The graphic nature of the attack at the Boston Marathon can be difficult for many to process, and that includes young people.
Whether or not they were physically there at the bombing, children can be profoundly affected by what they hear and see. It can be normal to notice some anxiety and fear after an event like the marathon bombing, Dr. Alan Hilfer, director of psychology at Maimonides Medical Center in New York, explained to CBSNews.com.The most important thing is that someone will be there for them -- because they'll be turning to the adults in their life and their peer for answers and support.
"Talk to kids in an honest, yet reassuring manner," Hilfer suggested. "Kids take cues from their parents. If they're parents are agitated or upset, it will make it harder for kids to understand what's going on.
"Let the kids know it's an isolated event, and it doesn't happen all over the place. It happened in one place, and parents and schools will do everything else to keep the kids safe. He added, "Of course, it's much harder to say those things these days."
Symptoms of post-traumatic stress disorder (PTSD) are uncommon during the time right after a traumatic event. Instead, adrenalin activation is common, said Dr. Paul Summergrad, Tufts Medical Center chair of psychiatry, at a press conference. People can have a huge stress reaction, numbing and disorientation. As days and months pass, new psychological aspects to deal with occur.
"A week later, people tend to disappear, and you have to go into a process over time," Summergrad explained.
It could take 30 days or more for PTSD symptoms to appear, Summergrad pointed out. PTSD symptoms include flashbacks, bad dreams, frightening thoughts, staying away from places, events or objects that remind them of the experience, feeling numb or guilty, loss of interest in activities, lack of memory about the event, being easily startled, feeling tense and having difficulty sleeping. For children, difficulty doing schoolwork, listlessness, depression and phobias (for example of entering crowded places) should be warning signs as well, Hilfer said.
"It doesn't always happen right away, but some of the symptoms can emerge and are often not noticed," Hilfer stated. "Everyone expects a little anxiety, but PTSD tends to be the lingering stuff -- people who have terrible reactions when a car backfires or in crowds."
Children who might have experienced a traumatic event in the past -- should especially be watched after events like Monday's tragedy because they may go through retraumatization right away -- even if they weren't physically at marathon. A study in November 2012 in Psychological Science showed that children who had lived in areas hard hit by Hurricane Katrina who had PTSD symptoms werethe more Hurricane Gustav coverage they watched.
"I certainly saw it in 9/11 when people heard airplanes or when they became anxious because the airplane was flying low," Hifler said. "It's not the fact that people become anxious a little bit about it. It's when anxiety begins to interfere with their daily functions, when they're not interacting in the community or at school."
Hilfer said that parents should reach out to medical professionals if they start noticing their children having any prolonged symptoms. Psychologists and psychiatrists are trained to help kids talk about their feelings, help them develop coping strategies and work with their families to come up with ways to help manage anxieties. In severe cases, kids may need medication.
One thing that almost always helps, however, is returning to daily life.
"I advise as quickly as possible to resume normal routines and not to take too much time off from school. Get kids back to school. That helps everyone move to get some of the difficulties and anxieties," he said.