“My heart breaks to say this, but we’re going to be here again”

By Maureen Gilmer, IU Health senior writer, mgilmer1@iuhealth.org

Last month’s deadly school shooting in Nashville, Tenn., followed by Monday’s mass shooting in Louisville, Ky., reawakened unsettling feelings of fear, grief and anger in parents.

How can they talk to their kids about these terrifying events?

No matter how hard we might try to protect our children from such news, the reality is they are likely to hear about it – at school, on the bus, online.

For that matter, kids who attend school outside the home already practice for the unthinkable during lockdown drills.

That is reason enough for parents to have age-appropriate conversations with their kids about these traumatic events, according to Dr. Gabriela Rodriguez, assistant professor of clinical psychiatry at the IU School of Medicine and director of the ADHD and Disruptive Disorders Clinic at Riley Children’s Health.

How can parents help kids process these events?

“What I say to parents in my clinic is, start the conversation,” Dr. Rodriguez said. “A lot of kids will be aware these things are happening but may not know how to bring it up. I think it’s important for parents to take that step and let kids know that they can ask any questions.”

When is it appropriate to start that dialogue?

“We never want to scare kids for no reason. But if a child is going to school, they’re likely to know something about this because there are likely to be drills,” she said. “As soon as they start to have that type of exposure, I think it’s important for parents to start the conversation. It’s also OK to start by saying, ‘There have been some things going on in the news. Is there anything you are worried about, anything we should talk about together?’ Follow your child’s lead and respond to whatever their concerns are. We want to open the conversation, but we don’t want to push them if they don’t want to talk. Let them know we’re there and we are ready to talk when they are ready.”

What signs should a parent look for to know if their child is anxious?

“Behavior is communication. Keep an eye out for changes,” she said. “You might not think it’s related if a child is acting out a little, but often it is. Kids aren’t always going to show us the emotions we expect. So any sort of change in behavior we want to be sure to address. It won’t necessarily look the way it would in an adult. They might show some signs of anxiety or fear, they might be worried that it might happen at their school or another school. Or they might be more irritable or angry, they might have changes in their sleep or their appetite, less interest in their usual activities. Often in kids, anxiety and fear show up as physical complaints – stomach aches or headaches. We want to look for a broad change in behavior overall and pay attention to that if it sticks around … over several days or weeks.”

How can parents help their kids feel safe?

“This is tough because anytime we’re talking about kids experiencing any sort of worry or anxiety, usually the conversation is around parents reminding kids what they’re doing to be safe,” Dr. Rodriguez said, using the recent tornadoes in Indiana as an example.

“Whether that means keeping an eye on the news, going to a safe location, having food and water – it’s a little easier to have the conversation. It’s tougher in this scenario because there are things happening in schools to promote safety like drills, but it’s challenging that as a society we’re not necessarily doing much to make a change, so that’s a really difficult conversation.”

But it starts with listening, she said. To get the conversation started, a parent might say, “I’ve noticed you’re having a harder time sleeping the past few nights,” and see what their child says. She encourages parents to model good coping skills as well and to acknowledge their own emotions.

When should parents seek medical advice for their kids?

If it’s a change in sleep habits or increased worry, and it persists for a couple of weeks, your child’s pediatrician can talk you through coping strategies. If it’s a marked change, if there is any safety concern, or your child is starting to engage in self-harm, speak to your pediatrician immediately, Dr. Rodriguez said, and get a referral to a mental health professional.

PARENT AND PEDIATRICIAN

Dr. Sarah Bosslet is a Riley Children’s Health pediatrician and the mother of four children. Her oldest two – twins – were in first grade a decade ago when the Sandy Hook Elementary School shootings in Newtown, Conn., took place. Twenty first-graders were among those murdered that day.

Her kids didn’t go to that school or even live in that state, but it still shakes her to this day.

“I went out of my way to not expose them to any of it as much as I could,” Dr. Bosslet recalled. “I was especially cautious not to have radio or TV on so they wouldn’t overhear things, but I did watch them and nudge, asking if they heard anything at school, because I wanted to be ready if they asked about it.”

Ten years later, school shootings have become more and more frequent around the country, each time tearing at the sense of security parents feel when sending their kids to school.

“Personally, I’m still in a place of complete denial that my kids have to be exposed to this,” Dr. Bosslet said. “I get so angry that it’s feeling so much more ubiquitous now. I have to check my own emotions about it all and just speak to them more matter-of-factly.”

The fact is, gun violence is now the leading cause of death for U.S. children under the age of 18, according to the American Academy of Pediatrics.

TALKING WITH TEENS

Dr. Bosslet’s twins are teenagers now, so she and her husband, Dr. Gabriel Bosslet, can talk more openly about gun violence, but they have younger kids as well.

“With a teenager, it’s a different conversation. They know I’m pretty vocal about it ... in advocating and speaking up about how important it is to keep our children safe from gun violence,” she said. “That’s one way I feel some control over something that feels very out of control.”

With their youngest, a second-grader, she makes a point to ask questions if she finds out there has been a lockdown drill at school.

“I talk to him about why they’re doing that, what does that mean,” she said. “I don’t want to feed him information that he doesn’t need right now, but I do want to make sure he knows he can talk to me about it and that he understands it.”

She and her husband also keep a watchful eye on what media their children consume.

The American Academy of Pediatrics offers an interactive tool on its healthychildren.org website that allows families to create a media use plan for individuals in the family – from toddlers to teens.

WATCH AND LISTEN

Like Dr. Rodriguez, Dr. Bosslet said you can learn a lot about how your child is feeling by paying attention to behaviors they might exhibit.

“That’s how kids show stress,” she said. “If they’re not sleeping well, if they’re waking up or having nightmares, if they are more irritable and agitated, those are usually early signs. Some kids will eat less, and some kids will eat more when they feel stress,” the pediatrician said.

“A lot of kids will complain about upset stomachs. These things will happen to almost every kid at some point, but if it becomes a recurrent pattern and if it is getting in the way of them functioning, those are signs they probably need to check in with their pediatrician.”

Dr. Bosslet begins any such consultation by talking to parents about their own adult response to trauma and how they calm themselves. Sometimes that can mean deep breathing (for younger kids, blowing bubbles or a pinwheel can help), taking a walk, or creative activities like drawing.

The goal is to reassure kids, help them feel safe and let them know that these anxious feelings won’t last forever.

For those kids who aren’t improving, or if it’s a situation that the parents and pediatrician sense is more acute, a referral to therapy might be appropriate.

Dr. Bosslet has one more tip for parents of middle-schoolers and teens.

“We often wait for them to come to us with what they need or want,” she said. “And we all know as parents that they will hide in their room and online. I encourage parents to actually go to where their child lives – in their room – and do a check-in there. You’ll learn so much more about them and from them if you ask permission to come into their space than if you wait for them to come to you to initiate a conversation.”

PUBLIC HEALTH CRISIS

In the wake of the slaughter of 19 students and two adults at Robb Elementary School in Uvalde, Texas, last May, IU Health President Dennis Murphy spoke directly to IU Health team members when he said, “We have a responsibility to call out gun violence as a public health crisis.”

“Many of our clinicians and leaders advocate for better public policy when our loved ones and neighbors are suffering and dying unnecessarily,” Murphy wrote. “We speak up about maternal and infant mortality, opioid addiction, tobacco and alcohol dependence, and most recently, COVID-19 vaccinations. Reasonable people may disagree on solutions, but we have a duty to advocate and speak openly when evidence-based research points toward responsible solutions. Remaining silent is unacceptable.”

IU Health is working to expand access to mental health services in the communities it serves, as well as advocate for public health policies that will help Indiana become one of the healthiest states, he said.

WHERE DO WE GO FROM HERE?

“My heart breaks to say this, but we’re going to be here again, unfortunately,” Dr. Rodriguez said. “As much as I wish that this was never going to happen again so we don’t have to talk about it, I don’t think that’s the case, given the rate that we’re seeing.”

To learn more about helping kids deal with stress related to gun violence, check out the National Child Traumatic Stress Network website, NCTSN.org.

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