FEAR AND ANXIETY · Children are afraid that the trauma will happen again, and that they or their family will be injured or killed. A child’s most central fear is that he or she will be left all alone. These fears are very real to a child, even if they seem exaggerated to adults.

“CHILDISH” OR REGRESSIVE BEHAVIOR · Children’s fear and anxiety may cause them to act younger than their age. They may begin behavior such as bed-wetting, thumb-sucking, and being very clingy or afraid of strangers. An older child, who has been independent in his or her activities away from the family, may wish to spend more time at home. A child does not want to act immaturely, and may not even realize that
he or she is behaving like this, but the anxiety may temporarily disrupt his or her normal, more mature behavior.

BEDTIME PROBLEMS · Frequently children show their anxiety and fear through having nightmares or being afraid of sleeping alone. They may develop fears of the dark or have difficulty falling or staying asleep at night.

PHYSICAL REACTIONS · Some children have stomach aches, headaches, nausea, eating problems or other physical symptoms of distress. These can be in response to fear, guilt, anger or feeling vulnerable to future tragedies.

“TRIGGER” RESPONSES · Sometimes a child will associate a particular smell, sound, object or activity with the trauma. Whenever they are exposed to that reminder, excessive anxiety, avoidance, and sometimes physical reactions may follow.

PROBLEMS WITH THINKING · Children of all ages can experience difficulties with concentration. Many find that they are easily distracted and feel somewhat confused and disoriented.

DEVELOPMENTAL REACTIONS SEEN IN CHILDREN BIRTH TO 2 YEARS · When children are preverbal and experience a trauma, they do not have the words to describe the event or their feelings. They can, however, retain memories of particular sights, sounds or smells. Infants may react to trauma by being irritable, crying more than usual or wanting to be held and cuddled. As they get older, their play may involve acting out elements of the traumatic event that occurred several years in the past and was seemingly long forgotten.

PRESCHOOL – 2 TO 6 YEARS · Preschool children often feel helpless and powerless in the face of an overwhelming event. Because of their age and small size, they lack the ability to protect themselves or others. As a result, they feel intense fear and insecurity. Preschoolers cannot grasp the concept of permanent loss. They see consequences as being reversible. In the weeks following a traumatic event, a preschooler’s play activities may involve aspects of the event. They may re-enact the accident, earthquake or fire over and over again.

SCHOOL AGE – 6 TO 10 YEARS · The school age child has the mental ability to understand the permanence of loss from a trauma. Some children become intensely preoccupied with the details of a traumatic event and want to talk about it continually. This preoccupation can also interfere with a childs concentration at school, and academic performance may decline. The maturity of school-age children gives them the ability to understand more complicated issues, and can result in a wide range of reactions, i.g. guilt, feelings of failure, anger that the event was not prevented or fantasies of playing rescuer.

PRE-ADOLESCENCE TO ADOLESCENCE – 11 TO 18 YEARS · As children get older, their responses begin to resemble adult reactions to trauma. They may have a combination of some of the more childlike reactions mentioned previously, and in addition, others that seem more consistent with adult reactions. Survival of the trauma can be equated with a sense of immortality. A teenager may become involved in dangerous, risk-taking behavior, such as reckless driving or substance abuse. In contrast, a teenager can become fearful of leaving home. Much of adolescence is focused on moving out into the world. After a trauma, the world can seem dangerous and unsafe. A teenager may feel overwhelmed by intense emotions, and yet feel unable to discuss them with family members.