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.

Talking politics with your kids: Advice for parents

With election season here, it’s hard to miss the onslaught of media coverage and chatter about political issues and candidates. While this is an important time for our country, it can be overwhelming for parents wondering how to talk to kids about politics.

“Politics are front and center right now, making it a great time to talk to kids about the democratic process,” says Dr. Mery Taylor, a CHOC pediatric psychologist. “It’s not something that is abstract – we are all watching it unfold. Now that many kids are back in school, there is sure to be buzz about current events. It’s important for parents to get ahead of the information so they can be prepared.”

Starting a conversation with kids about politics

Dr. Taylor encourages parents to start with the basics. Here are some conversation starters she encourages parents to use:

  • What is a democracy?
  • What are the roles of people in elected office?
  • Why is this happening now?

Next, emphasize your personal responsibility as a citizen to vote, Dr. Taylor says.

“Talk to your kids about what it means to have elected officials that represent the diverse society we live in, and how that helps everybody,” she says. “Discuss the values that are important for your family. It is likely your children know who you will be voting for, but why?”

Parents can use a discussion on politics and the election as a way to model their critical thinking process for their children. To do that, Dr. Taylor encourages parents to talk about the values that shape their decision.

“Explain to your children the process of evaluating candidates’ policies and the impact of those policies on individuals, the environment and the American society as a whole,” Dr. Taylor says. “Children and adolescents are naturally curious creatures and you might be surprised by the questions that they will ask. You may find a conversation with your child or teen might even help you to articulate your own views more clearly.”

Parents can also tailor this conversation to their child’s personal interests, Dr. Taylor says.

“Focus on things that your child cares about. Are they passionate about saving turtles? Help them learn about candidates’ views on animal welfare. Do they want to be a business owner someday? Help them research candidates’ views on small business. Are they interested in health and science? Find out about the candidates’ policies on science and education funding,” Dr. Taylor says. “There are sure to be issues that speak to your child’s interest and help them feel connected to the election, and why politics matter as a whole.”

Share your plan to vote with your child. Take them along to the mailbox or polling station, depending on your voting plan.

How to deal with your child’s stress over the election

If you think your child is probably not affected by the election process, think again – this can be an overwhelming and stressful time for children and teens as well. Dr. Taylor offers the following tips for parents worried about how to talk to kids about politics:

Acknowledge your children’s feelings

Ask what they feel and why. Listen closely and try to connect with your child’s emotions before problem solving. If they have concerns or fears about a particular issue or how it may affect your family, reassure them that they are safe and that your family will work out any issue together.

Keep the conversation positive

 Focus on the positive aspects of a candidate or an issue. Take this opportunity to explain to your kids how to voice their opinions with respect, even when he/she doesn’t agree with someone else. Talk about what you believe and why in a respectful way, too. For younger children, keep the conversation light. For teens, ask them what they’ve heard at school, and/or what they’re unclear about – their answers may surprise you.

Talk about the election process

Explain to them that everyone has a voice. While they may not be able to vote, encourage your kids to get involved at school or in the community with issues that are important to them, such as the environment or the economy, for example. Let them know their contributions can make a big difference.

Talk Openly To Your Kids About Bullying

Bullying continues to make headlines around the country.  In particular, cyberbullying has become an increasingly common and serious issue largely due to the easy access, and in some cases the anonymity, of digital devices.

CHOC offers the following tips to help you start a conversation with your child around bullying, and guidelines to help you and your child combat bullying.

Dr. Heather Huszti, chief psychologist at CHOC, says one of the best ways to protect your children from bullying is to talk openly about it. “Have a discussion about why some kids might be bullies,” she says. “You can explain that most bullies have low self-esteem and that they bully other people to try to feel better about themselves.”

Dr. Heather Huszti
Dr. Heather Huszti, chief psychologist at CHOC

Dr. Huszti suggests asking your child open-ended questions such as, “Is there anything going on?” or “Is there anything I can help you with?” This approach usually works better than firing off a list of specific questions.

If you learn your child is being bullied, here are some additional steps you can take:

  • Inform your child’s school about the bullying.
  • Talk with the bully’s parents about the behavior.
  • Help your child build up his or her self-esteem. The better your child feels about herself, the less effect a bully will have on her overall well-being.
  • Be mindful of your child’s online activity.
  • Have a plan. Talk about what your child might do if he or she is bullied, including who to tell.
  • Pay close attention to signs from your child that may show something is wrong, such as acting withdrawn, sad or irritable, or changes in their sleep or appetite. Keep in mind however, that sometimes kids will not display any signs at all so it’s important to keep an open dialogue with your child.

Learn more about CHOC’s commitment to mental health

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How to Help Your Child Navigate the Emotional Aftermath of a Traumatic Event

By Dr. Sheila Modir, pediatric psychology post-doctoral fellow at CHOC

It’s difficult for adults to make sense of a tragedy, so consider how difficult it can be for children. To help parents support their children as they navigate trauma either in their own lives or process a tragic event they see on the news, consider the five E’s of helping a child navigate the emotional aftermath of a traumatic event: 

  • Explore what your child already knows in a gentle and calm manner. You can start with a neutral question inquiring about how their school day was or if anything happened while they were at school.
  • Explain what has happened in a way that your child can understand based on his/her age.
    • This is the time to address any misinformation your child might have picked up at school and help them understand that a scary thing did happen, but also reassure their sense of safety as schools and adults work hard to keep their children safe on daily basis.
    • Limit information that you provide to your child to the questions that they ask you, so that you avoid overwhelming them with information that they may not already have been exposed to.
    • You can provide examples of ways you and others in your community keep your child safe every day (i.e., how when you drop them off at school in the morning and you look both ways before crossing the road, how doctors are working hard to help the children that have been hurt).
  • Express to your child that feelings are normal and it is okay to feel sad, mad or angry when a tragic event occurs. Remember to reduce media exposure after a traumatic event, as repeated exposure to the event has been associated with psychological distress and intensifying already heightened emotions.
  • Emotionally model for your child healthy expression of feelings as children take their cues from their parents. Describe how you cope with your distressing emotions to your child (i.e., When I feel scared when something bad happens to me, I talk about it with someone who makes me feel safe or I take three deep breaths).
  • Ensure stability by continuing to adhere to your child’s daily routine. This will provide them with a sense of reassurance and safety during a chaotic time. Engaging in a daily routine is not meant to ignore what has happened, rather to continue to provide the child with structure, stability, and predictability.

If you are struggling to help your child process a traumatic event, or if you feel your child could benefit from additional support, ask your pediatrician for a referral to a pediatric psychologist or psychiatrist.

Below are a few additional resources on coping with trauma that I often share with my patients and their families:

Helping Children Survive the Aftermath– Florida International University

Mobile App: PTSD Family Coach– U.S. Department of Veterans Affairs

Responding to a School Crisis– The National Child Traumatic Stress Network

Resources for Parents and Caregivers– The National Child Traumatic Stress Network

Helping Traumatized Children: A Brief Overview for Caregivers– Child Trauma Academy

Tragic Events: Parent Resources – The Fred Rogers Company

Learn more about mental health services at CHOC

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  • Helping children cope with mass violence
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  • Tips for coping with political stress
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  • Talking to children about tragic events
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CHOC Announces Plans to Address Pediatric Mental Health Crisis

CHOC Children's Mental Health Inpatient CenterCommunity leaders and executives from CHOC recently announced a transformative initiative to ensure children and adolescents with mental illness receive the health care services and support they currently lack in Orange County’s fragmented system of care.

One in five children experience a diagnosable mental health condition during childhood — about 150,000 children in Orange County alone; yet there are no psychiatric inpatient beds for patients under 12 years in Orange County . Due to the absence of designated space to treat young patients, sometimes children with serious mental health episodes remain in the emergency department for days at a time. In addition, there aren’t enough inpatient psychiatric beds for adolescents either, with many needing to be hospitalized outside of Orange County.

“We recognize that pediatric mental illness has become a nationwide epidemic, and are committed to ending it,” Kimberly Chavalas Cripe, CHOC president and chief executive officer, said. “CHOC and our partners are excited by the opportunity to create a scalable model for pediatric mental health care that other communities nationwide can replicate.”

Establishing a Caring, Healing Home for Children in O.C.

Children’s advocate Sandy Segerstrom Daniels, managing partner, C.J. Segerstrom & Sons, donated a $5 million lead gift to help establish CHOC Children’s Mental Health Inpatient Center. The new center will provide a safe, nurturing place for children ages 3 to 18 to receive care for mental health conditions. It will also provide specialty programming for children ages 11 and younger.

CHOC Children's Mental Health Inpatient CenterLocated on the third floor of CHOC’s Research Building, the Center will feature:

  • 18 beds in a secure, healing environment
  • Outdoor area for recreation
  • Specially trained pediatric staff

Construction is expected to begin by fall 2015 and finish in late 2017.

CHOC has launched a fundraising campaign to raise $11 million for inpatient capital and startup costs, and $16 million to endow the program. CHOC is raising additional funds for outpatient mental health services.

1 in 5 children experience a diagnosable mental health condition during childhood.

Recognizing the urgency to help meet the community’s need, last fall CHOC and Rick and Kay Warren, co-founders of Saddleback Church formed a taskforce — led by Dr. Maria Minon, CHOC chief medical officer, and Dr. Heather Huszti, CHOC chief psychologist, and comprised of community leaders, educators and faith-based advisors — to begin discussing a comprehensive pediatric system of care for patients with mental illness.

CHOC’s support of the pediatric system of care includes:

  • expanding mental health services this year for CHOC patients being treated for serious/chronic illnesses (these children are more likely to have mental health problems, such as depression and severe anxiety, than their healthier peers);
  • opening an intensive outpatient program in 2016 to keep struggling children out of the hospital and assist those who have been released;
  • expanding CHOC’s outpatient eating disorders program by 2016;
  • and continuing to facilitate and work on multiple county-wide projects with the task force.

“We know our plans are ambitious, but they are critical and life-saving. The vision begins with establishing a caring home at CHOC for our children and families to turn to for help,” said Cripe.

To learn how to support CHOC’s mental health campaign, please visit

Related posts:

  • Helping children cope with mass violence
    A CHOC pediatric psychologist offers insight into behaviors and reactions parents might expect from their children – as well as themselves – and strategies to help.
  • Tips for coping with political stress
    It can be hard for parents and caregivers to figure out how best to care for children in their lives while they’re dealing with political stress. These coping tips from ...
  • Talking to children about tragic events
    A CHOC pediatric psychologist offers advice to parents on when, and how, to talk to children and adolescents about tragedies.