Specific fears: of real people or situations (animals or darkness) or of imaginary ones (witches, etc.)
Reactions during the second and third months
School or day care center refusal
Headaches and bodily pain
Food refusal or excessive eating
Repetitive play enactment of the traumatic event
Reactions within the first 72 hours
Behavioral changes: passivity
Aggressiveness, irritability
Confusion (they look puzzled and disorientation)
Frequent crying
Regressive behavior
Language impairments
Reactions within the first month
Unjustified fear
Difficulty keeping still
Difficulty focusing attention
Headaches and other somatic complaints
Repetitive play enactment of the traumatic event
Reactions during the second and third months
Difficulty concentrating at school
School refusal
They feel guilty or assume the disaster is a consequence of something they have done or thought
They look withdrawn or shy
Repetitive play enactment of the traumatic event
Reactions within the first 72 hours
Confusion and disorientation
Withdrawal, refusal to speak
They look distracted or as if their mind were elsewhere
Reactions within the first month
Loss of appetite
Loss of sleep
Headaches and bodily pain
Loss of interest in usual activities
Reactions during the second and third months
Rebellious behavior against their family or any kind of authority
Behavioral problems
Escaping from home
School refusal
From: PAHO, Practical guide of mental health in disaster situations. Washington D.C., 2006
General recommendations for children and adolescent psychosocial care in a disaster situation
Recommendations for parents
Reassure them
Be firm about sleeping time
Stay with them for a while
Leave a night-light on
If they wake up fully and are scared (nightmare), reassure them; should they recall the event the following day, talk about the cause of their fears. If they are not fully awake (night terror), do not wake them, since they will not recall the event the following day
Recommendations for teachers
Identify the problem (for instance, if you notice the child is exhausted)
Recommendations for parents
Reassure them
Encourage physical contact and cuddle them
In case of separation, tell them where you are going, and when you are coming back. Have somebody stay with them
Recommendations for teachers
Allow parents to be in the classroom for some time, reducing it gradually
Recommendations for parents
Avoid punishments and mockery
Change their clothes and reassure them
Limit liquids at night
Take them to the bathroom before they go to bed and during the night
Show them how pleased you are when they do not wet the bed (tell them to register the days they have not wet the bed in a calendar, etc.)
Leave a night-light on
Recommendations for teachers
Do not allow mockery or rejection from classmates
Resume school activities as soon as possible
Recommendations for parents
Do not punish them (ignore these behaviors)
Make them focus on something else
Recommendations for teachers
Make them focus on something else
Ignore these behaviors
Recommendations for parents
Seek rapid school reintegration
Do not punish them for their faults; instead, reward any progress
Seek a return to normal routines at home
Be firm about a reasonable study schedule
Recommendations for teachers
Rapid school reintegration
Partial parental presence (in the case of the youngest children)
Special support in case of poor performance: sit the child in the first row; provide individualized attention at the end of school-day, etc.
Encourage participation
Reward achievements
Prevent discrimination
Recommendations for parents
Reassure them
Do not transmit the adults’ anxiety
Give clear and honest explanations about the past and current situation (avoid making assumptions about an uncertain future)
Explore management strategies with them (breathing techniques, physical activity, etc.)
Recommendations for teachers
Bear in mind that anxiety interferes with attention and concentration and causes restlessness
Reward positive behaviors: staying seated, following instructions, etc.
Make periodic evaluations of achievements with them (acknowledgment and reinforcement of positive behaviors) and ignore negative behaviors
Recommendations for parents
Help them face fears gradually; be with them
Set an example as regards self-control
Do not use either corporal or verbal punishment; the best punishment is indifference or a neutral attitude (still loving)
Make it clear that aggression to others shall not be allowed
Declare a truce: ignore the aggression while demanding isolation in a supervised place for a short time —until you are able to control yourself
Let them know what the desirable and expected behavior is
Encourage channeling of excessive energy, anxiety and anger through non-harmful strategies
Explain what the desirable and expected behavior is
Reward achievements
Punish through indifference
Recommendations for parents
Be patient
Be firm and object to unacceptable behaviors
Set clear rules in the family environment
Encourage communication
Recommendations for teachers
Behavior model
Consider possible external assistance for the family
Recommendations for parents
Rule out any medical condition; if necessary, resort to health services
Establish the relationship between what happens and the symptoms
Do not allow manipulation through symptoms
Recommendations for teachers
Warn parents and facilitate medical aid
Recommendations for parents
Let them perceive their own sadness
Let them express their feelings and memories freely (sadness, anger, guilt) and talk about it in the family group
Provide company and manifest affection
Do not conceal reality
Do not encourage denial; talk about losses and their permanent nature, despite which it is necessary to “carry on”, and try to return to normal life as soon as possible, including individual and collective social activities
Allow their participation in funeral rites (burial, religious services in case of death, etc.)
Counteract possible feelings of anger and guilt explaining the real circumstances of the loss (or death)
Allow adolescents to deal with mourning before they assume new responsibilities
Recommendations for teachers
Inform classmates before the child starts attending classes. Briefly explain what normal reactions the child will have
Provide emotional support
Facilitate spaces to talk with the child individually, but do not focus all your attention on him/her
Encourage participation in regular educational and recreational activities
Check the child’s evolution and identify red flags (growing sadness, death or suicidal thoughts, etc.)
Contact parents and coordinate actions
From: PAHO, Practical guide of mental health in disaster situations. Washington D.C., 2006
