A child’s response to disaster is influenced by developmental stage, parental coping, and family stability. Parents are expected to monitor the eating, sleeping, and socializing of very young children, while students in elementary school require less monitoring. Yet school children still depend on adults for support. When adults experience injury, loss of income, or displacement, family routines are inevitably disrupted. Teens may be overwhelmed if expected to fill parenting roles during times parents are emotionally unavailable or stressed. Parents with developmental problems manifested by educational or vocational failure tend to impose their difficulties on their children. Importantly, heads of households need to keep children engaged in schoolwork, involved with healthy peers, and committed to steady routines around eating, sleeping, playing, and studying.

Clinicians should assess and monitor risks to normal child development across all phases of a disaster.^1,2 Studies indicate symptoms of anxiety and depression are the most common vulnerabilities in a disaster. Notably, the greater the proximity to the event, the greater the likelihood that emotional reactions will persist. Researchers found that over two years following the 9–11 terrorist attacks in New York, “Younger children (6–11 years) were more likely to present with anxiety, problems concentrating, social isolation, and withdrawal, whereas older children (12–17 years) were more likely to exhibit numbing, avoidance reactions, and substance abuse.”³ Children at risk may show signs of sleep disturbance, conflicts with caregivers, and poor school adjustment. Children at low risk usually experience little distress or change in functioning.

First aid to persons in psychological distress involves mobilizing support and assistance. Government, private, and volunteer organizations comprise the system of disaster care. Command and control of the response includes coordination of responders like the American Red Cross, who partner with other agencies providing disaster relief. Local agencies unique to the community serve in familiar settings like places of worship or halls operated by service organizations. Media and public service announcements can provide information on the availability of these support services – especially services available to children and families. Importantly, repeated viewing of media coverage in shelters may induce excessive or visible anxiety in both children and their parents.

Researchers analyzing the response to Hurricane Andrew concluded that adults who diverted children from watching excessive television while out of school reduced emotionally troubling images in their children. School is a major life activity for children. A school psychologist is often the key person to whom faculty, staff, and parents turn to when confronted with events that overwhelm the coping ability of students. School psychologists in some locations have been trained as mental health partners in disaster response. Importantly, they may be familiar with the most vulnerable students and families and the services they already receive in the local system of care. School psychologists serve as a vital resource for helping children and families feel supported and more in control of their lives.

Children and adolescents do best when routines are preserved. The routine of sleep is crucial for healthy functioning. Investigators from the Department of Epidemiology and Public Health London, England found that young children with regular bedtimes have fewer behavioral problems than youngsters who did not. Clinicians should support family routines that encourage adequate sleep and rest. When children present with sleep problems, melatonin is recommended over prescription sleep aids for the restoration of earlier bedtimes and earlier wake up times. For children and adolescents taking prescription medications, adult should limit access to psychotropic or controlled medications to prevent non-medical use. Parents need to be reminded of the importance of proper storage and safeguarding of medications with abuse potential, such as stimulants or anti-anxiety pills. Investigators at the University of Michigan noted over 70% of adolescents recently prescribed controlled medications had unsupervised access to prescriptions pills at home.⁴

The Ministry of Social Development in New Zealand reviewed the literature on family resilience and noted certain qualities allow families to cope with adversity and challenges to their well-being.⁵ Families with strong emotional bonds, who are able to find meaning in difficult circumstances do better than families unable to make sense of events altering the family’s sense of place or future in the community. Although families with teenagers may demonstrate less cohesion, families with adolescents actively seeking autonomy do not necessarily show impaired functioning during a crisis. On the contrary, adolescents often have networks of support and communication that provide robust connections to resources. Importantly, social media used by teens may provide a methodology for rapid location of persons separated from families. Teens may provide a ready source of energy and optimism, when resolution of a disaster is prolonged.

Economic calamity for parents may aggravate abuse or neglect of children. The presence of clinicians at a disaster may provide opportunity for recognition of child maltreatment. Recognition may be difficult under ordinary circumstances. Marital problems, intimate partner violence, and financial stress contribute to child maltreatment. Inquire about safety and welfare. Ask, “How are things at home?” Clues to potential problems include responses like, “Mom and Dad yell all the time.” Ask, “What do you wish was different that would make you feel better?” You might get an answer like “I wish dad would not drink so much.” If the mother is being assaulted, the chances increase that the children are witnessing abuse. Use systems in place for reporting domestic violence. When confronted with evidence of child maltreatment, engage social services or child protective services. When circumstances prevent a definitive determination of abuse, engage trained volunteers to provide crucial support to families, whose crisis may not rise to the level of investigation by protective services.

Some families are raising special needs children. These children may have mobility issues or have limited flexibility involving daily routines. The importance of maintaining consistent routines is vital for these youngsters. In a policy statement regarding youth preparedness for disaster the American Red Cross advised parents, “How you react to an emergency gives them clues on how to act. If you react with alarm, your child may become more scared. They see your fear as proof that the danger is real. If you seem overcome with a sense of loss, your child may feel their losses more strongly.” A resource for parents is a mobile application developed by the American Red Cross called “Monster Guard” (www.redcross.org/monsterguard). Sponsored by the Disney Corporation, this application includes games in addition to tips on how to manage real-life emergencies. Games can be particularly helpful for anxious kids or older kids with developmental challenges overwhelmed by new environments. For mobile devices to function, these devices must be charged and re-charged. Portable chargers or special radios are available with hand-cranks to energize batteries when off the grid.

Informed consent is different for youth, especially if they are under the age of 16. By age 16 some jurisdictions recognize that an individual may demonstrate sufficient maturity and intellectual capacity to grasp the nature of the procedure, the implications of the proposed procedure (reversible or non-reversible), the alternatives, and possible risks by expressing a choice in his or her own best interest. When a person is unable to make a reasoned decision due to intellectual delay or cognitive impairment, he or she would be considered unable to give expressed informed consent, even if that individual has reached the age of consent. Under these circumstances, a court order would be necessary unless delay would compromise the life of the patient. Magistrates may need to be involved if an older teen is refusing a procedure his or her parents advocate, but the individual has not reached his or her eighteenth birthday. For example, standard trauma practice may require amputation, but the young person objects. Ideally, the child, the parents, and the clinician agree on the best intervention. When a parent’s refusal to provide consent for a non-elective procedure places an underage child at risk, the physician may seek an injunction or order. Legal counsel is advised when in doubt about the doctor’s authority to provide care.

Disasters may produce conditions conducive to human trafficking. A toll free hotline for human trafficking, 1–888-373–7888, is provided by the National Human Trafficking Resource Center. This hotline is designed as a coordination mechanism between law enforcement and government. According to the Polaris Project half of the 27 million people trafficked globally are children. The website http://globalmodernslavery.org/ provides a directory of antitrafficking agencies based on location. These locations tend to be at international entry points, such as port cities. Notably, coastal regions are often subjected to hurricanes and flooding. Important indicators and red flags for human trafficking include poor mental and physical health among persons under the age of 18, who seem reluctant to speak freely, who are not free to come and go and who lack sufficient funds, typical photo identification or permanent address. Disaster responders should look for signs of trafficking amongst young people who appear without family or legitimate employment.