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ORLANDO – Pediatricians can do a great deal to help their patients and communities in the wake of tragedies involving violence affecting children, according to Dr. David Schonfeld.
Unfortunately, it appears that such events are increasing in frequency, as evidenced by the headlines in recent months and years, Dr. Schonfeld, director of the National Center for School Crisis and Bereavement at St. Christopher’s Hospital in Philadelphia said at the annual meeting of the American Academy of Pediatrics.
It is important that when such events do occur, pediatricians work to address the impact of trauma on children; research suggests that supportive and nurturing adults can indeed mitigate the effects, said Dr. Schonfeld, a developmental and behavioral pediatrician and a member of the AAP Disaster Preparedness Advisory Council.
The available research, including both rat and human studies, highlights the role that nurturing by both mothers and other adults can play in protecting children.
In one set of experiments in rats, infants who experienced higher levels of maternal nurturing were less fearful and less reactive to stressful situations, and performed better on tasks thought to depend on optimal functioning of the hippocampus, Dr. Schonfeld explained.
Related studies showed that cross-fostering infant rats from mothers who provided less nurturing compensated for the lack of maternal nurturing.
This suggests that care and support provided by adults outside of the family can help promote the development and adjustment of children affected by a crisis, he said.
"These findings are directly applicable to humans. The National Collaborative Perinatal Project showed similar findings in humans at 8 months of age," he noted.
The project demonstrated that the degree of maternal nurturing in an experimental setting predicted the infants’ degree of emotional distress in adulthood.
An epigenetic phenomenon may explain how early parental nurturing results in less stress reactively in offspring in adulthood, he said, noting that this idea was supported by findings from recent postmortem analyses of the brains of suicide victims. Victims with a history of early-life adversity had lower levels of glucocorticoid receptor messenger RNA in their hippocampus and higher rates of DNA methylation in the same promoter region as in the rat model.
"A whole separate and growing body of research has also demonstrated that chronic severe stress, especially during critical periods of brain development, leads to long-term changes in brain function and structure," he said.
"If you take all of this together, it underscores the need to protect children from stressful situations as much as possible, to intervene quickly after stressful events occur, and to pay particular attention to minimizing subsequent stressors because of the particularly detrimental effects of chronic stress on children," he added.
He cautioned, however, that a child’s adjustment following a traumatic event is related not just to the trauma, but to what occurs as a result of the event.
For example, if a child loses a family member as a result of violence, difficulties experienced by the child may be a result of bereavement.
Dr. Schonfeld described one teen affected by the 2012 Aurora, Colo., shooting who was reluctant to return to school, and who declined offers of trauma counseling. Although many of his trauma-related symptoms – such as fidgeting and difficulty sleeping – had abated, he disclosed that he "just didn’t feel right, and felt sad and empty."
Further discussion revealed that his problem was one of bereavement; he had lost a close friend in the shooting.
"No one had suggested that might be an issue for him, and I have seen this in crisis event after crisis event when I’ve responded," Dr. Schonfeld said.
After a crisis, a "cascade of secondary losses" can occur, and any one of these can be the cause of difficulty for those affected, he added.
Also, keep in mind that even as such events seem to be occurring more often, children don’t "get used to it," he said.
"They simply learn that there is little benefit in asking for support or assistance from adults in these communities, because it is so infrequently offered to them," he said.
As a result, children may become fatalistic and engage in reactive risk-taking behaviors or counterphobic behaviors that place them at greater risk.
"But they don’t get used to it. And I would contend that neither should we," he said.
Pediatricians should, however, recognize and celebrate what they have done and can do every day to support children and families dealing with difficult situations.
"It makes a big difference. I don’t want you to get overwhelmed by all that could – and unfortunately does – happen, and the long-lasting and profound impact these violent events can have on children. Instead, I challenge you ... to commit to at least one strategy to advocate for violence prevention and/or readiness for your practice or your community to support those who have been impacted by these events," he said.
Such strategies can include:
• Working to decrease violence crisis and loss, and advocating for meaningful change.
• Giving voice to children impacted by these events, allowing them to tell their stories, and forcing a dialogue that can help move the agenda forward.
• Advocating for better systems and services for children affected by these events, and other adverse events in the lives of children, including poverty, exposure to urban violence, and food insecurity, for example.
• Becoming more skilled in supporting children who are grieving and traumatized.
• Ensuring that other professionals in positions to support children – such as teachers and other school staff – are better prepared, more skilled, and more effectively supported in helping children after these events (and introducing information that can help before such events occur).
• Inquiring about exposures and experiences routinely in the practice setting. (The Medical Home for Children Exposed to Violence project [MHCEV] is working to provide resources for identifying, treating, and referring affected children and youth.)
• Promptly identifying affected children at the time of an event, and facilitating discussion about the impact of the event, and offering "psychological first aid and psychoeducation." Attend to basic needs, provide triage and referral, and remember that services will be needed throughout the recovery period, which may be weeks, months, or years.
• Helping in one’s own community when events happen elsewhere, as communities struggle to understand and cope with the events, and deal with distress that can surface as a result of concerns and personal experience.
• Becoming aware of the resources and support efforts of the AAP with respect to disaster preparedness and response. The academy’s department of federal affairs has helped make the AAP one of the leading forces for positive change at the federal level, Dr. Schonfeld said.
"The [AAP] Friends of Children’s Fund in general, and specifically the disaster relief part of that fund, helps not only children, families, and communities recover, but also assists professionals with self-care after these events," he said, noting that it is important to recognize that "it is distressing to be with children in distress."
"Events that are troubling our patients and their families are troubling to us as pediatric health care providers, as well," he said.
Dr. Schonfeld recommended the following resources for additional information:
• The AAP Children and Disasters site.
• The AAP Children and Disasters site, Coping and Adjustment.
• The AAP Medical Home for Children Exposed to Violence.
• The National Center for School Crisis and Bereavement.
Dr. Schonfeld reported having no relevant financial disclosures.
ORLANDO – Pediatricians can do a great deal to help their patients and communities in the wake of tragedies involving violence affecting children, according to Dr. David Schonfeld.
Unfortunately, it appears that such events are increasing in frequency, as evidenced by the headlines in recent months and years, Dr. Schonfeld, director of the National Center for School Crisis and Bereavement at St. Christopher’s Hospital in Philadelphia said at the annual meeting of the American Academy of Pediatrics.
It is important that when such events do occur, pediatricians work to address the impact of trauma on children; research suggests that supportive and nurturing adults can indeed mitigate the effects, said Dr. Schonfeld, a developmental and behavioral pediatrician and a member of the AAP Disaster Preparedness Advisory Council.
The available research, including both rat and human studies, highlights the role that nurturing by both mothers and other adults can play in protecting children.
In one set of experiments in rats, infants who experienced higher levels of maternal nurturing were less fearful and less reactive to stressful situations, and performed better on tasks thought to depend on optimal functioning of the hippocampus, Dr. Schonfeld explained.
Related studies showed that cross-fostering infant rats from mothers who provided less nurturing compensated for the lack of maternal nurturing.
This suggests that care and support provided by adults outside of the family can help promote the development and adjustment of children affected by a crisis, he said.
"These findings are directly applicable to humans. The National Collaborative Perinatal Project showed similar findings in humans at 8 months of age," he noted.
The project demonstrated that the degree of maternal nurturing in an experimental setting predicted the infants’ degree of emotional distress in adulthood.
An epigenetic phenomenon may explain how early parental nurturing results in less stress reactively in offspring in adulthood, he said, noting that this idea was supported by findings from recent postmortem analyses of the brains of suicide victims. Victims with a history of early-life adversity had lower levels of glucocorticoid receptor messenger RNA in their hippocampus and higher rates of DNA methylation in the same promoter region as in the rat model.
"A whole separate and growing body of research has also demonstrated that chronic severe stress, especially during critical periods of brain development, leads to long-term changes in brain function and structure," he said.
"If you take all of this together, it underscores the need to protect children from stressful situations as much as possible, to intervene quickly after stressful events occur, and to pay particular attention to minimizing subsequent stressors because of the particularly detrimental effects of chronic stress on children," he added.
He cautioned, however, that a child’s adjustment following a traumatic event is related not just to the trauma, but to what occurs as a result of the event.
For example, if a child loses a family member as a result of violence, difficulties experienced by the child may be a result of bereavement.
Dr. Schonfeld described one teen affected by the 2012 Aurora, Colo., shooting who was reluctant to return to school, and who declined offers of trauma counseling. Although many of his trauma-related symptoms – such as fidgeting and difficulty sleeping – had abated, he disclosed that he "just didn’t feel right, and felt sad and empty."
Further discussion revealed that his problem was one of bereavement; he had lost a close friend in the shooting.
"No one had suggested that might be an issue for him, and I have seen this in crisis event after crisis event when I’ve responded," Dr. Schonfeld said.
After a crisis, a "cascade of secondary losses" can occur, and any one of these can be the cause of difficulty for those affected, he added.
Also, keep in mind that even as such events seem to be occurring more often, children don’t "get used to it," he said.
"They simply learn that there is little benefit in asking for support or assistance from adults in these communities, because it is so infrequently offered to them," he said.
As a result, children may become fatalistic and engage in reactive risk-taking behaviors or counterphobic behaviors that place them at greater risk.
"But they don’t get used to it. And I would contend that neither should we," he said.
Pediatricians should, however, recognize and celebrate what they have done and can do every day to support children and families dealing with difficult situations.
"It makes a big difference. I don’t want you to get overwhelmed by all that could – and unfortunately does – happen, and the long-lasting and profound impact these violent events can have on children. Instead, I challenge you ... to commit to at least one strategy to advocate for violence prevention and/or readiness for your practice or your community to support those who have been impacted by these events," he said.
Such strategies can include:
• Working to decrease violence crisis and loss, and advocating for meaningful change.
• Giving voice to children impacted by these events, allowing them to tell their stories, and forcing a dialogue that can help move the agenda forward.
• Advocating for better systems and services for children affected by these events, and other adverse events in the lives of children, including poverty, exposure to urban violence, and food insecurity, for example.
• Becoming more skilled in supporting children who are grieving and traumatized.
• Ensuring that other professionals in positions to support children – such as teachers and other school staff – are better prepared, more skilled, and more effectively supported in helping children after these events (and introducing information that can help before such events occur).
• Inquiring about exposures and experiences routinely in the practice setting. (The Medical Home for Children Exposed to Violence project [MHCEV] is working to provide resources for identifying, treating, and referring affected children and youth.)
• Promptly identifying affected children at the time of an event, and facilitating discussion about the impact of the event, and offering "psychological first aid and psychoeducation." Attend to basic needs, provide triage and referral, and remember that services will be needed throughout the recovery period, which may be weeks, months, or years.
• Helping in one’s own community when events happen elsewhere, as communities struggle to understand and cope with the events, and deal with distress that can surface as a result of concerns and personal experience.
• Becoming aware of the resources and support efforts of the AAP with respect to disaster preparedness and response. The academy’s department of federal affairs has helped make the AAP one of the leading forces for positive change at the federal level, Dr. Schonfeld said.
"The [AAP] Friends of Children’s Fund in general, and specifically the disaster relief part of that fund, helps not only children, families, and communities recover, but also assists professionals with self-care after these events," he said, noting that it is important to recognize that "it is distressing to be with children in distress."
"Events that are troubling our patients and their families are troubling to us as pediatric health care providers, as well," he said.
Dr. Schonfeld recommended the following resources for additional information:
• The AAP Children and Disasters site.
• The AAP Children and Disasters site, Coping and Adjustment.
• The AAP Medical Home for Children Exposed to Violence.
• The National Center for School Crisis and Bereavement.
Dr. Schonfeld reported having no relevant financial disclosures.
ORLANDO – Pediatricians can do a great deal to help their patients and communities in the wake of tragedies involving violence affecting children, according to Dr. David Schonfeld.
Unfortunately, it appears that such events are increasing in frequency, as evidenced by the headlines in recent months and years, Dr. Schonfeld, director of the National Center for School Crisis and Bereavement at St. Christopher’s Hospital in Philadelphia said at the annual meeting of the American Academy of Pediatrics.
It is important that when such events do occur, pediatricians work to address the impact of trauma on children; research suggests that supportive and nurturing adults can indeed mitigate the effects, said Dr. Schonfeld, a developmental and behavioral pediatrician and a member of the AAP Disaster Preparedness Advisory Council.
The available research, including both rat and human studies, highlights the role that nurturing by both mothers and other adults can play in protecting children.
In one set of experiments in rats, infants who experienced higher levels of maternal nurturing were less fearful and less reactive to stressful situations, and performed better on tasks thought to depend on optimal functioning of the hippocampus, Dr. Schonfeld explained.
Related studies showed that cross-fostering infant rats from mothers who provided less nurturing compensated for the lack of maternal nurturing.
This suggests that care and support provided by adults outside of the family can help promote the development and adjustment of children affected by a crisis, he said.
"These findings are directly applicable to humans. The National Collaborative Perinatal Project showed similar findings in humans at 8 months of age," he noted.
The project demonstrated that the degree of maternal nurturing in an experimental setting predicted the infants’ degree of emotional distress in adulthood.
An epigenetic phenomenon may explain how early parental nurturing results in less stress reactively in offspring in adulthood, he said, noting that this idea was supported by findings from recent postmortem analyses of the brains of suicide victims. Victims with a history of early-life adversity had lower levels of glucocorticoid receptor messenger RNA in their hippocampus and higher rates of DNA methylation in the same promoter region as in the rat model.
"A whole separate and growing body of research has also demonstrated that chronic severe stress, especially during critical periods of brain development, leads to long-term changes in brain function and structure," he said.
"If you take all of this together, it underscores the need to protect children from stressful situations as much as possible, to intervene quickly after stressful events occur, and to pay particular attention to minimizing subsequent stressors because of the particularly detrimental effects of chronic stress on children," he added.
He cautioned, however, that a child’s adjustment following a traumatic event is related not just to the trauma, but to what occurs as a result of the event.
For example, if a child loses a family member as a result of violence, difficulties experienced by the child may be a result of bereavement.
Dr. Schonfeld described one teen affected by the 2012 Aurora, Colo., shooting who was reluctant to return to school, and who declined offers of trauma counseling. Although many of his trauma-related symptoms – such as fidgeting and difficulty sleeping – had abated, he disclosed that he "just didn’t feel right, and felt sad and empty."
Further discussion revealed that his problem was one of bereavement; he had lost a close friend in the shooting.
"No one had suggested that might be an issue for him, and I have seen this in crisis event after crisis event when I’ve responded," Dr. Schonfeld said.
After a crisis, a "cascade of secondary losses" can occur, and any one of these can be the cause of difficulty for those affected, he added.
Also, keep in mind that even as such events seem to be occurring more often, children don’t "get used to it," he said.
"They simply learn that there is little benefit in asking for support or assistance from adults in these communities, because it is so infrequently offered to them," he said.
As a result, children may become fatalistic and engage in reactive risk-taking behaviors or counterphobic behaviors that place them at greater risk.
"But they don’t get used to it. And I would contend that neither should we," he said.
Pediatricians should, however, recognize and celebrate what they have done and can do every day to support children and families dealing with difficult situations.
"It makes a big difference. I don’t want you to get overwhelmed by all that could – and unfortunately does – happen, and the long-lasting and profound impact these violent events can have on children. Instead, I challenge you ... to commit to at least one strategy to advocate for violence prevention and/or readiness for your practice or your community to support those who have been impacted by these events," he said.
Such strategies can include:
• Working to decrease violence crisis and loss, and advocating for meaningful change.
• Giving voice to children impacted by these events, allowing them to tell their stories, and forcing a dialogue that can help move the agenda forward.
• Advocating for better systems and services for children affected by these events, and other adverse events in the lives of children, including poverty, exposure to urban violence, and food insecurity, for example.
• Becoming more skilled in supporting children who are grieving and traumatized.
• Ensuring that other professionals in positions to support children – such as teachers and other school staff – are better prepared, more skilled, and more effectively supported in helping children after these events (and introducing information that can help before such events occur).
• Inquiring about exposures and experiences routinely in the practice setting. (The Medical Home for Children Exposed to Violence project [MHCEV] is working to provide resources for identifying, treating, and referring affected children and youth.)
• Promptly identifying affected children at the time of an event, and facilitating discussion about the impact of the event, and offering "psychological first aid and psychoeducation." Attend to basic needs, provide triage and referral, and remember that services will be needed throughout the recovery period, which may be weeks, months, or years.
• Helping in one’s own community when events happen elsewhere, as communities struggle to understand and cope with the events, and deal with distress that can surface as a result of concerns and personal experience.
• Becoming aware of the resources and support efforts of the AAP with respect to disaster preparedness and response. The academy’s department of federal affairs has helped make the AAP one of the leading forces for positive change at the federal level, Dr. Schonfeld said.
"The [AAP] Friends of Children’s Fund in general, and specifically the disaster relief part of that fund, helps not only children, families, and communities recover, but also assists professionals with self-care after these events," he said, noting that it is important to recognize that "it is distressing to be with children in distress."
"Events that are troubling our patients and their families are troubling to us as pediatric health care providers, as well," he said.
Dr. Schonfeld recommended the following resources for additional information:
• The AAP Children and Disasters site.
• The AAP Children and Disasters site, Coping and Adjustment.
• The AAP Medical Home for Children Exposed to Violence.
• The National Center for School Crisis and Bereavement.
Dr. Schonfeld reported having no relevant financial disclosures.
EXPERT ANALYSIS FROM THE AAP NATIONAL CONFERENCE
