Children — the smallest victims — need extra help after disasters

American families have faced some of the worst natural disasters in our country’s history this year, as massive hurricanes, multiple tornadoes, and raging wildfires wreaked havoc on communities large and small.

While recovery is daunting, the physical part of rebuilding is obvious and visible — restoring power grids, repairing and reconstructing homes, schools, and businesses. Another part of recovery is just as crucial, though more easily missed — the mental health of those affected. Least visible of all is the emotional toll on babies and toddlers, who absorb everything around them but cannot yet verbalize their distress and fears. As Congress considers recovery funding for disaster-affected areas, Members need to keep infants and toddlers’ long-term cognitive, social, and emotional development in mind.

{mosads}The key to helping babies and toddlers cope and recover from these traumatic events is acknowledging that young children are very aware of and affected by what is happening around them. During the first three years of life, more than one million new neural connections are formed in babies’ brains every second. Critical wiring and learning takes place right from the start, influenced by the environment around them — including close, trusting caregivers.

Responding to natural disasters frequently requires leaving home, evacuation to shelters, and loss of daily routines and consistent care that is so important for their stability and security. These stressful experiences can literally change the wiring of a baby’s developing brain and affect the young child’s future ability to manage stress, solve problems, and make decisions. 

Staff in the Early Head Start program in Ponce, Puerto Rico, for instance, reported classic trauma symptoms in young children following Hurricane Maria, such as regression in toileting, separation anxiety, nightmares, withdrawal from play or class activities, increased aggression, and, expectedly, fear of storms.  Due to their own stress, parents may not be able to give their young children the attention and support they need and may even misinterpret signs of anxiety as misbehavior. These traumatic experiences can damage young brains if the signs are not recognized and addressed with support needed to promote recovery and resilience.

Congress would be wise to look to the extensive work of infant and early childhood mental health professionals during previous disasters. This past work created a roadmap for treating very young victims. The drawn-out recovery and extended dislocation from Hurricane Katrina — a situation that could be repeated in Puerto Rico, Texas, and California — required dealing with long-term psychological effects. That experience provided the infant and early childhood mental health field with proven resources for the new challenges they face in the wake of these recent disasters — and those that are sure to come.

Ongoing training for professionals, easy access to resources for parents and caregivers, and an established network that enables the sharing of best practices should be areas of focus and priority. Embedding infant and early childhood mental health clinicians in primary care and early childhood settings will facilitate early identification through screening protocols. Pediatric practices, Federally Qualified Community Health Centers, and early childhood settings where families go in the aftermath of disasters will be the best way to reach them. Young children in need of services can then be identified earlier before mental health issues become more serious and difficult to treat.

Quite simply, well-managed response to early trauma can improve outcomes for very young children.

The Puerto Rico Ponce Early Head Start staff were well-prepared for managing the fall-out from the hurricane with the aid of a comprehensive disaster relief plan that enabled them to reopen their program quickly, giving children a sense of routine and stability they so urgently needed. Staff also visited and offered support to the families, including the extended families who were sheltering them. They encouraged older toddlers to talk and draw pictures about their experiences and observed their play to begin the process of ongoing monitoring of their trauma symptoms to identify possible after-effects months down the road.

These proven types of techniques can turn the tide for thousands of infants and toddlers early in their development. 

As communities awaken to the need to rebuild in a more thoughtful way, we must ensure we have a robust mental health system designed to meet the needs of infants and toddlers. As part of any recovery funding package, Congress should ensure support for existing and new programs tailored to those three and younger. Little ones, unfortunately, can often be overlooked in recovery efforts, but investing in them now will achieve significant and lasting emotional and cognitive benefits — and significant savings for states and municipalities — for years to come. 

Joy D. Osofsky, Ph.D., is a professor in the Departments of Pediatrics and Psychiatry, Louisiana State University Health Sciences Center, New Orleans, and led infant and early childhood mental health efforts in Louisiana after Hurricane Katrina. Matthew Melmed is the executive director of ZERO TO THREE, a national non-profit committed to promoting the health and development of infants and toddlers.