By Gregory K. Fritz, M.D.

It has been devastating to see, again and again -- the images of a jetliner smashing into the World Trade Center, the massive buildings still full of people collapsing upon themselves, the usually forbidding Pentagon on fire with an airplane shaped hole in its side, fireman sobbing on the sidewalks of New York and countless other horrific scenes from our nation's greatest tragedy.

Even as we trembled with the first shock of learning what happened, most parents immediately thought of our children. The desire to gather them together, to hold our children, in person or on the telephone, is a fundamental reaction of parents to news of a disaster.

Soon after, the questions arise: what does one say to children about events that we can't fully fathom ourselves? How can we help our children, whose lives we want to be filled with joy and trust? Will there be scars, permanent psychological damage to fresh young minds left by the images and the events?

Fortunately, there are things parents can do for their children to help them cope with a disaster that seems overwhelming. Most important is for parents to realize that children are more affected by their immediate environment than by a distant catastrophe, no matter how awful it is.

The younger the child, the more the family constitutes their world. Parents need to monitor their own reactions and moderate their expressions of anxiety, grief or rage. In their children's presence, they should be sufficiently composed to be able to respond to their needs for support, comfort and explanation. Without minimizing the horror of what happened, a parent's calm demeanor and a sense of stability will allow children to mobilize their own coping mechanisms.

Television coverage is nearly constant and extremely vivid in a major disaster. Thus it is impossible to completely shield children from the troubling images, even if it were desirable.

Parents can, however, limit the exposure to televised accounts of the tragedy. When parents watch the television with their children, they can see their reactions, provide an atmosphere of security, clarify misperceptions and initiate discussion of what is depicted.

Using communication

Communication is key to coping. A catastrophe is frightening to both children and adults, and it is important to acknowledge the frightening aspects. Expression of feelings, even when there is not a "solution" to them, is helpful.

Scheduling periodic family meetings, in which family members describe their reactions, ask questions and ventilate emotions, can provide a needed sense of structure as well as promote family cohesion and support.

Parents should recognize that children need extra time and attention in the days following a disaster. The family routine should be maintained, at least in part, to allay fears that everything is falling apart.

Response may depend on age

A child's age and level of cognitive development will affect how he or she responds to the disaster. A young child may demonstrate a need for security by wanting to sleep in the parents' bed. Parents should be direct and confident in reassuring young children that they are safe, that they can and will take care of them.

Young children are not reassured by subtle qualifications ("we'll try our best to make sure nothing happens to you"; "it's unlikely the terrorists will come here"); they need clear, black-and-white reassurance. They have a whole lifetime ahead of them to deal with ambiguity and uncertainty, and the period immediately following a disaster is not the time to practice.

Older children, in contrast, have a broader range of responses and ask tougher questions. A nine-year-old, upon hearing about the terrorist attack, asked concretely, "is the President safe?" Rather than reflecting political interest, this question conveyed fears about whether the as yet only dimly understood structures of our society were still in operation. "He's in a safe place with the army on guard" was a very satisfying answer.

Adolescents' questions about the nature of evil, why terrible things happen to good people, what the degree of safety really is, etc. don't have pat answers. Parents should respond based on their own values and beliefs, but the crucial aspect is willingness to discuss them thoughtfully with the adolescent.

Active, tangible outlets for strong feelings are useful to both children and adults, whether it's giving blood, drawing a picture, raising money for the disaster relief or sending a card. The natural resiliency of children, combined with a sensitive reaction from parents, teachers and other professionals, will make an adaptive response likely. Those children who were directly exposed to the catastrophe or who lost loved ones are at the most risk for subsequent problems. If fears, sleep disturbance, decreased ability to concentrate or other behavioral symptoms persist beyond 2-3 weeks, professional treatment should be sought.