Psychological First Aid:
Tips for Helping Children after Traumatic Events
Psychological First Aid is an evidence-informed approach to helping survivors in the aftermath of traumatic events. It is consistent with research evidence on risk and resilience following trauma, understanding that survivors will experience a broad range of reactions and will need compassionate support from caregivers.
Below are situations where children exhibit trauma responses and what caregivers can do to respond and provide trauma-informed care.
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If the child has problems sleeping, doesn’t want to go to bed, won’t sleep alone or wakes up at night sleeping…
When children are scared, they want to be with people who help them feel safe, and they worry about their families when they are not together. Going to bed alone may remind them of that separation. Since bedtime is a time when there are less distractions, it is often a time when children think about the things they fear and can be scared of going to sleep.
Have a bedtime routine like a story or cuddle time. Explain the routine so they know what to expect.
Hold them and assure them that they are safe, that you are there and will not leave. Understand that they are not being difficult on purpose. This may take time, but when they feel safer, they will sleep better.
Do calming and positive activities together to help them think about other things.
If a child cries or complains whenever you leave them, even when you go to the bathroom…
Children who cannot yet speak or say how they feel may show their fear by clinging or crying. It is not a form of manipulation. Children’s bodies react to separations – their stomach sinks and their heart beats faster. Goodbyes may remind them of any separation.
Respond by trying to stay with them and avoid separations. For brief separations, help them name their feelings and link them to their experience. Let them know that this goodbye is different and that you’ll be back soon.
“I know you’re scared and you don’t want me to go but this is different, and I’ll be right back.”
For longer separations, have them stay with familiar people and let them know what to expect. It’s important to tell them where you are going and why, and when you will come back. Let them know you will be thinking of them. You can also leave something of yours and call them often if you can.
If the child has problems eating, eats too much, or refuses food…
Stress affects children’s appetite. Eating healthy is important but focusing too much on eating can cause stress and tension in your relationship.
Keep healthy snacks around. Young children often eat on the go. As the child’s level of stress goes down, their eating habits will likely return to normal. Don’t force them to eat. Eat together and make meal times fun and relaxing.
If you are worried, or if the child loses a significant amount of weight, consult a pediatrician.
If the child is not able to do the things they used to do, such as use the potty, or talk like they used to…
When young children are stressed or scared, they temporarily lose abilities or skills they recently learned. This is their way of telling us that they are not okay and need our help. As the child feels safer, they will recover the ability he lost.
Losing an ability after children have gained it (like starting to wet the bed again) can make them feel ashamed or embarrassed. Caregivers should be understanding and supportive. The child is not doing this on purpose.
Avoid criticism. It makes them worried that they’ll never learn or relearn something.
Do not force the child. Instead of focusing on the ability, help the child feel understood, accepted, and supported.
If the child is reckless and does dangerous things…
It may seem strange, but when children feel unsafe, they often behave in unsafe ways. It is one way of saying, “I need you to keep me safe.”
Respond by showing them other more positive ways that they can have your attention.
Be calm and explain that what they are doing is unsafe. Tell them that they are important, and you wouldn’t want anything to happen to them.
If the child is scared by things that did not scare them before.
Young children believe their adults especially their parents and caregivers are all-powerful and can protect them from anything. This belief helps them feel safe. A traumatic event causes this belief to change and without it, the world is a scarier place for the child.
Many things may remind the child of the traumatic event such as ambulances, people yelling or a scared look on your face. When the child is scared, talk to them about how you will keep them safe.
If they talk about monsters, join her in chasing them out. “Go away, monster. Don’t bother (child’s name). I’m going to tell the monster boo, and it will get scared and go away.”
If the child seems hyperactive, can’t sit still, and doesn’t pay attention to anything…
While some children are naturally active, children who have experienced traumatic events are often fearful that they will happen again. Fear creates nervous energy that stays in children’s bodies. When their minds are stuck on traumatic memories, it is hard to pay attention to other things.
Respond by helping the child recognize and name their feelings (e.g. fear, worry, etc) and reassure them that they are safe.
Help them get rid of nervous energy by doing some deep breathing, stretching, running or playing. Sit with them and do an activity you both enjoy. Even if they don’t stop running around, this helps them. If the child is naturally active, focus on the positive. Think of all the energy they have and find activities that fit his needs.
If a child plays in a violent way…
Young children often talk through play. Violent play can be their way of telling us how difficult things were or are, and how they feel inside. Listen carefully when they talk. As your child plays, notice the feelings they have and help them name feelings. Be there to support them by holding them and soothing them.
If they get overly upset or plays out the same upsetting scene, help them calm down and feel safe. Consider getting professional help to help address the behaviour.
If the child seems stubborn, demanding and controlling, insisting that things be done their way…
Between the age of 18 months to 3 years, young children often seem to have controlling behaviour. It is a normal part of child development and helps them feel safe and important. When children feel unsafe, they may become more controlling than usual. This is one way of dealing with fears and the lack of control they felt during the traumatic event. They are saying, “Things were so difficult so I need to have control over something.”
Respond by allowing the child to have control over small things. Give them choices over what they wear or eat, the games you play or the books you read. Balance giving the child choices and control with giving her structure and routines. Predictability will make them feel safe. Cheer the child on as they try new things.
If the child throws tantrums and yells a lot more than usual…
Tantrums are a normal part of childhood. It’s frustrating when you can’t do things and when you don’t have the words to say what you want or need.
Let the child know that you understand how hard this is for them. Respond with understanding rather than correction. If they cry or yell, stay with them and let them know that you are there for them.
If a child hits you…
For children, hitting is a way of expressing anger or getting your attention. When children hit adults, it’s a sign that they feel unsafe. It’s scary to be able to hit someone who’s supposed to protect you. If the child can already use words, help them name their feelings and express their anger in more positive ways (e.g. talking, pausing, deep breathing).
Hitting can also come from seeing other people hit each other. Each time the child hits, let them know that this is not okay. Hold her hands, so she can’t hit and have her sit down. Say something like, “It’s not okay to hit, it’s not safe. When you hit, you are going to need to sit down.” If you are having conflict with other adults, try to work it out in private, away from where the child can see or hear you.
If the child says “go away, I hate you!”
When traumatic memories are triggered in the child’s brain, young children often get mad at adults because they believe they should have stopped it from happening. Remember what the child has been through. They don’t mean everything that they are saying. They are angry and dealing with so many difficult feelings.
Support the child’s feeling of anger, but gently redirect the anger. Say something like, “I know you are mad because lots of bad things have happened. I really wish they didn’t happen, but sometimes there are things that are out of our control.”
If a child doesn’t want to play or do anything or seems to not have any feelings…
The child may be feeling sad and overwhelmed. When children are stressed, some can be expressive and others shut down. Children need you in both circumstances. You can sit by the child and keep them close. Let them know that you care. If you can, give words to their feelings. Let them know it’s okay to feel sad, mad, or worried. Say something like, “It seems like you don’t want to do anything. I wonder if you are sad. It’s okay to be sad. I will stay with you until you are feeling better.”
Try to do things with the child, anything they might enjoy like read a book, sing, play together.
If a child cries a lot…
If the child has experienced difficult changes, it is natural to feel sad or even feel grief and loss. Allow the child to express feelings of sadness.
Help them name their feelings and understand why they may feel that way. Support the child by sitting with her and giving her extra attention. Wait for them to open up and become ready to talk. When they’re ready to share their thoughts and feelings, listen with judgment.
Spend more time together and help the child feel hopeful about the future. Together, think about some plans for the future like going to the park or zoo and playing with friends.
If a child misses people that they are unable to see temporarily or permanently in cases of death…
Even though young children do not always express how they feel, be aware that it is difficult for them when they lose contact with important people in their family and community. If someone close to the child died, they may have questions as young children do not understand death and may think that the person can come back. Answer the child’s questions using simple and age-appropriate language. When strong reactions last longer than two weeks, seek help from a professional.
If it is safe, help the child stay in touch in some way (e.g. sending pictures or cards, calling, etc).
Help the child talk about these important people. Acknowledge how hard it is to not be able to see people we care for. Explain that, even when we are apart from people, we can still have positive feelings about them by remembering and talking about them.
If a child misses things that they have lost because of a disaster or move…
It is easy to lose sight of how much the loss of a toy or other important item such as a blanket can mean to a child. The things they miss give them a sense of safety and familiarity. Grieving for a toy is also the child’s way of grieving for the life they had before the traumatic event.
Allow the child to express feelings of sadness, grief and loss. If possible, try to find something that would replace the item that they are missing that would be acceptable and satisfying to the child. You can also distract them with other activities.
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