When children have questions about the news

On the morning of Dec. 14, 2012, the authors submitted this piece on helping parents to discuss difficult events in the news with their children. It was written in the spirit of the many circumstances children hear or watch on the television news describing violent, scary, or sad events.

Within the hour, news broke that a gunman had entered an elementary school in Newtown, Conn., and shot many people, including children. Over the course of that terrible day, the full story took shape in a constant news flow that gripped all of us. Sandy Hook was unbearably tragic. Twenty first-grade students were murdered. Six teachers and staff members were murdered. The shooter had started by murdering his mother and finished by killing himself. Although there was some safety that he would not hurt anyone ever again, there was also the massive insecurity that we will never be able to feel safe again, even in an elementary school, and are unable to understand what could have made a person commit this crime.

Several of the points we make in this article are especially relevant to the events in Newtown. This event has received such intensive and unremitting coverage that even the youngest children probably have been exposed in some way to it. Parents will need to be attuned to any indications that their children have seen, heard, or read something about this, and they should check in with their children and find out what they know, what questions they have, and what they are worried about. Parents who are anxious that they will be introducing this horrifying story might ask, "Have you ever heard or seen something that was scary or upsetting, and hard to get out of your thoughts afterwards?" They should try to limit children’s exposure to these news reports, as children may be overwhelmed or confused by the constant repetition of the story and will have difficulty managing disturbing images.

Parents should be reassured that well-loved, valued children can cope with troubling news with the help of their parents’ explanations, reassurance, and guidance, and the resumption of normal activities. Most of the millions of children (and parents) indirectly exposed to the Sandy Hook murders will be resilient. Longer term, some children in your pediatric practice will not return to their usual functioning. Some children may have a vulnerability to anxiety or depression, and others may have had previous losses of loved ones through divorce or death. Some will be vulnerable secondary to poverty, abuse, or neglect. For these vulnerable children and parents, Sandy Hook will be a critical, longer-term event.

A parent who may have become too absorbed in the acute phase of the story did not limit access to the media. A child may develop anxiety about being safe in school, become clingy to parents, regress to a younger age, or have posttraumatic stress disorder symptoms of what they have seen on television (nightmares, flashback images, etc.). A parent may become very anxious about school safety and overly restrictive. These anxieties are a way of coping with past and current events – a solution to their anxiety. Pediatricians should be empathic, take a family history for anxiety and depression, and consider a mental health referral.

Even the best-adjusted parents in your practice should be reminded that their children’s feelings, questions, and worries will be different from their own. This particular tragedy will have a profound, painful resonance for all parents. It will be difficult to drop off their children at elementary school without worries about their safety and feelings of breathtaking sadness for those parents whose children did not come home on Dec. 14.

If parents don’t manage their own distress, their children will surely sense or pick up on parental anxiety and will be much harder to reassure. It is critical for parents (and teachers, librarians, classroom aides, principals, social workers, and physicians) to tend to themselves. They must manage their own sadness and distress by getting meaningful support and reassurance from friends, loved ones, spouses, religious leaders, community leaders, and counselors. They should turn off the news not only when their children are around, but also when it becomes too much for them to bear. They should make sure that their family’s routines, including their routine limits and rules, continue. This is organizing and reassuring for children and adults alike.

Of course, supporting the families who were directly affected by the murders in Newtown will be very different from supporting those affected by the news of those murders. There will need to be a thoughtful, community-wide mental health plan for all of these survivors; the parents, siblings, and spouses who suffered the death of a loved one; and the first responders so stressed by the intensity of what they had to do and see.

Just as surely, there will be questions about whether mental illness or developmental disorders are linked to these horrifying incidents of violence. The fact that the perpetrator in Newtown has already been described in the media as having been diagnosed with Asperger’s disorder ensures that many families, especially those raising children with developmental disabilities, will have questions about any association. We as physicians must be clear that only clinicians who personally evaluated or treated this young man can speak to any of his personal problems or diagnoses. More broadly, there is no predictable association between acts of mass murder and psychiatric illness or developmental disorder. Indeed, it would be a disservice and counterproductive to increase the stigma and social isolation that already make it so difficult for so many to seek psychiatric help.

On a final note, adults as well as children should be encouraged to consider appropriate, meaningful action they could take in response to this event. Whether they want to try to demonstrate compassion to the families of Newtown, work to improve safety in their schools and communities, be activists for gun regulation, or support improved mental health care, they should be encouraged to channel their emotional responses constructively. We can teach our children that there are inevitable small risks that are part of growing up, that we can only control so much of our future, and that we need to tolerate these risks – try to minimize them when it’s possible and to grieve and recover when we cannot.

It seems that not a week goes by without the occurrence of a heartbreaking or terrifying event that gets exhaustive coverage in the news. Although overwhelmed adults can choose to take a hiatus from media or emotionally distance themselves from events, parents quickly learn that children come to them routinely with questions about something they saw, heard, or read about in a newspaper, online, on the radio, on television, via social media, or just from talking with a friend at school. Without imposing restrictions that would severely limit the child’s appropriate growing autonomy, there is simply no way that parents can fully control that to which their school-aged children are exposed.

Talking about the news-based facts of life poses challenges for most parents. It is unlikely that any parent woke up on the morning of Sept. 11, 2001 ready for the questions their children would come home from school with that afternoon. School and mall shootings and deaths from child abuse can be especially frightening for children and parents alike. Even natural disasters or accidents can be terrifying in their randomness and heartbreaking in their consequences. Should parents offer blanket reassurances? Can they speak honestly about the bad things people do or the uncertainty and vulnerability that are (often unacknowledged) facts of life?

The first thing you might offer a worried parent is the reassurance that the good news is that their children are asking them these questions at all and that children cope with troubling news. The fact that they bring their feelings and questions to their parents is a great marker of their judgment and trust. Remind parents that if they simply welcome these questions, are curious about their children’s thoughts and feelings, and remind their children to never worry alone, they will have done a great job at handling these types of questions.

Beyond welcoming difficult questions, there are some strategies to share with parents to help them handle these types of questions well. If at all possible, the parent should "strike while the iron is hot" and find the time and privacy to have these conversations when they arise. But if they come up in a busy public setting, such as the check-out line at the grocery store, it is probably best to respond that this is a very important question that deserves their full attention. They can talk about it once they get back in the car or can sit down at home together.

The conversation should start by gathering more information. What got the child thinking about this topic? Did they see or hear or read something about it? What was their response to this? It is important that parents remember not to assume that they know what their child is actually asking or worried about. What might worry a parent about a plane crash or a mass shooting may be different from what worries a child. What may be on the mind of a first grader could be quite different than a sixth grader. Often, children will want to gather information also. They may have a lot of factual questions about an event that they have heard about. It is natural for parents to want to protect their young children from material that is scary or sad, but it would be harder for these children to overhear this material or have to navigate it alone. Therefore, acknowledging what is true about what the child has heard is appropriate.

If a child has heard that people died in a school bus accident, then it is appropriate for a parent to acknowledge what is true without euphemism. Difficult facts should then be followed with an acknowledgment of the difficult feelings that can come with them. "How does this make you feel?" or "It makes me so sad that some children died in that accident" are examples of labeling and bearing these strong feelings. Again, parents should be sure to be curious about their child’s feelings as well as modeling how they handle such feelings.

After having a chance to discuss some of the factual details of the news and the emotions that follow, it will be critical for parents to offer appropriate reassurance and even a potential course of action. School-age children have the cognitive capacity to learn about complex issues that may be reflected in news events, such as global warming or mental illness, but they usually lack the emotional maturity to comfortably hold the anxiety and uncertainty that can follow. Therefore, parents should offer clear reassurance to their school-age children.

Although they cannot promise total immunity from illness, risks, or accidents, they can remind their children about how they are safe. For example, after discussing that there is fighting in Syria in which some children have been injured or killed, they should remind their children that their family lives in a safe community where there is no war or fighting. There may be an opportunity to teach their children about how to protect themselves in specific situations if the difficult topic lends itself to this. They could, for example, review what children should do in case of a fire or if they witness a physical fight or are offered a ride by a stranger.

Finally, school-age children can feel very distressed by the unfairness that is often a component of newsworthy events. At this stage in development, children are working hard to master and follow the rules in all sorts of settings, from soccer to social situations to algebra. They can become very upset when the rules don’t seem to apply, and, of course, life is often unfair in ways that parents cannot make right. Offering their children some perspectives, values, and actions they might take in response to a specific tragedy or injustice is helpful for their children’s coping and their development.

Parents may talk with their children about ways to raise money to help victims of an earthquake or to collect food for people displaced by a flood. Or they might want to think about working with friends and teachers at their school to create a bike safety curriculum. There are many schools and communities that have been profoundly affected in positive ways by efforts that grew from such conversations between concerned school-age children and their parents.

Pediatricians are uniquely qualified to help parents manage these difficult topics when they arise. Some parents may ask about this directly, but it may be helpful to create a handout to keep in the waiting room about this issue. Or you could create a page on your practice’s website. You also should remain attuned to when parents mention troubling news events in passing and take those opportunities to find out how they have handled them with their children. Although parents naturally feel that there are stories they would prefer to shield their children from, with your guidance they can see that even these difficult topics present opportunities to support their children’s preparation for adolescence and adulthood.

Dr. Swick is an attending psychiatrist in the division of child psychiatry at Massachusetts General Hospital, Boston, and director of the Parenting at a Challenging Time (PACT) Program at the Vernon Cancer Center at Newton Wellesley Hospital, also in Boston. Dr. Jellinek is professor of psychiatry and of pediatrics at Harvard Medical School, Boston. He is also chief of clinical affairs at Partners HealthCare, also in Boston. E-mail Dr. Swick and Dr. Jellinek at pdnews@elsevier.com.

On the morning of Dec. 14, 2012, the authors submitted this piece on helping parents to discuss difficult events in the news with their children. It was written in the spirit of the many circumstances children hear or watch on the television news describing violent, scary, or sad events.

Within the hour, news broke that a gunman had entered an elementary school in Newtown, Conn., and shot many people, including children. Over the course of that terrible day, the full story took shape in a constant news flow that gripped all of us. Sandy Hook was unbearably tragic. Twenty first-grade students were murdered. Six teachers and staff members were murdered. The shooter had started by murdering his mother and finished by killing himself. Although there was some safety that he would not hurt anyone ever again, there was also the massive insecurity that we will never be able to feel safe again, even in an elementary school, and are unable to understand what could have made a person commit this crime.

Several of the points we make in this article are especially relevant to the events in Newtown. This event has received such intensive and unremitting coverage that even the youngest children probably have been exposed in some way to it. Parents will need to be attuned to any indications that their children have seen, heard, or read something about this, and they should check in with their children and find out what they know, what questions they have, and what they are worried about. Parents who are anxious that they will be introducing this horrifying story might ask, "Have you ever heard or seen something that was scary or upsetting, and hard to get out of your thoughts afterwards?" They should try to limit children’s exposure to these news reports, as children may be overwhelmed or confused by the constant repetition of the story and will have difficulty managing disturbing images.

Parents should be reassured that well-loved, valued children can cope with troubling news with the help of their parents’ explanations, reassurance, and guidance, and the resumption of normal activities. Most of the millions of children (and parents) indirectly exposed to the Sandy Hook murders will be resilient. Longer term, some children in your pediatric practice will not return to their usual functioning. Some children may have a vulnerability to anxiety or depression, and others may have had previous losses of loved ones through divorce or death. Some will be vulnerable secondary to poverty, abuse, or neglect. For these vulnerable children and parents, Sandy Hook will be a critical, longer-term event.

A parent who may have become too absorbed in the acute phase of the story did not limit access to the media. A child may develop anxiety about being safe in school, become clingy to parents, regress to a younger age, or have posttraumatic stress disorder symptoms of what they have seen on television (nightmares, flashback images, etc.). A parent may become very anxious about school safety and overly restrictive. These anxieties are a way of coping with past and current events – a solution to their anxiety. Pediatricians should be empathic, take a family history for anxiety and depression, and consider a mental health referral.

Even the best-adjusted parents in your practice should be reminded that their children’s feelings, questions, and worries will be different from their own. This particular tragedy will have a profound, painful resonance for all parents. It will be difficult to drop off their children at elementary school without worries about their safety and feelings of breathtaking sadness for those parents whose children did not come home on Dec. 14.

If parents don’t manage their own distress, their children will surely sense or pick up on parental anxiety and will be much harder to reassure. It is critical for parents (and teachers, librarians, classroom aides, principals, social workers, and physicians) to tend to themselves. They must manage their own sadness and distress by getting meaningful support and reassurance from friends, loved ones, spouses, religious leaders, community leaders, and counselors. They should turn off the news not only when their children are around, but also when it becomes too much for them to bear. They should make sure that their family’s routines, including their routine limits and rules, continue. This is organizing and reassuring for children and adults alike.

Of course, supporting the families who were directly affected by the murders in Newtown will be very different from supporting those affected by the news of those murders. There will need to be a thoughtful, community-wide mental health plan for all of these survivors; the parents, siblings, and spouses who suffered the death of a loved one; and the first responders so stressed by the intensity of what they had to do and see.

Just as surely, there will be questions about whether mental illness or developmental disorders are linked to these horrifying incidents of violence. The fact that the perpetrator in Newtown has already been described in the media as having been diagnosed with Asperger’s disorder ensures that many families, especially those raising children with developmental disabilities, will have questions about any association. We as physicians must be clear that only clinicians who personally evaluated or treated this young man can speak to any of his personal problems or diagnoses. More broadly, there is no predictable association between acts of mass murder and psychiatric illness or developmental disorder. Indeed, it would be a disservice and counterproductive to increase the stigma and social isolation that already make it so difficult for so many to seek psychiatric help.

On a final note, adults as well as children should be encouraged to consider appropriate, meaningful action they could take in response to this event. Whether they want to try to demonstrate compassion to the families of Newtown, work to improve safety in their schools and communities, be activists for gun regulation, or support improved mental health care, they should be encouraged to channel their emotional responses constructively. We can teach our children that there are inevitable small risks that are part of growing up, that we can only control so much of our future, and that we need to tolerate these risks – try to minimize them when it’s possible and to grieve and recover when we cannot.

It seems that not a week goes by without the occurrence of a heartbreaking or terrifying event that gets exhaustive coverage in the news. Although overwhelmed adults can choose to take a hiatus from media or emotionally distance themselves from events, parents quickly learn that children come to them routinely with questions about something they saw, heard, or read about in a newspaper, online, on the radio, on television, via social media, or just from talking with a friend at school. Without imposing restrictions that would severely limit the child’s appropriate growing autonomy, there is simply no way that parents can fully control that to which their school-aged children are exposed.

Talking about the news-based facts of life poses challenges for most parents. It is unlikely that any parent woke up on the morning of Sept. 11, 2001 ready for the questions their children would come home from school with that afternoon. School and mall shootings and deaths from child abuse can be especially frightening for children and parents alike. Even natural disasters or accidents can be terrifying in their randomness and heartbreaking in their consequences. Should parents offer blanket reassurances? Can they speak honestly about the bad things people do or the uncertainty and vulnerability that are (often unacknowledged) facts of life?

The first thing you might offer a worried parent is the reassurance that the good news is that their children are asking them these questions at all and that children cope with troubling news. The fact that they bring their feelings and questions to their parents is a great marker of their judgment and trust. Remind parents that if they simply welcome these questions, are curious about their children’s thoughts and feelings, and remind their children to never worry alone, they will have done a great job at handling these types of questions.

Beyond welcoming difficult questions, there are some strategies to share with parents to help them handle these types of questions well. If at all possible, the parent should "strike while the iron is hot" and find the time and privacy to have these conversations when they arise. But if they come up in a busy public setting, such as the check-out line at the grocery store, it is probably best to respond that this is a very important question that deserves their full attention. They can talk about it once they get back in the car or can sit down at home together.

The conversation should start by gathering more information. What got the child thinking about this topic? Did they see or hear or read something about it? What was their response to this? It is important that parents remember not to assume that they know what their child is actually asking or worried about. What might worry a parent about a plane crash or a mass shooting may be different from what worries a child. What may be on the mind of a first grader could be quite different than a sixth grader. Often, children will want to gather information also. They may have a lot of factual questions about an event that they have heard about. It is natural for parents to want to protect their young children from material that is scary or sad, but it would be harder for these children to overhear this material or have to navigate it alone. Therefore, acknowledging what is true about what the child has heard is appropriate.

If a child has heard that people died in a school bus accident, then it is appropriate for a parent to acknowledge what is true without euphemism. Difficult facts should then be followed with an acknowledgment of the difficult feelings that can come with them. "How does this make you feel?" or "It makes me so sad that some children died in that accident" are examples of labeling and bearing these strong feelings. Again, parents should be sure to be curious about their child’s feelings as well as modeling how they handle such feelings.

After having a chance to discuss some of the factual details of the news and the emotions that follow, it will be critical for parents to offer appropriate reassurance and even a potential course of action. School-age children have the cognitive capacity to learn about complex issues that may be reflected in news events, such as global warming or mental illness, but they usually lack the emotional maturity to comfortably hold the anxiety and uncertainty that can follow. Therefore, parents should offer clear reassurance to their school-age children.

Although they cannot promise total immunity from illness, risks, or accidents, they can remind their children about how they are safe. For example, after discussing that there is fighting in Syria in which some children have been injured or killed, they should remind their children that their family lives in a safe community where there is no war or fighting. There may be an opportunity to teach their children about how to protect themselves in specific situations if the difficult topic lends itself to this. They could, for example, review what children should do in case of a fire or if they witness a physical fight or are offered a ride by a stranger.

Finally, school-age children can feel very distressed by the unfairness that is often a component of newsworthy events. At this stage in development, children are working hard to master and follow the rules in all sorts of settings, from soccer to social situations to algebra. They can become very upset when the rules don’t seem to apply, and, of course, life is often unfair in ways that parents cannot make right. Offering their children some perspectives, values, and actions they might take in response to a specific tragedy or injustice is helpful for their children’s coping and their development.

Parents may talk with their children about ways to raise money to help victims of an earthquake or to collect food for people displaced by a flood. Or they might want to think about working with friends and teachers at their school to create a bike safety curriculum. There are many schools and communities that have been profoundly affected in positive ways by efforts that grew from such conversations between concerned school-age children and their parents.

Pediatricians are uniquely qualified to help parents manage these difficult topics when they arise. Some parents may ask about this directly, but it may be helpful to create a handout to keep in the waiting room about this issue. Or you could create a page on your practice’s website. You also should remain attuned to when parents mention troubling news events in passing and take those opportunities to find out how they have handled them with their children. Although parents naturally feel that there are stories they would prefer to shield their children from, with your guidance they can see that even these difficult topics present opportunities to support their children’s preparation for adolescence and adulthood.

Dr. Swick is an attending psychiatrist in the division of child psychiatry at Massachusetts General Hospital, Boston, and director of the Parenting at a Challenging Time (PACT) Program at the Vernon Cancer Center at Newton Wellesley Hospital, also in Boston. Dr. Jellinek is professor of psychiatry and of pediatrics at Harvard Medical School, Boston. He is also chief of clinical affairs at Partners HealthCare, also in Boston. E-mail Dr. Swick and Dr. Jellinek at pdnews@elsevier.com.

On the morning of Dec. 14, 2012, the authors submitted this piece on helping parents to discuss difficult events in the news with their children. It was written in the spirit of the many circumstances children hear or watch on the television news describing violent, scary, or sad events.

Within the hour, news broke that a gunman had entered an elementary school in Newtown, Conn., and shot many people, including children. Over the course of that terrible day, the full story took shape in a constant news flow that gripped all of us. Sandy Hook was unbearably tragic. Twenty first-grade students were murdered. Six teachers and staff members were murdered. The shooter had started by murdering his mother and finished by killing himself. Although there was some safety that he would not hurt anyone ever again, there was also the massive insecurity that we will never be able to feel safe again, even in an elementary school, and are unable to understand what could have made a person commit this crime.

Several of the points we make in this article are especially relevant to the events in Newtown. This event has received such intensive and unremitting coverage that even the youngest children probably have been exposed in some way to it. Parents will need to be attuned to any indications that their children have seen, heard, or read something about this, and they should check in with their children and find out what they know, what questions they have, and what they are worried about. Parents who are anxious that they will be introducing this horrifying story might ask, "Have you ever heard or seen something that was scary or upsetting, and hard to get out of your thoughts afterwards?" They should try to limit children’s exposure to these news reports, as children may be overwhelmed or confused by the constant repetition of the story and will have difficulty managing disturbing images.

Parents should be reassured that well-loved, valued children can cope with troubling news with the help of their parents’ explanations, reassurance, and guidance, and the resumption of normal activities. Most of the millions of children (and parents) indirectly exposed to the Sandy Hook murders will be resilient. Longer term, some children in your pediatric practice will not return to their usual functioning. Some children may have a vulnerability to anxiety or depression, and others may have had previous losses of loved ones through divorce or death. Some will be vulnerable secondary to poverty, abuse, or neglect. For these vulnerable children and parents, Sandy Hook will be a critical, longer-term event.

A parent who may have become too absorbed in the acute phase of the story did not limit access to the media. A child may develop anxiety about being safe in school, become clingy to parents, regress to a younger age, or have posttraumatic stress disorder symptoms of what they have seen on television (nightmares, flashback images, etc.). A parent may become very anxious about school safety and overly restrictive. These anxieties are a way of coping with past and current events – a solution to their anxiety. Pediatricians should be empathic, take a family history for anxiety and depression, and consider a mental health referral.

Even the best-adjusted parents in your practice should be reminded that their children’s feelings, questions, and worries will be different from their own. This particular tragedy will have a profound, painful resonance for all parents. It will be difficult to drop off their children at elementary school without worries about their safety and feelings of breathtaking sadness for those parents whose children did not come home on Dec. 14.

If parents don’t manage their own distress, their children will surely sense or pick up on parental anxiety and will be much harder to reassure. It is critical for parents (and teachers, librarians, classroom aides, principals, social workers, and physicians) to tend to themselves. They must manage their own sadness and distress by getting meaningful support and reassurance from friends, loved ones, spouses, religious leaders, community leaders, and counselors. They should turn off the news not only when their children are around, but also when it becomes too much for them to bear. They should make sure that their family’s routines, including their routine limits and rules, continue. This is organizing and reassuring for children and adults alike.

Of course, supporting the families who were directly affected by the murders in Newtown will be very different from supporting those affected by the news of those murders. There will need to be a thoughtful, community-wide mental health plan for all of these survivors; the parents, siblings, and spouses who suffered the death of a loved one; and the first responders so stressed by the intensity of what they had to do and see.

Just as surely, there will be questions about whether mental illness or developmental disorders are linked to these horrifying incidents of violence. The fact that the perpetrator in Newtown has already been described in the media as having been diagnosed with Asperger’s disorder ensures that many families, especially those raising children with developmental disabilities, will have questions about any association. We as physicians must be clear that only clinicians who personally evaluated or treated this young man can speak to any of his personal problems or diagnoses. More broadly, there is no predictable association between acts of mass murder and psychiatric illness or developmental disorder. Indeed, it would be a disservice and counterproductive to increase the stigma and social isolation that already make it so difficult for so many to seek psychiatric help.

On a final note, adults as well as children should be encouraged to consider appropriate, meaningful action they could take in response to this event. Whether they want to try to demonstrate compassion to the families of Newtown, work to improve safety in their schools and communities, be activists for gun regulation, or support improved mental health care, they should be encouraged to channel their emotional responses constructively. We can teach our children that there are inevitable small risks that are part of growing up, that we can only control so much of our future, and that we need to tolerate these risks – try to minimize them when it’s possible and to grieve and recover when we cannot.

It seems that not a week goes by without the occurrence of a heartbreaking or terrifying event that gets exhaustive coverage in the news. Although overwhelmed adults can choose to take a hiatus from media or emotionally distance themselves from events, parents quickly learn that children come to them routinely with questions about something they saw, heard, or read about in a newspaper, online, on the radio, on television, via social media, or just from talking with a friend at school. Without imposing restrictions that would severely limit the child’s appropriate growing autonomy, there is simply no way that parents can fully control that to which their school-aged children are exposed.

Talking about the news-based facts of life poses challenges for most parents. It is unlikely that any parent woke up on the morning of Sept. 11, 2001 ready for the questions their children would come home from school with that afternoon. School and mall shootings and deaths from child abuse can be especially frightening for children and parents alike. Even natural disasters or accidents can be terrifying in their randomness and heartbreaking in their consequences. Should parents offer blanket reassurances? Can they speak honestly about the bad things people do or the uncertainty and vulnerability that are (often unacknowledged) facts of life?

The first thing you might offer a worried parent is the reassurance that the good news is that their children are asking them these questions at all and that children cope with troubling news. The fact that they bring their feelings and questions to their parents is a great marker of their judgment and trust. Remind parents that if they simply welcome these questions, are curious about their children’s thoughts and feelings, and remind their children to never worry alone, they will have done a great job at handling these types of questions.

Beyond welcoming difficult questions, there are some strategies to share with parents to help them handle these types of questions well. If at all possible, the parent should "strike while the iron is hot" and find the time and privacy to have these conversations when they arise. But if they come up in a busy public setting, such as the check-out line at the grocery store, it is probably best to respond that this is a very important question that deserves their full attention. They can talk about it once they get back in the car or can sit down at home together.

The conversation should start by gathering more information. What got the child thinking about this topic? Did they see or hear or read something about it? What was their response to this? It is important that parents remember not to assume that they know what their child is actually asking or worried about. What might worry a parent about a plane crash or a mass shooting may be different from what worries a child. What may be on the mind of a first grader could be quite different than a sixth grader. Often, children will want to gather information also. They may have a lot of factual questions about an event that they have heard about. It is natural for parents to want to protect their young children from material that is scary or sad, but it would be harder for these children to overhear this material or have to navigate it alone. Therefore, acknowledging what is true about what the child has heard is appropriate.

If a child has heard that people died in a school bus accident, then it is appropriate for a parent to acknowledge what is true without euphemism. Difficult facts should then be followed with an acknowledgment of the difficult feelings that can come with them. "How does this make you feel?" or "It makes me so sad that some children died in that accident" are examples of labeling and bearing these strong feelings. Again, parents should be sure to be curious about their child’s feelings as well as modeling how they handle such feelings.

After having a chance to discuss some of the factual details of the news and the emotions that follow, it will be critical for parents to offer appropriate reassurance and even a potential course of action. School-age children have the cognitive capacity to learn about complex issues that may be reflected in news events, such as global warming or mental illness, but they usually lack the emotional maturity to comfortably hold the anxiety and uncertainty that can follow. Therefore, parents should offer clear reassurance to their school-age children.

Although they cannot promise total immunity from illness, risks, or accidents, they can remind their children about how they are safe. For example, after discussing that there is fighting in Syria in which some children have been injured or killed, they should remind their children that their family lives in a safe community where there is no war or fighting. There may be an opportunity to teach their children about how to protect themselves in specific situations if the difficult topic lends itself to this. They could, for example, review what children should do in case of a fire or if they witness a physical fight or are offered a ride by a stranger.

Finally, school-age children can feel very distressed by the unfairness that is often a component of newsworthy events. At this stage in development, children are working hard to master and follow the rules in all sorts of settings, from soccer to social situations to algebra. They can become very upset when the rules don’t seem to apply, and, of course, life is often unfair in ways that parents cannot make right. Offering their children some perspectives, values, and actions they might take in response to a specific tragedy or injustice is helpful for their children’s coping and their development.

Parents may talk with their children about ways to raise money to help victims of an earthquake or to collect food for people displaced by a flood. Or they might want to think about working with friends and teachers at their school to create a bike safety curriculum. There are many schools and communities that have been profoundly affected in positive ways by efforts that grew from such conversations between concerned school-age children and their parents.

Pediatricians are uniquely qualified to help parents manage these difficult topics when they arise. Some parents may ask about this directly, but it may be helpful to create a handout to keep in the waiting room about this issue. Or you could create a page on your practice’s website. You also should remain attuned to when parents mention troubling news events in passing and take those opportunities to find out how they have handled them with their children. Although parents naturally feel that there are stories they would prefer to shield their children from, with your guidance they can see that even these difficult topics present opportunities to support their children’s preparation for adolescence and adulthood.

Dr. Swick is an attending psychiatrist in the division of child psychiatry at Massachusetts General Hospital, Boston, and director of the Parenting at a Challenging Time (PACT) Program at the Vernon Cancer Center at Newton Wellesley Hospital, also in Boston. Dr. Jellinek is professor of psychiatry and of pediatrics at Harvard Medical School, Boston. He is also chief of clinical affairs at Partners HealthCare, also in Boston. E-mail Dr. Swick and Dr. Jellinek at pdnews@elsevier.com.