Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. Through stories from my behavioral pediatrics practice (with details changed to protect privacy) I will show how contemporary research in child development can be applied to support parents in their efforts to facilitate their children’s healthy emotional development. I will address factors that converge to obstruct such support. These include limited access to quality mental health care, influences of a powerful health insurance industry and intensive marketing efforts by the pharmaceutical industry.

Wednesday, September 7, 2011

Keeping Children in Mind on 9/11/11

When I first learned of the planes hitting the twin towers, my initial thought was that I wanted my children, then three and six, home with me. This is despite the fact that I live in a rural community 125 miles north of New York City that was in no way physically affected by the trauma. As the 10th anniversary of 9/11 approaches, I have been thinking of reaction, of how in the face of overwhelming fear our first instinct is to be near our children.

Children, in fact, have a similar reaction. This behavior was initially termed "attachment behavior" by John Bowlby, a British psychoanalyst who developed his theories in England during World War II, when he saw the devastating effects on children who were routinely separated from their parents and moved to the countryside, ostensibly to "keep them safe." Heavily influenced by Charles Darwin, he recognized this behavior, this drive to seek out primary caregivers in the face of fear, as essential to the survival of our species. Over 50 years of subsequent research based on his original theories has shown that in order for a child to feel secure in this attachment, a parent needs to be reliably available, both physically and emotionally. It is this sense of safety and security that gives children the freedom to explore, grow and develop.

In other words, in order for them to be OK, they need first and foremost for us to be OK. Certainly it is important include children in conversations about 9/11, to listen carefully to what they are thinking and feeling, and to clarify any misperceptions they may have. But this listening cannot happen effectively if parents do not first take care of themselves.

I once saw a mother in my behavioral pediatrics practice who's family had experienced a different mass trauma (to protect privacy I will omit details) She wanted me to meet with her two school age girls to "make sure they're OK," a perfect example of that instinct to protect the children first. I suggested instead that I meet with the parents. The mother came by herself- the father was still back at the site of the trauma. She had relocated to my town to stay with family. We spent an hour talking mostly about what the experience had been like for her.

She was suffering from anxiety not only about the effects of the initial trauma on her children but also the massive uncertainly of their future and such basic questions as where they would live. But we also talked about other things. One was her relationship with her own parents. Her father, who had died recently, was an incredibly stoic man who had himself survived unimaginable trauma. We talked about how she thought of him often and tried to emulate him. But she recognized that she was shouldering in a lot in trying so hard to be brave. At the end of the hour, she smiled, let out a big sigh, and said, " I really needed to talk about this. I feel so much better!" She recognized that her children were doing well, as evidenced by the fact that they were doing their schoolwork and participating in all of their usual activities. More than anything they needed for her to be fully present with them. And to do that, she herself needed to be heard .

Immediately following the terrorist attacks of September 11, 2001, leading trauma researcher Susan Coates provided critical mental health services to children and their parents at the Family Assistance Center set up by Disaster Psychiatry Outreach in New York City. In an interview Dr. Coates said, "Parents are often surprised by how much their children have taken in. And sometimes we find that we need to shift our attention to parents who are so overwhelmed already that they cannot take in what their children are communicating and find that their own posttraumatic stress is triggered by what their children are communicating."

As pediatrician, I often have parents ask me "what to do" in a range of situations. I understand this wish to have some kind of instruction manual, especially in the face of this upcoming anniversary. But in fact parents are the experts regarding their child, and if I tell them what to do I am undermining their natural authority. What I do instead, as I did with this mother, is offer them a place to be heard, with the hope that this will free them to be with their child both physically and emotionally- to be, in Bowlby's words "a secure base." From this place, "what to do" will follow naturally.

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