keep going. Here are just a few suggestions to get you started:

Check in with yourself

Take a few minutes daily to check in on how you’re feeling. Are you feeling stressed? Worried or feeling down? Irritated and snapping more than usual? Having a hard time sleeping or concentrating on work? These could be signs that you need to slow down and practice self-care. First thing in the morning, or right before bed, set a few minutes aside to check in with yourself and how you’re feeling. Journaling, either with pen on paper or by using a free smartphone app, could be a helpful way to monitor how you’re feeling.

Practice self-care

Limit media and social media exposure

“Doomscrolling” can amplify upsetting feelings and increase stress levels. It’s tempting to want to know every update on an evolving news situation or to keep up with all the commentary, but sometimes it gets to a point where it’s unhelpful or overwhelming. Take a break from media and the news and be more intentional about when to follow the news. For example, set limits by only watching one hour of news per day without spending additional time reading or scrolling online, or use your smartphone settings to set daily limits on screen time. You can also disable pop-up notifications from any news apps you have downloaded.

It is also important to be critical of news and be mindful of possible misinformation. Consider the source of the news and information you’re receiving and consider any possible bias in reporting.

Engage in healthy habits

Habits that may seem small such as getting enough sleep and eating a balanced diet can make a significant impact on how you feel overall and may make it easier to tackle and handle stressful events when they occur.

Also, make time to stretch. Stress and worry like to creep into our bodies and make our muscles sore or tense. Even if you don’t feel up to a full workout, make sure you are stretching every day to relieve that tension. If it’s hard to remember to do this, practice the “Seventh inning stretch” and set a timer for 7 a.m. or 7 p.m. on your phone, and stretch for seven minutes each time it goes off.

Prioritize

Make a list of the things you need to accomplish, and then highlight the ones that are at a “Need to do today” level and get started with those. After you’ve checked off a couple items, reevaluate the list again and make sure everything else truly needs to be done ASAP. Repeat this process throughout the day, and then throughout the week. When we’re under extra stress, we don’t likewise need to be extra productive. Get the essential things done, but let the vacuuming wait a week, or hold off on starting a new project for now if your plate is already feeling full.

Make time for fun activities

Focus on engaging in a hobby or activity you enjoy. Prioritize spending a few minutes each day reading, connecting with friends and family, listening to music, creating art, running or dancing — whatever it is that sparks joy for you.

Remember to engage all five senses. You can do this by ordering a dish from your favorite restaurant, listening to music that brings up pleasant feelings, surrounding yourself with pleasant smells (if you don’t have candles, try vanilla extract or fresh laundry), looking through photos of happy memories, and taking a warm shower (or if you’re craving cold, put a damp washcloth in the fridge for a DIY chilled eye mask).

Take action

Anxiety is fueled not just by stressful events, but by the belief that we are helpless to stop these events. One strategy to reduce our anxiety is to find ways to take action.

If you are upset, disappointed or concerned, speak up! Call or write to your elected officials. Find ways to get involved in your community and with local politics, such as attending your local town halls. These activities may be virtual during the pandemic.

Check in on family and friends. Begin conversations within your community. Activism can itself be a form of self-care.

Talking to children about tragic events

When it comes to discussing tragedy with young children, honesty might not always be the best policy, a CHOC psychologist says.

“Shielding them from any exposure should always be the first effort,” Dr. Mery Taylor says. “Children can be unpredictable about how they may respond to information, and even events far away can trigger a traumatic stress response.”

Children, as well as adults, can suffer affects from watching a traumatic event unfold on TV or even hearing about it. Given the potential short- and long-term consequences of coping with a trauma, parents should consider the proximity of the event and whether the child truly must know about specific details of the event.

What is trauma?

  • Trauma is a shocking, scary or dangerous experience that leads to a strong feeling of sadness, stress or worry.
  • Traumas can be natural disasters, like a hurricane or earthquake, or a life event, like the sudden loss of a loved one. They can also be caused by others. For example, as in abuse, car accident, crime or a terrorist attack.
  • Traumas can result from direct experience, witnessing, or repeated or intense exposure to the trauma (i.e., TV or overhead conversations).

Experiencing a traumatic event is shocking and can make you fear for your safety and can contribute to traumatic stress symptoms.

Traumatic stress symptoms can include:

  • Being easily upset or angry
  • Feeling anxious, jumpy or confused
  • Being irritable or uncooperative
  • Feeling empty or numb

Sometimes, shielding children from tragic events can be difficult. Dr. Taylor recommends that parents who are considering discussing a tragedy or trauma with a child consider some other factors:

Proximity of the event

When a tragedy occurs close to home, it may be more difficult to control what the child might see or hear. And even if unaware, children still might sense tension and anxiety from adults around them.

Other caregivers

Together, discuss your concerns about what and how you might share about an event with your child. Come up with a consensus so that those close to the child on the same page and presenting a consistent message. Consider what the school or teachers may relay to the student body. Often, a school district may send out a position statement on tragedies affecting the community. How might this impact what you share with your child?

Siblings and older peers

If your young child is around much older children, consider the likelihood that she may hear something frightening. In these cases, it may be helpful to inoculate her by going ahead and giving her some minimal information while keeping her developmental age in mind. You can always go back and answer more questions as they come. It is not recommended to ask an older child (8 to 12 years old) to not talk about the event with their younger sibling. This would likely only pique their curiosity.

Your child’s personality

All children are different. You know your child best. Is she likely to be scared by tragic news more than most children? Or is she the kid who would likely go explain the event to her class? Let her personality help guide your decision.

Media

School, other children, television, computers and smartphones may lead to your children knowing more than you think. Be sure to ask about their day; let them know you are there for them; and notice changes in behavior or mood that might be an indication that they may have heard something that doesn’t make sense in their world.

We understand that as the caretaker of a child, it can be stressful to make decisions about relaying tragic news to them. Here are more quick tips for parents on talking to children about traumatic events:

Quick tips for parents

  • Children need comforting and frequent reassurance of their safety.
  • Let your child lead the discussion and only answer questions that they ask.
  • Be honest and open about the tragedy or disaster using age-appropriate language. This may take the form of very simple and concise language.
  • Encourage children to express their feelings through talking, drawing or playing.
  • Try to maintain your daily routines as much as possible.
  • Monitor your own anxiety and reactions to the event. Ensure you are practicing self-care.
  • Emphasize what people are doing to help others impacted by the tragedy.

Preschool-aged children

  • Reassure young children that they’re safe. Provide extra comfort and contact by discussing the child’s fears at night, telephoning during the day, and providing extra physical comfort.
  • Get a better understanding of a child’s feelings about the tragedy. Discuss the events with them and find out their fears and concerns. Answer all questions they may ask and provide them loving comfort and care.
  • Structure children’s play so that it remains constructive, serving as an outlet for them to express fear or anger.

Grade school-aged children

  • Answer questions in clear and simple language.
  • False reassurance does not help this age group. Don’t say that tragedies will never happen again; children know this isn’t true. Instead, remind children that tragedies are rare, and say “You’re safe now, and I’ll always try to protect you,” or “Adults are working very hard to make things safe.”
  • Children’s fears often worsen around bedtime, so stay until the child falls asleep so she feels protected.
  • Monitor children’s media viewing. Images of the tragedy are extremely frightening to children, so consider significantly limiting the amount of media coverage they see.
  • Allow children to express themselves through play or drawing, and then talk to them about it. This gives you the chance to “retell” the ending of the game or the story they have expressed in pictures with an emphasis on personal safety.
  • Don’t be afraid to say, “I don’t know.” Part of keeping discussion of the tragedy open and honest is not being afraid to say you don’t know how to answer a child’s question. When this happens, explain to your child that tragedies cause feelings that even adults have trouble dealing with. Temper this by explaining that adults will still always work hard to keep children safe and secure.

Adolescents

  • Adolescents may try to downplay their worries, so encourage them to work out their concerns about the tragedy.
  • Children with prior trauma or existing emotional problems such as depression may require careful supervision and additional support.
  • Monitor their media exposure to the event and information they receive online.
  • Adolescents may turn to their friends for support. Encourage friends and families to get together – virtually if need be – and discuss the event to allay fears.

Should parents opt to discuss tragic events with children, or should the child already be aware of the circumstances, Mental Health America and National Child Traumatic Stress Network offer more ways parents can talk to their children about tragedy-related anxiety and help them cope.

If you think your child would benefit from speaking to a pediatric mental health professional, ask your pediatrician for a referral to a pediatric psychologist.

This article was updated Jan. 15, 2021.

How parents can help kids navigate holiday disappointment during COVID-19

By Dr. Mery Taylor, pediatric psychologist at CHOC

mindfulness
Dr. Mery Taylor, pediatric psychologist at CHOC

By this point in the COVID-19 pandemic, many children have experienced disappointment about missing out on birthday parties, family vacations or special occasions they had been looking forward to. If your child or teen feels disappointed right now over missed holiday celebrations, let her express her feelings, and validate them. Share your own disappointments and how you are managing your feelings.

As a parent, it is difficult to see your child experience disappointment. As adults, we have the perspective of knowing that there will be other holiday seasons in their future. During this time, children will be most comforted by parents’ words of reassurance that you will get through these challenging times together, and that life will return to normal eventually.

Remind children why things have changed

It can be helpful to remind them about why things are different right now. Remind your child that as a community, we are all doing our part to curb the spread of COVID-19

Discuss changes in plans earlier vs. later

For most young children, it will be helpful to start to discuss changes in plans earlier than later. Start slow and return to the topic several times, each time adding a little more detail. Ask for your children’s input on how they would like to spend the holidays given the stay-at-home order and how they might celebrate with loved ones who they cannot see in person. For example, they can help you bake your favorite holiday recipe to drop off on someone’s doorstep or create a special holiday craft to mail to a loved one who lives far away.

Limit children’s exposure to the news

At this point, all but very young children are clear that something has drastically changed in their world. While it is important to keep very young children away from the daily news which can include death tolls and speculations, parents should be honest about what we are trying to accomplish by social distancing. Here’s an explanation of social distancing. It could be helpful to ask them what they already know, debunk misinformation, and provide additional information for better understanding and clarification.

Let them use their imagination

Have fun thinking about what makeup holiday celebrations and other gatherings with family and friends would look like. Let them use their imaginations on what decorations they would have, food they would eat and people they most want to see.

Celebrate special events in a creative way:

  • Use technology such as FaceTime, Zoom or Skype to enjoy a holiday meal with loved ones who don’t live in your household. Consider sharing recipes between family members and friends ahead of time and cooking your meals together over video chat.
  • Host a virtual party — decorate a backdrop, make a music playlist and create a themed game.
  • Join friends for a virtual cookie or gingerbread house decorating party.
  • Have a virtual, interactive watch party for your favorite holiday movie using Netflix Party or Disney +’s GroupWatch. These services allow you to synchronize your show or movie with friends and family, and chat while you’re watching.
  • If your traditional outings during the holiday season aren’t an option due to COVID-19, consider planning a virtual field trip and inviting families from other households. Many museums and other attractions are offering free virtual visits during this time.
  • Help your child prepare a special meal or dessert for the holiday or special day.
  • Go into nature for a scavenger hunt or take a drive through a holiday light display.
  • Organize a Zoom or Skype call with family and friends to sing your favorite holiday songs.

Building resiliency

Although this pandemic is not the situation that we would have chosen for our kids to face, experiencing adverse events, with their parent’s support, will help kids build resiliency. They will be able to look back on this time and reflect on how they were creative in finding ways to celebrate holidays and how they found new ways to entertain themselves at home, while persevering over new challenges.

Mental health tips during COVID-19

For many of us, the COVID-19 pandemic has created a fluid environment that has forced us to adapt to countless changes in many areas of our lives – school, work, activities and socialization, to name a few. In this roundup, mental health experts from CHOC offer their go-to mental health tips during COVID for family members of all ages.

Idea: Track your G-R-A-P-E-S

Submitted by: Dr. Francesca Bahn, pediatric psychologist

I like to use G-R-A-P-E-S tracking calendars to help with mood stability and management that doesn’t require intensive therapy. This stands for:

  • G Gentle to self
  • R Relaxation
  • A Accomplishment
  • P Pleasure
  • E Exercise
  • S Socialization

Kids can create a calendar or download one online that tracks days of the week on one axis and each “grape” along the other axis. They should place a sticker in each box when they engage in that activity for the day.

Idea: Look for ways to stay kind, created and connected during COVID-19

Submitted by: Dr. Adrianne Alpern, pediatric psychologist

Kids for Peace is a non-profit organization that works to create peace through service, global friendships and acts of kindness. I recommend their activities to many families who I work with, who have found them to be really helpful.  Some of my favorite activities include:

  • Make peace rocks — paint rocks with kind words and place them around town to delight your neighbors.
  • Harvest seeds from fruits and replant them.
  • Discover something new about a different culture or a different country.
  • Listen to music from different parts of the world.
  • Pick at least one country from each continent and discover their favorite food or dish.
  • Create an acts of kindness checklist and complete as many items as possible from home.
  • Create a family vision board to track your dreams and goals

Idea: Activities to help boost your mood

Submitted by: Paloma Bautista, licensed clinical social worker

  • Arts and crafts — Paint your favorite quote on a canvas and hang it in your bedroom or a common area. Or, gather old magazines and create a collage with short-term goals and positive quotes.
  • Journaling — Practice journaling by writing three to five positive things that happened today, and/or explore your personal strengths and add them in your journal.
  • Exercise — Go on a short 10-15 minute “mind-full’ walk with a loved one from your household. Incorporate your five senses. Identify five things you can see, four things you can feel, three things you can hear, two things you can smell and one thing you can taste
  • Movie — Watch your favorite or perhaps a new holiday movie with a loved one. Take turns after the movie talking about your favorite part.
  • Baking — Bake your favorite holiday treat or learn to bake a popular family dish.

Idea: A new way to ask and answer, “Are you OK?”

Submitted by: Liz Hawkins, CHOC volunteer and mental health advocate

One simple check-in I heard that really resonated with me was from managers at Dell beginning team meeting asking team members, “Are you above the line or below the line?” It gives you the opportunity not to delve too personally if you don’t want to with your co-workers but at the same time that shorthand gives people a snapshot that things may not be great today. I think this could also apply with teens and with others in your life that don’t always want to go into detail but for whom you want to know how they are really doing.

Idea: Window swap

Submitted by: Liz Hawkins, CHOC volunteer and mental health advocate

WindowSwap is a beautiful website that allows you to escape mentally to someone else’s view outside their window — all around the word — even if for just a few moments. When our travel is limited, this is a great way to escape our current reality and gaze upon someone else’s for a while.

Idea: Draw it out

Submitted by: Liz Hawkins, CHOC volunteer and mental health advocate

Drawing mundane household objects using prompts – like the ones in Believer magazine – forces us to look at these everyday objects in a different way. These activities are great for kids and adults alike.

Idea: Self-care comics

Submitted by: Liz Hawkins, CHOC volunteer and mental health advocate

Creating your own comic can be a way to track emotions, and visualize yourself in soothing situations. These prompts from Believer magazine are my favorite:

  • What am I grateful for today?
  • What is out of my control today?
  • What is in my control today?
  • What can I do for my body today?
  • How will I (safely) connect to other humans today?
  • Think of your safe, no-stress zone/place and draw it.

Idea: Make your own self-care kit

Submitted by: Liz Hawkins, CHOC volunteer and mental health advocate

Similar to the idea of a coping box, self-care kits might include physical items such as a white noise machine, puzzle or your favorite lotion, or intangible options like reminders to relax your muscles, get outdoors or reminders to take to-do lists one step at a time.

This is a good reminder that it’s OK for self-care to be “boring.” Social media can lead us to believe that self-care equates to luxurious bubble baths or nice meals, but to can really be as simple as setting aside time to read a book or magazine, taking a shower or changing your sheets.

Idea: Repeat mantras

Submitted by: Liz Hawkins, CHOC volunteer and mental health advocate

I repeat these sayings to myself often. These might help you, too – or maybe you’ll find your own phrases that resonate most with you:

  • Relate. Reason.
  • You’ve made it through 100% of your bad days.
  • Wake up intentionally. Work intentionally. Eat intentionally. And rest intentionally.

Idea: Coping cards

Submitted by: Liz Hawkins, CHOC volunteer and mental health advocate

Coping Skills for Kids has an online store that offers customizable workbooks and coping skills cue cards. Children can get cards to focus on distraction, calming, processing or physical activities.

Idea: Write it down; tear it up

Submitted by: Joni Rogers, mental health assistant, Cherese Mari Laulhere Mental Health Inpatient Center

If kids are struggling with a parent, friend or situation and they haven’t found the words or strength to talk to them, I have them write it down on a piece of paper and then tear it up when they are done. It’s double gratifying to be able to put your thoughts, feelings and emotions down but also be able to tear it up and help put the past behind you.

Idea: Plan fun moments

Submitted by: Michael Ketterer, interim nurse manager, Cherese Mari Laulhere Mental Health Inpatient Center

The biggest tip I can give coming from a father of six kids in the middle of this crazy pandemic is to plan fun moments into your week. Having something planned to look forward to that your children really enjoy can help them push through the times they don’t enjoy. My wife is so good at doing this; she basically plans fun moments into every day. It doesn’t have to be big – it can be a favorite desert, board game, movie, or going for a walk around the reservoir in our neighborhood. In warmer seasons we would plan a safe beach day or drive up to the mountains to play in the snow. We always have family movie night once a week.

Idea: Question Jenga

Submitted by: Dr. Sheila Modir, pediatric psychologist

Label Jenga pieces with fun and engaging questions, so when the child pulls on that block piece, they answer that question. Also label some pieces with “feeling” words like brave, sad or happy, and have them provide a time they have felt that way. You can give a prize for the most “labeled” pieces a person has so there can be two ways to win the game — whoever doesn’t knock all the pieces over, and whoever has the most labeled pieces — to reinforce getting a labeled piece.

Idea: Sunday family meetings

Submitted by: Dr. Sheila Modir, pediatric psychologist

Have family meetings every Sunday night to review the plan for the week ahead, anything coming up in the family agenda, check in with everyone, and end with a fun family board game. This helps get children ready for the week and can be a source of predictability amid a chaotic and unpredictable time.

This article was updated Dec. 10, 2020