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As war begins in Iraq, expert says talk, play and routine are important for children to cope

– With "No War" signs in neighborhood windows, protesters on city streets and televised images of soldiers in combat, children can't help but notice the war in Iraq. At home and at school, many are asking questions about war and picking up on adults' own anxieties and fears.

"The kinds of events we're now experiencing as a nation and society potentially affect all or most kids," said W. Thomas Boyce, MD, professor of epidemiology and child development at the University of California, Berkeley, School of Public Health.

"There's not much in the way of concern, anxiety or fearfulness on the part of the parents that can actually be hidden from young children," he added.

Boyce emphasizes the importance of communication between parents and children to help cope with stress. Parents should be available to listen to and reassure their children, and to answer their questions simply and honestly, said Boyce, who has 25 years of clinical experience in developmental pediatrics, 10 of them at UC San Francisco as head of the Division of Developmental and Behavioral Pediatrics.

While everyday life can be fraught with such concerns as financial security or school performance, Boyce said exceptional events, such as a devastating earthquake or war, present salient stresses for children.

Depending upon the developmental stage of the child, normal reactions range from temporary regressive behaviors, such as a loss of toilet training for toddlers, to greater separation fears for preschoolers, said Boyce. Older kids in primary school may complain of body aches, have nightmares, and experience a transient decline in school performance.

Such symptoms were quite common in the aftermath of the 1989 Loma Prieta earthquake, and it's important for parents to understand that such behaviors are normal coping mechanisms that typically pass with time, said Boyce.

"Under these kinds of conditions, kids need a sort of predictable world that is filled with people they know they can depend on and who care about them," said Boyce. To the extent possible, he said, parents should try to maintain routine and structure for a child.

He also noted that parents need not discontinue daycare for children going through separation anxiety, but can stay a bit longer at the point of separation to ease the transition into school.

"In any kind of event like this, the single most important thing parents can do is be present and available and in contact with their kids," he said. "And hold them. That physical presence of the parent and the parent's availability for questions create security for the child."

Parents and teachers may also notice children incorporating aspects of war into their play, which is another common strategy kids use to cope with the world around them, said Boyce.

Military families face special concerns as troops deployed begin to battle. What can parents do when a child asks about a close relative or family friend who was sent to war?

"I often tell parents to lead with the question, not with the answers," said Boyce. "Don't assume that the question is what you think it's about. Ask for more specifics from the child."

For instance, a child asking about a father deployed overseas may actually be wondering what his parent's daily life will be like, not whether he will be attacked with chemical or biological weapons.

"If the child goes on to ask specifically about the family member's safety, an honest answer can include reassurances that everything we know to do is being done to protect this person we love," said Boyce.

At UC Berkeley, Boyce continues his research into how children react to stress. He has found in studies that there is a subset of children - as many as one in five - who are exceptionally sensitive to adversity and stress.

If a child appears to be unusually obsessed with war or experiences inconsolable anxiety, Boyce recommends that parents seek help from an expert such as a pediatrician or child psychiatrist.

To help children deal with stress, Boyce developed the following tips for parents and caretakers:

  • Be present and available. Talk, listen and reassure.
  • Provide simple, direct answers to questions. Be honest.
  • Touch your kids. Holding and physical contact helps.
  • Maintain routines. Stick with regular bedtimes, mealtimes, etc.
  • Understand developmental differences. Reactions differ depending upon the developmental age of the child.
  • Allow stress-related play, which is one of the principal methods of coping for a child.
  • Set a good example for coping methods. Pace yourself, divide tasks into manageable pieces, exercise and become involved in extracurricular activities.
  • Seek professional help when needed. Pediatricians, child psychiatrists, social workers and child psychologists are good resources.