With you – and with everyone who cares about children – we at The REACH Institute are appalled by the shooting in Uvalde, Texas, yesterday. We weep for the slaughtered children and teachers. Our hearts go out to their grieving families.
As I write, the only thing I know about the shooter is that he was 18 years old. Surely his story is also a tragedy.
In the wake of such a horrific event, we all have the impulse to DO something. Here at REACH, there’s little we can do to comfort grieving families or prevent future school shootings. What we can do is to help you help your young patients. If there is more we can do for you, please let me know.
Lisa Hunter Romanelli, PhD
for the staff of The REACH Institute
In the wake of the Texas school shooting tragedy, your young patients–and their families–may be experiencing anxiety that can affect normal functioning. That anxiety can manifest in many ways, from reluctance to go to school to increased aggressive tendencies.
In fact, pediatric primary care providers (PCPs) have been observing the effects of news consumption on their young patients for years now. The spike in anxiety at the beginning of the Covid pandemic is another example. Families may be experiencing trauma as they watch scenes of devastation and displacement in Ukraine. Every act of terrorism or mass violence inspires more fear. The examples go on.
As your families’ trusted PCP, you can influence how patients and families deal with anxiety over recent events and the continuous barrage of bad news that characterizes today’s media culture. To find out how, we talked with REACH faculty member Ruth E.K. Stein, MD, of Albert Einstein College of Medicine and the Children’s Hospital at Montefiore in the Bronx, New York.
“The first thing for providers and parents to watch is whether you’re anxious yourself,” said Dr. Stein. “Families and providers both need to contain their own level of worry so they don’t transmit anxiety to children.”
One important way to decrease anxiety is to assess actual risk. PCPs can remind both themselves and their patients’ families that terrorism, violent crime, accidental death, and the like are all extremely unlikely. Even the risk of death by Covid, particularly for children, has sometimes been exaggerated.
“It’s easy for adults to catastrophize,” said Dr. Stein. “But that’s not helpful for children’s anxieties.” Parents who overestimate the risk of danger not only will worry unnecessarily but also can pass their anxiety to their children.
The next thing Dr. Stein recommends is to give children a chance to talk. “PCPs may hear more than the parents do because many children don’t want to upset their parents,” she noted. “I see children all the time who seem very anxious. I ask them what they are worried about, and they say they don’t know.”
In that case, Dr. Stein makes a suggestion: “I know lots of kids worry about their family” or “Some kids worry that there could be a mass shooting at their school.”
“I can just see the relief on their faces,” she went on to say, “to know that it’s OK to have that fear.”
Normalizing the anxiety is a big step toward alleviating it, said Dr. Stein. Children often worry about their worry, thinking that it means there is something wrong with them. “Just being a good interviewer, reading body language, and normalizing the natural concerns of children can make a difference.”
Next, said Dr. Stein, is finding out what the real concerns are. For school-aged children who worry about their parents, she said, the big issue often is “Will someone be there to take care of me if something happens to Mom and Dad?” Children feel better knowing that there’s a plan in place and that other family or friends are committed to their well-being and will always make sure they are taken care of.
The security engendered by such a plan can help even in cases where the risks portrayed on the news may be real. For example, in communities with large numbers of undocumented immigrants, the threat of immediate deportation in the wake of a workplace raid may be real—though the chances are still small that any given parent will be caught. Younger children, particularly, need to know that someone will take care of them if that happens. Adolescents, though they may be less concerned about their own survival, will still benefit from an honest discussion both about the likelihood of deportation and about what they can do if it happens.
PCPs can also suggest measures caregivers can take to reduce their children’s news-related anxiety—and their own!
If PCPs can help parents develop realistic expectations and a positive outlook, then much of the job of managing children’s anxiety may be done. Use of the screening tools covered in the REACH program can help clinicians determine if more intervention is necessary.
Leiner M, Peinado J, Villanos MT, Lopez I, Uribe R, Pathak I. Mental and emotional health of children exposed to news media of threats and acts of terrorism: The cumulative and pervasive effects. Front Pediatr. 2016 Mar; 4:26. https://doi.org/10.3389/fped.2016.00026
Council on Communications and Media, American Academy of Pediatrics offers many resources on children, adolescents, and the media, including a tool to create a Family Media Plan
Talking to Children About Tragedies & Other News Events from the American Academy of Pediatrics’ Healthy Children
News and Children from the American Academy of Child and Adolescent Psychiatry
“The opportunity to learn information to help me manage psychiatric conditions in my patients in this time where demand clearly outweighs supply of services, is going to be excellent for me as a PCP in my community.”