And few issues generate as much advice — both solicited and unsolicited — from family, friends, and professionals. Whether it is the financial benefits of doing away with diapers to the adverse psychological effects of failure, everyone seems to have something to say about the subject. In my experience, the process goes quite well as long as parents relax and keep a few simple things in mind.

First, the key to successful toilet training is readiness. A child cannot be expected to complete a task if he has not developed the requisite tools for the task. Unfortunately, many parents fail to realize just how many tools are involved.

Obviously, the child must have developed the ability to control his bowel and bladder muscles. That is, he must be able to “hold on” and “let go” at will. And most children have achieved this ability by about 18 months of age. However, we are talking about a rather complex task. And while the ability to control the bowel and bladder muscles is necessary for successful toilet training, it is by no means sufficient. The child also must have developed the gross motor ability to climb onto the seat and balance himself comfortably, the fine motor ability to unfasten and remove his clothes quickly, the cognitive and linguistic ability to express his needs and follow instructions, etc.

Consequently, with regard to all the requisite physical and mental skills involved, most children will not be completely ready until months later. Thus, given the enormous variability in rates and patterns of development, the normal range for the accomplishment of toilet training is anywhere from two to almost four years of age.

More importantly, the child must be psychologically ready for the task. And this is where things can get complicated. Just as children start to become physically and mentally ready, they typically enter a phase referred to as “negativism.” This is when the child realizes that he has power in social relationships and is compelled to test the limits of his newfound power. His favorite word is now “no” and he takes delight in refusing any and all requests and instructions from his parents.

That is why it is critical for mothers and fathers to wait until doing away with diapers is something that the child wants as much as, if not more than, they do. As long as the child realizes this is something he can use to wield power in the parent-child relationship, he will be more inclined to drive them crazy than to cooperate. And the more desperate they appear to become, the more deeply entrenched his resistance will be.

As an aside, some parents induce cooperation by offering rewards — usually candy or some other sweet treat — for using the toilet. While this method does work on occasion, it can be rather risky as it reinforces the child’s sense of control. I’ve often witnessed the scene where a “successfully trained” child grabs a candy bar while waiting in the supermarket check-out line with his parents. When they tell him he can’t have it and has to put it back, the child squats and squints, indicating that if he doesn’t get what he wants, he will punish his parents by pooping in his pants.

So when will the child be psychologically ready? The basic answer to this question is that he will be prepared to cooperate when he realizes that being a “big boy” is better than being a “baby.” But there are many factors that influence the onset of this epiphany, so again, there is a great deal of variability among children.

Although it is not always the case, it is fairly typical that later-born children complete the toilet-training process earlier than first-born children, thanks to sibling rivalry. The younger child sees his older sibling as having more privileges and having more opportunities for fun activities, and he is eager to do anything that will help eliminate what he perceives to be his second-class status.

However, whether or not there is an older sibling, as the child approaches the third birthday, he develops a wonderfully aware and imaginative mind that enables him to picture the many advantages of ditching the diapers. By reading stories or simply by talking about fun-filled events that are only available to “big boys,” parents can incite a strong desire to “grow up” as soon as possible.

Mothers and fathers can make this a more tangible experience by relating being a big boy to items and experiences that are directly important and meaningful to the child. Let’s say the child has become enamored with a particular cartoon character. His parents can buy underwear featuring that character and point out that it can only be worn once the toilet-training process has been successfully completed. Or let’s say the child desperately wants to go to a local amusement park. It can be explained that the park is off-limits to children who are still in diapers.

In doing so, it is important for the parents to refrain from turning this into an “if you do this then you will get that” scenario. Like the sweet treat reward situation discussed earlier, this can create a power-and-control situation in which defiance becomes more important to the child than acquiescence. Parents must remain as calm and casual as possible, and always project the notion that this is something about which the child may be greatly concerned but is really no big deal to them.

If a little more encouragement is required, then parents can also count on peer pressure eventually being brought into play. Up until about two years of age, children generally have little or any interest in other children—all their social and emotional energy seems to be invested in the adults in their lives, and perhaps their siblings. But after children pass the second birthday, this gradually begins to change, and they become increasingly inclined to play with their peers.

Once this kicks in, having to take a “time out” to get a diaper changed becomes a significant source of inconvenience for the child. Furthermore, having to be treated like a baby in front of his playmates becomes an enormous embarrassment as well, especially if none of the other kids is still in diapers. Consequently, trips to the park, the beach, or any other area that provides peer play opportunities are now transformed into major motivational events.

Finally, mothers and fathers should remember to react to any inclination to get trained and any progress toward that end with pride rather than relief. A poop in the potty that results in an “I’m so proud of you” or “I’m so happy for you” is likely to be followed by more, whereas one that results in a “Thank goodness” or “It’s about time” may merely remind the child that this is a potentially valuable source of power.

I guess the whole thing can be summed up best by a quote from President Harry Truman, who once said, “The key to successful parenting is to find out what your child wants to do…and then tell him to do it.”

Toilet training photo available at Shutterstock

One of the perceived disadvantages is that the breastfeeding mother will get less sleep at night. This is an important and real concern. Sleep disruption is known to have a major impact on the mother’s ability to function during the daytime and is a risk factor for postpartum depression.

Postpartum women need to consider strategies — with their family and support partners — for ways to maximize their consolidated sleep. However, few scientific studies have addressed whether feeding methods really do affect the mother’s sleep. There are a handful of studies (mostly based on mother’s subjective report) that suggest that breastfed infants sleep longer and awaken less frequently during the night. But this does not tell us whether the mother’s sleep also differs.

Therefore, our goal with this study was to determine whether mothers’ sleep or daytime functioning differed based on whether she was exclusively breastfeeding, formula feeding, or using a combination of the two.

To accomplish this goal, my collaborators Dr. Heather Clawges (a pediatrician and lactation consultant), Ms. Eleanor Santy (an undergraduate research assistant) and I asked mothers to volunteer to wear a wristwatch-type device called an actigraph. The actigraph recorded the mothers’ movements, and told us when each mother was awake and asleep.

Every morning, within a short time after awakening, the mothers used a hand-held computer to tell us her perceptions of her sleep: how often she had awakened that night, how much total time she was awake during the night, and her sleep-quality score. During the day, whenever she fed her baby, the mother also used her hand-held computer to report her current level of sleepiness and fatigue.

The 80 women who participated in the study contributed this information for 15 continuous weeks, starting when their babies were one week old. A researcher visited the mother each week to give her a new wrist monitor and hand-held computer, but did not give her any sleep advice. It is also important to note that each woman was screened before the study started and was not eligible for the study if she had symptoms or a history of depression.

The results of this study were very straightforward: We did not find differences between women who had exclusively breastfed, exclusively formula fed, or used a combination of the two methods on any measure. In other words, feeding method made no difference in terms of objectively measured total sleep time, sleep efficiency (the ratio of sleep to wake during the night), or sleep fragmentation (the amount of sleep interruption during the night) as recorded by the wrist monitor. Nor were there any differences based on the mothers’ subjective reports of their number of nocturnal awakenings, total nocturnal wake time, or sleep quality. Finally, there were also no differences between groups on daytime levels of sleepiness or fatigue.

One sidenote is that we also asked the mothers who gave the nighttime feedings at each week. We were surprised to learn that not one single mother had help giving nighttime feedings, even if she was exclusively formula feeding! The contrast between our findings of no differences based on feeding methods and the previous studies showing that breastfed infants awaken more often at night is intriguing. Common sense would declare that if the infants awaken more often, then their mothers should, too. It is possible that despite their self reports, breastfeeding mothers awaken more often during the night to feed their infants but that they return to sleep more quickly or sleep during feedings, and consequently do not remember these awakenings. We cannot test this unequivocally because the wrist monitor is not sensitive enough to identify discrete awakenings.

Our speculation is that if breastfeeding mothers awaken more often at night, then breastfeeding itself may provide a form of compensation. In other words, breastfeeding mothers may return to sleep more quickly and not remember awakening. This could be because they are not exposed to as much ambient light or physical activity as would be required to prepare formula. It is also possible that breastfeeding mothers are sleeping during feedings. Researchers Qillin and Lee have previously reported that breastfeeding mothers who cosleep sleep more than both those who do not co-sleep and those that formula feed. The major limitation of our work was that we did not collect data about co-sleeping, which is very common in our society despite professional recommendations against doing so.

Breastfeeding may also have a soporific effect. Sanchez and colleagues have shown that nucleotides present in breast milk have both strong maternal circadian rhythms and appear to facilitate a “hypnotic action” in the infant. In addition, differences in circulating prolactin are suspected to have a primary role in sleep architecture differences between breast and formula feeding mothers. Prolactin shows a nocturnal peak, which is vital for milk production, and is usually associated with facilitation of sleep onset and the delta wave brain activity important for restorative sleep.

In sum, our study shows that choosing to formula feed does not equate to improved sleep for the mother. The risks of not breastfeeding should be weighed against the cumulative lack of evidence that breastfeeding has a negative impact on the mother’s sleep.

Breastfeeding photo available from Shutterstock

Our playgroup of preschoolers recently attended a production of “Cinderella.” All the children were enamored with the costumes, music and beauty of the play. Since that day, my three-year-old son has loved whirling and twirling as Cinderella. He occasionally plays different roles, but his favorite is Cinderella. Should I be concerned about whether or not my son is experiencing gender confusion?

As soon as a child is mobile, he ponders his identity. Seeing his mirror image, he wonders if there is someone standing behind a glass wall who looks just like him. He’ll make silly faces, walk away and look over his shoulder, sneak out from behind the chair to see if the image appears. Fairy tales, whether about a hero or heroine, can provide a doorway through which a child’s identity can safely be explored.

Preschoolers imitate, have wild and vivid imaginations and adore the dramatic. Dressing up and adopting a role for a period of time is common for both boys and girls. For most, it entails a process of exploring an aspect of their own identity, based on qualities represented by the hero or heroine’s role in the story, not gender, that made such a huge impression on them.

“Cinderella” is a tale of virtue rewarded and evil punished, of true merit being recognized even when hidden under rags and dirt, of a humble little person being elevated beyond her wildest dreams. Cinderella, herself, may represent to your son qualities of kindness and goodness.

Delighted these qualities eventually prevail, he may identify with her, believing that his innocence and value will also be recognized and rewarded. “Cinderella” also demonstrates the conflicts of sibling rivalry, an “evil” from which both sexes may seek to be rescued. Children realize they are small vulnerable creatures, thus rescue themes in fairy tales may help them work through fears associated with powerlessness. If a child feels threatened by a sibling’s successes, physically or mentally inferior, rejected by a parent and/or sibling, and powerless to resolve these often guilt-producing conflicts, then his or her identity may be negatively impacted, even injured. Seeing the powerless Cinderella rescued from her evil stepmother and siblings may provide some children with hope that all is, indeed, well with the world. Hope for a child cannot be underestimated, for as Emily Dickinson so eloquently wrote, “Hope is the thing with feathers/That perches in the soul,/And sings the tune—without the words,/And never stops at all,…”

Play is the work of children. Self-directed play helps them develop their own identity and work through everyday anxieties and fears—whether in the role of hero or heroine—using themes, props, and conversations with imaginary entities. They orchestrate and set their own stage to imitate characteristics or behaviors of those that make them feel, if not strong, smart, courageous, or powerful, at least worthy of being rescued by an entity that is.

The imagination at work in play can create a safe place to act out anger, happiness, fear, powerlessness, loneliness and even self-discipline. They pretend to be mothers, fathers, siblings, Batman, Superman, wizards, apprentices, Peter Pan, Tinkerbell, the Lion King, Beyonce and Cinderella. Typically, gender has nothing to do with it.

It is wise to accept your son’s play for what it is: play. Your approval will contribute to his self-confidence and pride. Indulge him by playing out the characters with him. This is his Cinderella time. He’ll move on to another character soon.

Some children barely stop for a moment to consider their own feelings or another’s feelings, and how their choices impact others. But, a child that is a) interested in the thoughts of others, b) shows empathy, c) has the skill to express her thoughts with words instead of “acts out” her feelings (e.g., misbehaves), and d) has the ability to negotiate with words, can compromise, and has a positive sense of self, is less likely to make intentionally hurtful choices towards another; she is less likely to be a bully. In essence, a child that exhibits the aforementioned skills is on the road towards being a person of character.

There is a direct connection between a child’s lack of empathy, a lack of taking ownership of his own actions, and a lack of communication skills. Your child’s ability to communicate in a healthy interactive manner that reflects good character should include sharing his feelings in a style that acknowledges the other with whom he dialogues, caring about and being interested in the other person’s thoughts and being interested in trying to understand his own thoughts.

The selfishness of being wrapped up in himself and what he needs emotionally, rather than considering not only what another child needs but also how his own actions affect another’s life experience, can be changed, taught, learned, and improved. It is our job as parents to teach and model those lessons.

Having great character includes caring for and about one’s self and others. This can be a “both/and” experience rather than an “either/or” life philosophy. Parenting absolutely impacts children’s development of character!

Here are four important life skills for your child to develop that will play a significant role in building his character:
1. Show empathy
2. Have the ability to compromise and negotiate
3. Take ownership of one’s own actions
4. Express one’s feelings and wants with words rather than with impulsive behavioral reactions

Empathy

In an effort to help your child develop empathy, teach him that “What the other person does says more about him than it does about you.”

Teach your child this statement about others and help him to understand what it means by offering concrete examples to which he can relate. Then, to make sure he really understands this concept, ask him to share with you an example that proves this statement is true.

For an example, your son tells you that a schoolmate, John (who used to socialize a lot with your son), now excludes him whenever his is playing with his other friend, Mark, and John is more aggressive in school lately. In addition, your son has noticed that Mark’s mother often drives John home.

Help your son examine the different reasons why John may be excluding him and being aggressive. Perhaps John’s mom cannot pick him up from school because she has to work more hours and Mark’s mom is doing John’s mom a favor. Perhaps John is angry and hurt that his mother is not as available or attentive as she used to be and he therefore is attaching himself more onto Mark since he feels like that is who is helping him through this painful time right now. Perhaps John is struggling sharing Mark and being inclusive because he feels the stability in his life is threatened and does not know how to communicate this feeling of instability with words; instead he acts out his feelings of instability and insecurity. Or, perhaps John’s aggressive behavior is also a result of his hurt feelings. Explore with your son what feelings he may have about John and whether his reaction to John’s behavior may be different based on this new perspective.

Compromise and Negotiation

In an effort to help your child develop the ability to compromise and negotiate, provide her with the “proud technique.” Communicate the following types of statements: “I’m so proud of you when you ______. Are you proud of yourself?” and “When you _______ it must make you not feel so good about your choices. Next time what are other options so you can feel great about your choices and who you are? What can you say to your friend? That is a great plan, I will be so proud of you when you _________ and I see you’ll be proud of yourself when you __________.”

Sharing that you are proud of your daughter helps develop her sense of self-worth. Also, exploring your child’s options with her of what she can do when she is not being her best is respectful. By sharing with her that both you and she will be proud when she implements positive behaviors relays that you believe she will.

Use examples that are in sync and fit with your child’s life that include themes such as negotiation with other children, compromise, and taking turns as it applies to the proud technique. If you teach your child how to handle these social interactions by offering healthy options, then she will have a toolbox to use when situations arise that include challenging negotiations. This instills the skills to negotiate and compromise rather than express her wants through controlling and disrespectful methods that can lead to bullying.

Ownership

It is important to teach your child to take ownership of his behavior, as his skill impacts his choices and thoughts about himself and others. When he takes ownership of his actions and words, he can choose to grow, enhance, improve, and not blame others for what he needs to improve upon.

The following statement to share with your child is a “self-talk technique” he can use when he feels frustrated, hurt, angry, sad, disappointed, or any other emotion with regards to someone else’s actions and/or any event that causes emotional distress, “I cannot control another’s behavior or words. What I can do is control my reaction to another and my own choices and actions.”

In an effort to feel in control of one’s self, which is an important part of character development, teach your child to use the “self-talk technique” in times when he should remind himself not to react impulsively or behaviorally, and rather to think first before he reacts, thereby being in control of his actions.

Words

Teach your child to use her words to share her feelings and opinions instead of “acting out” her feelings with her negative behavior.

Teach your child the following communication script to use when she interacts with you and with her peers. “When you ______, it makes me feel _____. When I feel _____, it makes me want to ________. Instead, I will _________, and hope _________.” (For example, “When you whisper to Mary and laugh, it makes me feel embarrassed. When I feel embarrassed, it makes me want to push you. Instead, I will go have fun with Laura, and hope that we can work it out and be friends.”)

Remember, on your parenting journey what you say and do matter immensely, and you play a significant role in your child’s character development.

I have found that often mothers are concerned that their son either is or will become a sexual deviant and that his behavior is inappropriate. Fathers more often think their son’s behavior makes sense; they understand the desire to look at porn, but they may still be concerned about it, even though it seems normal. These reactions may sound like a stereotype, but I have found this as the typical reaction that mothers and fathers have when discovering their teenage son is viewing porn. I am here to tell you that it is very normal and healthy for a teenage boy to desire to look at naked bodies. Males are visual, and teenage males experience physiological sensations that are normal and healthy. In addition, they are curious.

So knowing that teenage boys like to look at naked bodies, what should a parent do? There are three parts of how a parent should address this issue. First, discuss with your teenage son that you saw that a pornographic site was saved in the history on the computer so you know that he accessed it. Assure him that is normal to want to look at these sites and perhaps experience sexually arousing feelings. Dialoguing with your son in a nonjudgmental manner helps you to connect with him and make the point that sexual feelings are normal.

Second, explain to your son that along with the normalcy of his desires, as a parent you recognize how spending time on the computer with sexually explicit and stimulating material can impact how the viewer may be influenced to view a sexual relationship in a way that may not be reality because of the fantasy images that are put on the site. This discussion should include the exploration of the idea that an emotionally and physically safe, and healthy, sexual relationship may not be what is displayed on the site (or is it?).

Further discuss that you understand there are different types of sites and wonder what he understands of the types of sites. This open dialogue will help you to open up your son’s mind to thinking about that there are different ways of experiencing sex. Also, this discussion can allow you to explore and uncover your son’s view of sex and what he islooking at so you can help him with his thoughts and feelings.

Finally, discuss that you would like to team up with him to figure out together how not to let his albeit normal curiosity and interest negatively affect his personal growth and sexual health journey. Specifically discuss that if he is going to look at porn again then what is a healthy plan to assure:

• That he has a healthy view of sexuality and sexual relationships, thereby discussing from a philosophical point of view how to develop healthy relationships with others
• That his allowable time to watch pornography does not impact his involvement in extracurricular activities and responsibilities, thereby discussing what the house “rules” should be (e.g., time limitations, pornographic site restrictions, to view or not to view)
• That porn viewing does not become an escape method as his only release when having a stressful day, thereby discussing specific healthy outlets (e.g., music, sports, art), as well as sharing his thoughts with words, and confronting his conflicts
• That he stays safe when there are predators on different types of sites.

One of the most important things to keep in mind as a parent of a teenage boy is that boys often are very analytical and welcome philosophical discussion when you give them the opportunity. If you use the discovery that he is looking at porn as a opportunity to have a dialogue with him about his thoughts and feelings, and co-create with him a healthy plan as to if and when he should look at porn and its impact, then it is much more likely that he will develop a healthy view of sex. Specifically you can help enhance your son’s skills of analytical thinking, processing, and self-introspecting rather than
just reacting to sexually explicit material.

As a parent, you do not want to ignore this discovery since there are some teens for whom porn viewing can become a problem. If your son is substituting porn for real relationships, spending less time accomplishing tasks and responsibilities, putting himself in a potentially harmful situation with a stranger or using it as a coping method for life’s challenges as an escapism technique instead of talking about his feelings and/or confronting his problems head on, then you need to address it.

Teen couple photo available from Shutterstock

The mom and I started to chat about the symptoms the sick girls were exhibiting. But the mother was either distracted by the clicking or felt the girls were being rude, and she soon made the two sick teens turn their phones off.

The pair grudgingly obeyed, sticking the devices in their purses, but not before whining, “Why doesn’t she have to stop?” “Because she’s not the one with the doctor’s visit,” Mom replied. “But she’s the one who’s texting us!” the girls protested in unison.

I was speechless. Here were three sisters in a room together communicating with their thumbs. That encounter really hammered home to me just how plugged in we have all become. We are suffused daily in a multitude of digital communication options.

According to a recent Pew research study, one in three teens sends or receives over 100 text messages a day. It’s not that texting is inherently bad. Like many other forms of communication, it has the potential to keep us connected. But Sherry Turkle, MIT professor and author of Alone Together: Why We Expect More From Technology and Less From Each Other suggests that while constant texting may give the appearance of increased connectedness, these technologies may actually be keeping us isolated from each other. She argues that “Facebooking” is not socializing. “Thumbs up or thumbs down on a web site is not a conversation.”

Texting can also be dangerous. Texting while driving can be so deadly that it is banned in many states. When I’m at the gym, I cringe watching folks text while walking down stairs or running on treadmills. They look like accidents waiting to happen, like that poor woman whose YouTube video went viral when she fell into a fountain texting while she walked at a mall.

Children should be taught to turn off their cell phone when engaged in any activity that requires their full attention: school, homework, babysitting. Children also need to understand that some forms of texting—like sexting (sending nude or inappropriate photos in a text message) or cyber-bullying (sending mean, taunting or embarrassing text messages)—can have disciplinary consequences at school and even legal ramifications.

Another new issue being raised about texting is its effect on teens’ sleep. We are learning more and more about teens who bring their cell phones into their bedrooms and text long into the night.

Technology is developing at a rate that may be faster than our ability to monitor it and ensure its safe use. Parents should have frank conversations with their children about the dangers of texting and driving and the negative emotional and sometimes legal consequences of sexting and cyberbullying. Parents should review their children’s text logs to see who is texting them, when and how often. Limits can be placed on the number of texts sent and received as well as the hours texting is allowed. And parents can certainly confiscate phones after a reasonable hour, if necessary.

We need to be good role models for our children as well. While many parents take their kids’ cell phones away from them during our office visits so we can have face-to-face conversations, I have just as many parents who themselves text during our visits. We have to be careful what kind of example we set. My heart breaks whenever I see a mom or dad texting in the bleachers of their kid’s big game instead of watching their child play. If we are disengaged from our children, can it be long before they’ll disengage from us?

Kids texting photo available from Shutterstock

Dr. Ann Masten from the University of Minnesota wrote in the journal American Psychologist (2001) about resilience as “ordinary magic.” That is, given normal protective factors, most children will be able to cope, recover, and be fine after witnessing or experiencing a traumatic event.

Some children and adolescents may develop symptoms following a disaster, especially if they have experienced traumatic events earlier such as losses or other difficult situations. The symptoms related to trauma may appear as difficult behaviors or emotions shown at home or school. It is important for parents to know that children’s behaviors and emotions can become dysregulated, where they demonstrate more aggressive or withdrawn behaviors such as sadness or anger, and even “numbing” or little emotion as a way of coping with trauma.

Some of the “red flag” behaviors of concern when seen in children of different ages include:

• For children under 5 years of age: returning to earlier behaviors such as thumbsucking, bedwetting, fear of darkness, separation anxiety or excessive clinging
• For 6-11-year-olds: disruptive behaviors, extreme withdrawal, inability to pay attention, sleep problems and nightmares, school problems, psychosomatic complaints
  including stomachaches and headaches or changes in usual behaviors
• For 12-17-year-olds: sleep problems and nightmares, school problems including changes in performance and truancy, risk-taking behavior, problems with peers, changes in usual behaviors, psychosomatic complaints including stomachaches and headaches, depression or suicidal thoughts

Parents need to be able to recognize these “red flag” behaviors and identify when their child may be experiencing so much distress that he needs help. Parents may also need help in providing support to their child after traumatic events that may also traumatize the parents. Brief support and being able to talk to someone who can be more objective may be helpful to both parents and child after a traumatic event.

When they experience traumatic events, children can be protected most by support from their parents or trusted caregivers, being able to talk to them and have them listen, and if they are younger, being able to play freely. Younger children often play out what they have seen or experienced which, at times, may be difficult and upsetting for parents to observe but is important in helping the child recover from the event.

Returning to routines is also very important for children after they’ve experienced trauma, even if the routines are different from what they experienced before the traumatic event. If the children are older, then being able to go to school and be with friends will help in their recovery. Life needs to be predictable for children (and adults) and traumatic experiences disrupt that predictability. Reinstating routines help make life predictable again.

Guidelines for Parents to Help Their Child Cope with Trauma Include

1. Offer to listen to your child and help her, but don’t overwhelm her if she is not ready to talk. Don’t pressure your child to think or talk about what has happened beyond her willingness and readiness to do so. Children need answers to their questions that are age-appropriate and truthful, but it is not in their best interest to be flooded with more information than they ask for or need.

2. Talk about what has happened or is happening but in tolerable doses. It is wise to respect your child’s need to break off the discussion and to respect his wish to not talk further about the trauma for a while. He or you can ask to talk again at another time.

3. Do not underestimate a young child’s awareness or understanding of what has happened or may be happening. Answer your young child’s questions about injury or death truthfully, but in language she can understand without offering her
more than is necessary for her to hear.

Different age groups have different needs. For example, very young children need to be protected from exposure to too much television or other media; they are likely to have either seen or heard too much already.

Children need to be helped not only with their anxiety and confusion, but also with their anger. They may react to the traumatic event with anger and need to learn ways to express their feelings in healthy ways. Here are a few age-appropriate, healthy ways to help children express their confusion or anger about a traumatic event:

• It is often helpful for young children to have the opportunity to draw pictures of what has happened, perhaps depending on the traumatic event, including rescue vehicles coming to aid. Children who are a little older may want to play out the event with toys.

• Older children may find it helpful to use heroic action figures for their play or toy soldiers or military equipment to show danger as well as rescue.
• School-age children may want to use these less verbal forms of expression but they also might be able to be more direct and verbal about their feelings and concerns; they are more likely to also talk to teachers, relatives, and other adults in addition to parents.
• Teenagers may find it helpful to talk as part of a small group of peers their own age rather than talk by themselves. After disasters, teenagers can play a major role in helping others in recovery work at school and in their community and also help younger children. It is important to recognize and support prosocial activities for teenagers, which can also decrease the likelihood of higher-risk behaviors.

As I shared with one parent whose young child was very upset after experiencing a traumatic event that would impact both of their lives for some time, “Life will return to normal, however, after trauma, it may be a ‘new normal.’”

Flipped car photo available from Shutterstock