The American Academy of Pediatrics (AAP) has released a clinical report recommending a course of action in treating children who have experienced or witnessed a disaster. The full report, “Psychosocial Implications of Disaster or Terrorism on Children: A Guide for the Pediatrician,” was published in the September 2005 issue of Pediatrics and is available on the AAP Web site athttp://pediatrics.aap-publications.org/cgi/content/full/116/3/787.

The report outlines several studies that were conducted after the Sept. 11, 2001, terrorist attacks in New York and Washington, D.C. Three months after the attacks, some children were deeply dependent on parents for emotional and psychological support. The studies found that parents’ moods and behaviors after traumatic events may add to a child’s fears. Parents also may not recognize symptoms of their child’s stress.

After a disaster, children may experience a range of symptoms, from mild stress reactions to more severe cases of post-traumatic stress disorder (PTSD). A child with adverse stress reactions lasting longer than one month after a disaster may be at higher risk of developing PTSD or violent behaviors later in life. Boys generally display higher rates of symptoms and require more time to recover than girls. Shy, fearful, or poorly supported children are at greater risk of developing negative mental reactions after trauma. Children with indirect exposure to a disaster on television also face the same risk as those witnessing it directly.

Physicians treating children after a traumatic event should be aware of patients who are at risk of adverse reactions or the development of symptoms of PTSD, and they should educate and counsel parents about the range of normal emotional and behavioral reactions of children to disaster. Physicians should help parents recognize the potential deleterious effects of indirect disaster exposure from news media and educate them about the importance of helping children understand information at a developmentally appropriate level.

Physicians should screen for anxiety in all patient encounters after a disaster. A simple question and expression of concern is an effective, brief intervention. For many children with supportive families, peers, and teachers, the reaction to traumatic experience resolves in a few months. A follow-up screening four to six months after the disaster would be appropriate to identify children with continuing symptoms who may need referral for additional services.