Children are especially vulnerable to the impact of trauma. Without the understanding and support of parents, teachers and other caregivers, recovery

The following material is designed to assist children in their recovery from trauma:

• Guidelines for Children Who are Exposed to Trauma
  
• Dealing with Children About Death
  
• Questions Parents Ask About Death
  
• Trauma Related Treatment for Children

1. Children respond to extreme stress in various ways. They express feelings of fear, fear of dark, fear of being alone, sleeping problems, over sensitivity to family stress, regressive behaviors, increased irritability and physiological problems. These feelings and behaviors are normal given trauma. With time, for most children, they will decrease with intensity and frequency.
   
   
2. Provide reassurance and comfort to your children. Patience will be required. Let them know their feelings are okay. Talk with them and be careful to listen.
   
   
3. These feelings do not have quick cures. Don't try to make them go away by ignoring them or joking about them. Do not embarrass your children about their ongoing feelings about the traumatic event. Otherwise they may begin expressing their feelings in less acceptable ways.
   
   
4. Listen to your children. Encourage them to talk to you about their feelings. Work with your child to find ways to help them him/her feel safe. Gradually find less disruptive ways to comfort him/her.
   
   
5. Allow your children to talk about their particular experiences with the trauma. However, do not force them to talk and don't be surprised if they will not talk about it when others bring it up.
   
   
6. Do not transfer your fears to your child. While it is important to teach children safety measures, do not make them feel as if they are under constant threat of danger.
   
   
7. Build your child's self-confidence. Look for ways to give them successes and control. Do not do everything for them.
   
   
8. Be alert to your children's needs who may not have been directly involved in the traumatic event. Children away from home, for instance at college, will express feelings about the event that must be considered equally important.
   
   
9. Pay attention to anniversaries of the event. Original feelings about the event will resurface.

1. Give honest, brief answers to question.
2. Do not over-answer questions.
3. Keep responses at the child's level of understanding.
4. Listen.
5. Do not show anxiety. Answer slowly, calmly.

Let the child know that it is natural and acceptable to show emotions when someone loved is lost. It's ok to cry, show grief, etc.

Let the child know:

1. He is still loved, wanted, and needed.
2. Others still care.
3. The loss was not his fault (i.e. something he did or said).
4. The loss was not because of him.
5. It was not because the one who is gone wanted to leave him.
6. Death is the final, natural part of life.

Do not force the discussion or make the child face anything. Permit the child to sort-out his feelings. You provide the information necessary, but not all of the answers.

Keep the child in the family unit. Do not send him away from the home or prohibit attendance at the funeral, etc. Explain in advance what will happen and permit his contributions and help.

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Often, parents have specific questions regarding the grieving process.

Here are a few of the common ones:

1. Should my child go to the funeral?
   Most importantly, children should not be sent to a relative or friend's house for the duration of the mourning process. Children are aware that something is amiss at home and may conclude that it is not OK to feel bad or sad. In most cases, children should have the option of attending the funeral. When taking part in the family's grief, a child sees that he is not alone in his sense of loss and that he/she is an important part of the family.
   
   
2. When should my child return to school?
   Just as adults, children need time to prepare themselves for the daily routine. At the same time, they should not be allowed to get bogged down by their feelings. Within limits, children should be allowed to choose when they feel ready to return to school. However, if after a week, the child still refuses, the school must be consulted.
   
   
3. Should I mention God when I explain death?
   There are two considerations here. First, is the child old enough to understand the concept of God (five or six)? Second, has religion played an important part of the family life up to this point? If these two questions can be answered positively, the use of God in explanations may be considered appropriate.
   
   
4. How should I respond when my child asks if something might happen to me?
   A parent is hesitant to respond in the negative because he or she will eventually die. On the other hand, should a parent respond positively, the child might understand this to mean tomorrow. An alternative might be, "No, I do not expect to die for a long time," stressing the "no" and adding the expectation of a long life.
   
   
5. How can I tell if my child is reacting normally to the loss?
   There may be a wide variety of normal reactions to grief and loss. These include crying, bodily complaints, hostile reaction to the deceased or other family members, idealization of the deceased, and guilt. While there are no strict rules for what is "normal," more severe symptoms should not be present after approximately six months. After one year, many children show few or no symptoms. It is not uncommon to observe symptoms reoccurring after one year as "anniversary" reactions.

By supporting their efforts to be open, honest, and sensitive to their children's needs, parents can adequately handle the grieving situation.

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1. Relationship Building and Information Gathering Regarding the Trauma
   – Therapist describes the purpose and process for treating children who have been traumatized.
   – Therapist gathers extensive details of the trauma from family and other service providers.
   
   
2. Assessment of Child and Child's Family
   – Therapist gathers information regarding the family structure, childhood experiences, medical, social and psychological history, addictions patterns, previous traumatic experiences.
   – Therapist gathers information regarding presence of consequences or symptoms of post-traumatic stress disorder.
   
   
3. Trauma Interview
   – Therapist facilitates the child's telling of the traumatic experience through drawings or role-playing.
   – Therapist encourages specific attention to details including the sights, sounds, smells, and accountability for the event.
   
   
4. Identification of Treatment Issues
   Issues are identified for the child which need to be addressed such as difficulty coping with nightmares, physiologic reactivity or impulse control.
   
   Treatment issues are identified for the family including management of their own post-trauma consequences and their child's, parenting skills, communication skills.
   
   
5. Treatment
   Play therapy, activity therapy, family therapy, group therapy, individual therapy, and couples counseling are provided based on the age of the child and the needs of the family.
   
   Consultations are held with other service providers including the school system, social services, foster parents, etc.
   
   
6. Relapse Prevention
   Treatment goal is for the child and family to have skills for coping with post-trauma consequences and situations.
   
   Return of consequences is expected and viewed as normal. Child and family with the therapist identify situations where consequences might get worse.
   
   Permission is given to return to counseling, if necessary.

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1. Development of a commitment to treatment and establishment of a safe therapeutic relationship.
2. Acknowledgement and acceptance of the occurrence of the sexual abuse and/or incest.
3. Recounting the sexual abuse/incest.
4. The recognition, labeling and expression of feelings.
5. The resolution of responsibility and survival issues (victim vs survivor).
6. Loss/grief work
7. Cognitive restructuring of distorted perceptions, beliefs and stress responses.
8. Self-determination and behavioral changes.
9. Psycho education and skill-building.

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