Coping with Violence and Helping Children Cope with Violence

When children experience or witness a traumatic or violent event, they may not react to it immediately. In fact, in some cases it may be days or even weeks later that emotional reactions such as fear, anger, depression or withdrawal appear. Some may overcome their worries and bad memories with the passage of time and with emotional support.

Others may experience long-term effects from the emotional trauma — serious emotional distress caused by such things as experiencing or witnessing a violent event or natural disaster, losing a friend or family member, or being separated from parents at an early age.

The August 2, 2000, issue of The Journal of the American Medical Association (Heim et al) includes an article about adult women who experience stress as the result of sexual or physical abuse they experienced when they were children.

How to Help Children Cope

Explain the traumatic event as best you can and allow the child to ask any questions.
Comfort your children and let them know that you love them and will take care of them.
Encourage your children to talk about the traumatic event and their feelings connected with the experience; listen to their responses without judging them.
Allow children to express their emotions and vulnerabilities; do not expect them to be brave or "tough."
Do not criticize regressive behavior or shame children for the emotions or behavior they have returned to in order to cope.
Let children know that the traumatic event was not their fault.
Let children sleep with a light on, in a room with a sibling, or in your room for a limited time if it is comforting to them.
Gradually return to everyday routine; this can be comforting for many children.

If your child continues to have difficulty, seek professional help. Your doctor or your child's pediatrician can refer you to a child and adolescent psychiatrist.

Reactions to Trauma

Reactions to trauma may appear immediately after the traumatic event, but in some cases these reactions may appear days or weeks later. Everyone, including children and adolescents, reacts to stress in different ways. The following are just some examples of possible reactions:

Children 5 years old and younger may:

Have a persistent fear of being separated from parents or caregivers or be excessively clingy.
Cry, whimper or scream.
Have problems sleeping or have nightmares.
Have regressive behavior (children return to behavior that is not appropriate for their age, such as bedwetting, thumb sucking or being afraid of the dark).

Along with the reactions above, children 6 to 11 years old also may:

Withdraw from other people and everyday activities.
Act out with disruptive behavior, such as misbehaving at home and school in ways that are not typical for the child.
Have difficulty concentrating and paying attention.
Have irrational fears.
Be irritable.
Have outbursts of anger and fighting.
Become depressed, anxious, have feelings of guilt or become emotionally numb.
Get lower grades at school.

Along with the reactions above, adolescents 12 to 17 years old also may:

Have flashbacks.
Avoid any reminders of the traumatic event.
Abuse drugs, such as alcohol.
Have suicidal thoughts.

For More Information

National Institute of Mental Health
(800) 421-4211
American Academy of Child & Adolescent Psychiatry
Public Information
3615 Wisconsin Ave., N.W.
Washington, DC 20016
(202) 966-7300

Additional Sources: American Psychiatric Association, National Institute on Aging, American Geriatrics Society, National Institute of Mental Health, The AMA Family Medical Guide, The AMA Encyclopedia of Medicine

Brian Pace, M.A., Writer
Richard M. Glass, M.D., Editor

(JAMA. 2000; 284:654)

Published in JAMA: August 2, 2000

The JAMA Patient Page is a public service of JAMA and the AMA. The information and recommendations appearing on this page are appropriate in most instances; but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA and AMA suggest that you consult your physician. This page may be reproduced noncommercially by physicians and other health care professionals to share with patients. Any other reproduction is subject to AMA approval.