Pediatricians are often the first responders for children and families suffering emotional and psychological reactions to terrorism and other disasters. As such, pediatricians have a unique opportunity to help parents and other caregivers communicate with children in ways that allow them to better understand and recover from traumatic events such as terrorist attacks or other disasters. Pediatricians also can help to facilitate timely referral to mental health services, as appropriate, for these children and their families.

Important tips for parents and other caregivers include:

• Take care of yourself first. Children depend on the adults around them to be and feel safe and secure. If you are very anxious or angry, children are likely to be more affected by your emotional state than by your words. Find someone you trust to help with your personal concerns.
• Watch for unusual behavior that may suggest your child is having difficulty dealing with disturbing events. Stress-related symptoms to be aware of include depressed or irritable moods; sleep disturbances, including increased sleeping, difficulty falling asleep, nightmares or nighttime waking; changes in appetite, either increased or decreased; social withdrawal; obsessive play, such as repetitively acting out the traumatic event, which interferes with normal activities; and hyperactivity that was not previously present.
• Talk about the event with your child. To not talk about it makes the event even more threatening in your child's mind. Silence suggests that what has occurred is too horrible to even speak of.
• Start by asking what your child has already heard about the events and what understanding he or she has reached. As your child explains, listen for misinformation, misconceptions, and underlying fears or concerns.
• Explain—as simply and directly as possible—the events that occurred. The amount of information that will be helpful to a child depends on his or her age. For example, older children generally want and will benefit from more detailed information than younger children. Because every child is different, take cues from your own child as to how much information to provide.
• Limit television viewing of terrorist events or other disasters, especially for younger children. When older children watch television, try to watch with them and use the opportunity to discuss what is being seen and how it makes you and your child feel.
• Encourage your child to ask questions, and answer those questions directly. Like adults, children are better able to cope with a crisis if they feel they understand it. Question-and-answer exchanges help to ensure ongoing support as your child begins to understand the crisis and the response to it.
• Don't force the issue with your child. Instead, extend multiple invitations for discussion and then provide an increased physical and emotional presence as you wait for him or her to be ready to accept those invitations.
• Recognize that your child may appear disinterested. In the aftermath of a crisis, younger children may not know or understand what has happened or its implications. Older children and adolescents, who are used to turning to their peers for advice, may initially resist invitations from parents and other caregivers to discuss events and their personal reactions. Or, they may simply not feel ready to discuss their concerns.
• Reassure children of the steps that are being taken to keep them safe. Terrorist attacks and other disasters remind us that we are never com-pletely safe from harm. Now more than ever it is important to reassure children that, in reality, they should feel safe in their schools, homes, and communities.
• Consider sharing your feelings about the event or crisis with your child. This is an opportunity for you to role model how to cope and how to plan for the future. Before you reach out, however, be sure that you are able to express a positive or hopeful plan.
• Help your child to identify concrete actions he or she can take to help those affected by recent events. Rather than focus on what could have been done to prevent a terrorist attack or other disaster, concentrate on what can be done now to help those affected by the event.
• If you have concerns about your child's behavior, contact your child's pediatrician, other primary care provider, or a qualified mental health care specialist for assistance.

For additional information, please visit the American Academy of Pediatrics' Children, Terrorism & Disasters Web site at http://www.aap.org/terrorism.

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