Our hearts go out to the children and families affected by the recent floods in Central Texas, especially those at Camp Mystic and beyond. We understand many parents and loved ones are struggling to find the right words to explain this tragedy and console their children during this difficult time.

Kristen Pyrc, M.D., a mother and medical director of outpatient psychiatry at Cook Children’s, feels the weight of this weekend’s events both as a mother and as a psychiatrist. Dr. Pyrc shares her wisdom on how to navigate these difficult, heavy conversations with your children.

By Kristen Pyrc, M.D., medical director of outpatient psychiatry at Cook Children’s and mom of two sweet daughters

Yesterday was hard. I dropped off my daughter, Linden, at sleepaway camp with her bravest cousin, Evelyn. In light of the tragedy at Camp Mystic, there were many conversations and tears about whether to attend camp this week. Ultimately, both girls decided to attend. I am so proud of their strength and courage. I would have been equally proud of their self-awareness & honesty if they decided not to go. Many parents will have to navigate difficult conversations with our kids in the coming days so I put together some tips that will hopefully lighten your load a bit.

If you are concerned about how they will take the news, you should tell them. Other kids will be talking about it, and you want your kids to learn the news at home where they are safe to cry if they need to and ask questions. It is also important to impress upon them the sensitive nature of the matter. Encourage them to talk to an adult and not another child if they need to chat when they are away from you.

• Be factual when explaining what happened but shield them from harrowing details, wall-to-wall news coverage, or imagining what the kids went through. Their minds may go there on their own though.
• Survivor’s guilt is sneaky. Lots of kids will wonder about why this happened to other children and not them. Younger kids sometimes think they did something wrong to cause a tragedy to happen. In a few weeks, it may be good to check in about it (“Sometimes kids wonder why this happened to other kids and not them. Have you been thinking about that?”). Hopefully, it hasn’t come up for them, but it would be good to talk through if it has.
•  If they are grieving, give them something to do with their grief. I know this helps me. Could they pray, raise money, write letters, etc?
• Watch out for nightmares & intrusive thoughts. Sometimes kids tell me they can’t get thoughts out of their head, and it is very distressing to them.
• Reach out early to your pediatrician or mental health professional if you notice your kid is having trouble sleeping, not experiencing joy, spending a lot of time in their room, or just can’t turn their brain off. It is so incredibly hard to watch our babies suffer. I promise we want to help.
• I wish I had some magic words to take away our kids’ worries and sadness, but I don’t. The important thing is they have you, a parent who loves them beyond comprehension & is trying their best. I promise you that is good enough.

Cook Children’s is here to help, know you are not alone. We are providing resources below to help support you and your child. Talking to one another and seeking assistance is a vital first step in healing. 

• If your child needs additional support, please reach out to your child’s pediatrician. We have lots of resources here: https://www.cookchildrens.org/health-resources/mental-health/
• You can also access local mental health resources for your family 24/7 through MHMR by calling 1-800-866-2465.
• To learn more about Cook Children's behavioral health services or to schedule an appointment for your child, contact 682-885-3917.
• The Parent Pass app also has many resources for families: https://apps.apple.com/us/app/parent-pass/id1597475361

Social Media posts: Please feel free to share these resources from our Instagram, Facebook and LinkedIn pages.

Recognizing the need for support during this difficult time, Cook Children's physicians have come together to offer guidance and reassurance. Cook Children's Licensed Psychologist and Prosper Psychology Clinic Manager Christina York, Ph.D., provides valuable advice and guidance for parents navigating this sensitive situation. 

1. How do I help my teen make sense of something so senseless? 
When traumatic situations occur, we naturally want to make sense of them quickly. But when situations don’t seem to make any sense, it can help to think about what we can learn from the experience. 

2. What are the common signs of trauma in teenagers after witnessing or hearing about a violent event?
Teenagers who have experienced trauma may show several common signs, including:

• Trouble sleeping or nightmares 
• Feelings of sadness, helplessness and hopelessness 
• Difficulty concentrating, which can affect their schoolwork 
• Increased fear and anxiety 
• Loss of interest in usual activities 
• Social withdrawal 
• Avoiding things that remind them of the event (like talking about it) 
• Changes in appetite 
• Physical complaints such as stomachaches and headaches 
• Acting out 
• Feelings of anger, resentment or wanting revenge.

These reactions will generally subside over time. If they last for longer than a month or continue to worsen, parents may want to contact a mental health professional. 

3. If my teenager witnessed a traumatic event, is there anything I should look out for? How can I support them?
Pay attention to sudden changes in your child's behavior, speech patterns, and the way they express themselves, as well as strong emotions. Be particularly aware of:

Academic and Social Changes:

• Drastic drop in grades 
• Refusal or reluctance to go to school 
• Loss of interest in usual activities 
• Social withdrawal and increased isolation (which may include feeling numb and disconnected from themselves and others) 

Sleep and Emotional Reactivity Changes: 

• Changes in sleep patterns (difficulty sleeping, sleeping excessively, deliberately staying awake, frequent nighttime awakenings) 
• Increased reactivity (sudden mood swings, being easily startled and on edge, and/or quick to anger or tears). 

Support them by listening attentively and validating their feelings, even if you don’t agree with their emotional response. Instead of reacting negatively, try reflecting back what you hear them saying (for example, "It sounds like you're feeling scared and angry right now"). You might be surprised by how much they open up when you reflect instead of asking questions. Ask them directly how they're feeling and what they think about what happened. Always respect their choice to talk or not talk about the traumatic event. 

4. When should I seek professional help for my teen? 
If any of the signs of trauma listed above continue or worsen after two to three weeks, seeking professional help is advisable. Furthermore, any expression of suicidal thoughts is a critical warning sign requiring immediate professional attention. Additionally, engaging in risky behaviors like substance use, possibly as a way to avoid thinking, talking, or coping with the trauma, is another behavior that should be addressed quickly by a professional. 

5. How do I help my child process all of their emotions? 
First, be patient and never force your child to talk. Think of it as gently opening a door, not pushing it open. Reassure them that whatever they're feeling—sadness, anger, confusion, fear—is normal. If they don't want to discuss the traumatic event directly, encourage other forms of expression like drawing, journaling, music, art, or physical activity. 

Understand they might find it easier to talk to another trusted adult, such as a pastor, youth leader, teacher, counselor, coach, relative, or neighbor, and don't take it personally if they do. 

When your teen does decide to talk to you, ask how you can best support them: by simply listening, offering feedback, or helping to problem-solve. Be ready for any emotion they express and validate it without showing displeasure, anger, or frustration, even if it's unexpected. Instead of asking many questions, let your child guide the conversation and use open-ended questions. Remember that silence is acceptable; when they are ready, they will talk. 

6. What should I do if my teen is experiencing nightmares or flashbacks? 
Nightmares and flashbacks are common after trauma. If these symptoms continue for more than a couple of weeks, it may be helpful to seek help from a therapist experienced in trauma. Again, don't force your child to talk about nightmares. If they are experiencing a flashback, avoid startling them (like shaking or yelling). Instead, speak calmly, sit with them, and allow the flashback to pass.

7. What are some immediate coping strategies I can teach my teen to manage anxiety and fear?
Immediate coping strategies include: 

• Deep breathing: Slow, intentional breaths
• Grounding: Focus on your five senses to bring yourself to the present moment 
• Distraction: Engage in activities like holding ice, listening to calm music or watching something lighthearted 
• Physical activity: Movement can help release tension 
• Get creative: Activities like drawing or writing can provide an outlet for feelings. 

8. How do I help my teen feel safe again? 
Provide them with reassurance. Limit their exposure to repetitive news coverage on television, radio, and the internet, as this can prevent them from emotionally detaching from the traumatic situation. 

Talk with your teen about what they have seen or heard. Help them identify and focus on “cues of safety” in their environment, such as trusted people, rather than solely focusing on potential dangers. 

Because they may feel a loss of control, help them focus on what they can control, such as their choices, their bodies and their daily routines. Sticking to routines can provide a sense of predictability and stability, which is especially helpful when life feels unpredictable and chaotic. 

9. How can I address my own anxiety and fear without transferring it to my teen? 
Parents, please remember you are not alone. Talking with your partner or a trusted friend can alleviate your anxiety. Consider seeking your own individual therapy. Additionally, support groups for parents may be available through mental health clinics, churches, or other community resources, offering a space to connect, discuss fears and learn coping strategies. Taking care of your own well-being shows your children that seeking help is valuable. 

We encourage parents to engage in activities they enjoy, utilize helpful coping skills like deep breathing, mindfulness, meditation, physical activity, and journaling, and prioritize self-care, including sufficient sleep. It's okay for parents to communicate their feelings to their children calmly, as demonstrating their own coping skills in front of children can model healthy ways to manage anxiety and fear. 

Resources

Below is a list of resources for families, compiled by Cook Children’s physicians.

How to cope with traumatic stress
How to help children and teens manage their stress
How to Help Children Cope With Trauma - Child Mind Institute
Acute Stress Disorder in Children: A Quick Guide

Checkup Resources | Healing From the Inside Out | Cook Children's 
Behavior and Emotion Resources | Cook Children's 

The national suicide/crisis hotline (call, text, or chat options): 988 Lifeline 

Dr. Guzman, pediatric emergency medicine physician and Medical Director of the Aim for Safety Program, says that the school-aged kids who dealt with the tragedy will "definitely have long-lasting effects," some of which will include "stress, anxiety [and] their comfort level with returning to school."

Read the full story here.

But, as a parent whose child spent nearly eight months in the Neonatal Intensive Care Unit (NICU), I’m at risk for developing Post-Traumatic Stress Disorder (PTSD). Just like a war veteran or victim of abuse. That’s why Cook Children’s has added a Licensed Clinical Social Worker to help support parents during and after their time in the NICU.

People don’t often think about the effect that a NICU stay can have on a parent. Most of the time is spent worrying about the health of the baby and getting him or her healthy enough to go home. Once that happens, all the stress is over and life can go back to normal, right?

Not exactly.

Research tells us that up to 53 percent of mothers and up to 33 percent of fathers with babies in the NICU suffer from PTSD. So, why isn’t this talked about? What kind of resources exist for these parents?

Let’s start with a definition first.

What is PTSD?

PTSD is classified as an anxiety disorder characterized by a collection of persistent, debilitating physical and emotional reactions to traumatic, scary or life-threatening experiences. It can last or show up several years after the actual traumatic incident.

The first time I read that definition, I honestly didn’t think it had anything to do with me. Sure, the time we spent in the NICU was stressful but it hadn’t affected me THAT much.

Or had it?

It took our daughter Avery being back at Cook Children’s earlier this year for me to realize just how much it actually had affected me.

Avery has been home from the NICU for over two years. We’ve continued to have our struggles but nothing compared to our time in the NICU. For the most part, I really thought I had moved on. Avery’s 10-day stay in the hospital with RSV earlier this year has proven otherwise.

All it took was our first night back in at Cook Children’s to bring all the NICU memories rushing back.

The sight of Avery having to be on oxygen again. The familiar sounds of alarms going off and the smell of the hospital room. The hushed voices of the nurses trying to figure out what was going on. The fear and worry about whether Avery was going to be OK. The uncertainty of just how sick she was and how long we’d be there for. Except this time it was almost worse because Avery was older now and so much more aware of everything that was going on.

Even after all this time, the NICU memories flooded back in and honestly, I struggled but I wasn’t really sure why. She was nowhere near as sick as she had been in the NICU and 10 days didn’t even begin to compare to the 234 days we’d spent in the NICU.

It was after a recent visit with Helen Thomas, the newly hired clinical therapist for current and post NICU families, that I’ve begun to understand why. It was Helen who shared the analogy of the NICU being like a war zone with me. Since our initial conversation, we’ve been meeting regularly to talk more about how our time in the NICU has affected me. She’s helping me learn how to cope with the trauma that I’ve experienced.

“Because PTSD can develop from intense, life-threatening fear, having a child in the NICU can cause PTSD similar to individuals who have experienced military combat, victimization of violent crime/abuse or surviving a car accident,” she explained.

I felt an “Aha” moment went off in my head after hearing her explanation. It made so much sense. It was so validating. The NICU WAS traumatic. It has forever changed me. For the most part, it has changed me for the good. It has taught me perspective and to always celebrate the little things in life. But, as I recently learned, it did take its toll on me and my body and brain may not ever forget it.

Just like a war veteran doesn’t forget being on the battlefield, I will never forget my time in the NICU.

Previous articles documenting Avery's Journey:

• Avery's story - part 1
• Avery's story - part 2
• Avery's story - part 3
• Avery's story - part 4
• Avery's story - part 5
• Avery's journey - part 6
• Avery's journey - part 7
• Avery's journey - part 8
• Avery's journey - part 9
• Avery's journey - part 10
• An Autism Spectrum Diagnosis