Cook Children’s psychiatrists and psychologists are sharing some advice for parents.

How do I talk to my children?

• Ask them how they’re feeling and attempt to validate their feelings. Feelings of anxiety and sadness are normal. Reflect on what you hear and give them space to share. – Cook Children's family therapist Chris J. Gilbert, M.Ed, LPC, CCLS
• It’s OK if children ask questions that we don’t have an answer to. If you don’t have an answer, it’s OK to be honest and do what you can to help find an answer. You can follow up with “What makes you ask that?” – Kristen Pyrc, M.D., co-medical director of Psychiatry at Cook Children’s
•  If children feel sad or uneasy, validate what they are saying. Allow them to vent and share their own frustrations and reflect that back. – Family therapist Chris J. Gilbert, M.Ed, LPC, CCLS

Should I bring it up if my children haven’t mentioned it?

• For young children, you can ask them how their day went and if they heard anything unsettling at school. – Dr. Pyrc
• For children 10 and older, parents should consider starting the conversation because they will likely hear about it from a classmate.
• It’s also OK if they are not interested or don’t show interest. – Family therapist Chris J. Gilbert, M.Ed, LPC, CCLS

How can I comfort my children?

It’s important to talk with your child about things that frighten them because it helps reduce and manage fear. It lets them know that their parents empathize and care about their feelings and thoughts. – Cook Children's Neuropsychologist Lisa Elliott, Ph.D.

The best thing you can do for yourself and your family is to connect with them, tell them you love them, and hold them a little tighter because we are grateful they were able to come home. – Kia Carter, M.D., medical director of Inpatient Psychiatry at Cook Children’s Medical Center

Some tangible items to help your child feel more comforted:

• Create a small photo frame keychain with a family picture. They can attach it to their backpack or keep in their bag.
• Create matching bracelets to remind them of the connection to you and your family. – Dr. Elliott

You and your children can also:

• Donate to a charity.
• Write a letter to the family of a victim.
• Use your faith and pray for the needs of others.

These actions allow for some sense of a healthy outlet. - Family therapist Chris Gilbert

What if children do not want to go to school after hearing the news?

Let your child have one mental health day and do a lot of pouring into them and making memories together. Talk with them about how to handle problems and let them know we can still find joy. Do not let it be more than one day or it will only exacerbate the fear. – Dr. Elliott

“Kid’s worries about gun violence are valid,” said Kristen Pyrc, M.D., co-medical director of Psychiatry at Cook Children’s. “I have the same anxiety when I leave my house or send my kids to school. When you can, it is important to limit kids’ exposure to the news or information that is beyond their comprehension level. I hate having to have this conversation with increasing frequency because as adults we have not taken steps to adequately protect our children.”

Look for signs of anxiety

Keep an eye out for an increase in physical complaints. If these persist for more than a few weeks, seek professional help. - Dr. Elliott

• Stomach aches
• Headaches
• Change in appetite
• Nightmares
• Sleep disruptions
• Separation issues
• Panic symptoms
• Not wanting to participate in social activities

Parents, remember to take care of yourself

Model healthy coping skills as children take their cues from you. Children need to see that it’s OK to express emotion.

"It is vital for parents to take time to reflect on their own feelings before addressing their child’s fear centering around gun violence," Dr. Carter said. "We as parents have to remember to take care of ourselves first so that we can be the best parent for our children.  We encourage parents to find effective ways for themselves to cope by practicing in self-care whether it be exercising, meditation, seeking support in their religious faith. It can also be helpful for parents to consider joining parent support/community groups that can also serve as a platform to process these fears with other parents likely experiencing the same feelings. As parents, we are always modeling healthy behaviors for our children and this is a good time where we can model healthy coping skills and self-care for our children."

Effective ways to cope include speaking with other parents at school, forming/joining a parent support group, leaning on family members for support, eating nutritious meals, exercising, meditating, praying and speaking with your child’s school counselor for advice on resources or books on supporting yourself and your family through a school-related tragedy.

It's important that parents also process their feelings with other adults, support/communicate with their child's school staff and open up about their feelings and concerns.

Ways to help and ways to find support:

National Parent Helpline run by Parents Anonymous to get emotional support from a trained advocate: 1-855-427-2736

Tragedies such as these highlight the importance of donating blood. Giving blood supports nearby hospitals and rebuilds their supply for patients. Click here to sign up to donate blood at your local Carter BloodCare. Cook Children's Medical Center-Prosper is hosting its first blood drive. The drive is scheduled for 10 a.m. to 4 p.m. on May 12 on a Carter BloodCare bus. Register here.

Information from the National Association of School Psychologists about tips for administrators and how parents can talk to children about violence.

The National Child Traumatic Stress Network shares information for parents, including how to restore a sense of safety after a shooting.

For a great resource on how to speak up, visit sandyhookpromise.org.

For more on this topic:

• Sandy Hook Promise
• Cook Children's Behavioral Health
• Cook Children's Psychology
• Individual and family therapy
• Parent Education and Support
• Diagnostic Testing

Raising Joy Podcast

You can also listen to the recent Raising Joy Podcast with Dr. Jillian Peterson, founder of The Violence Project, as she informs listeners about her research findings related to mass shooters and what parents can do to help prevent the next school shooting.

Aim for Safety program at Cook Children’s

Safe storage. Safe children. Safe play.

When we have firearms in our homes, we must take certain steps to protect our children from unintentional shootings. Cook Children's Aim for Safety® initiative is designed to help reduce the number of injuries we see every year among children through gun safety education. This is not about whether guns are right or wrong. It's about taking the necessary steps to protect our children.

Safe storage: 

Parents and caretakers should always ensure safe storage in your own home and the homes you visit. Store firearms unloaded and in locked locations, out of reach of children.

• Use trigger locks and gun boxes.
• Secure ammunition separately.
• Hide gun safe and trigger lock keys.
• Keep unlocked guns in your possession.
• Make sure all guns are equipped with effective, child-resistant gun locks.

If a visitor has a gun in a backpack, briefcase, handbag, or unlocked car, provide them with a locked place to keep it when in your home.

Since the school shooting in Nashville last week, Lisa Elliott, Ph.D., psychologist at Cook Children’s, has seen an increase in conversation about school shootings with her patients and their parents who need help as well.

“It’s on everyone’s minds,” said Dr. Elliott, who has been a psychologist for 29 years. “Many of the moms have brought in their kids and asked for help themselves in navigating this.”

Dr. Elliott relates to these moms. School shootings now hit differently as her son is a middle school principal.

“Prayer gets me through,” she said.

We asked Dr. Elliott how to help children process this tragedy, along with tips for parents themselves. 

You can also listen to the recent Raising Joy Podcast with Dr. Jillian Peterson, founder of The Violence Project, as she informs listeners about her research findings related to mass shooters and what parents can do to help prevent the next school shooting.

What advice do you have for parents who are struggling with how to share the news of the school shooting with their children? How do they know when it is appropriate to talk with them?

The most critical part of reacting to this in front of children is to stay calm and always be honest with your responses.

To begin with, it all depends on how the kids process and handle emotions. You can wait to see if they say anything about it, and if they do, address it right away. I can tell you that late elementary, middle and high school students are talking about it. Do not minimize their concerns and immediately correct any inaccurate information. Let them talk first and lead the conversation, finding out what issues they want to talk through

Walk through the worst-case scenarios and talk to the school if needed, letting your child know all the safety measures in place. For some children, this kind of information empowers them.

Also, help them to know how to be observant – to be the helpers. We have to instill hope – Fred Rogers from Mister Rogers shared that his mother told him to “Always look for the helpers” in times of sorrow, tragedy, fear and anxiety, because if you also see the helpers you know there is hope.

At home, reinforce ideas of security and safety and maintain routines, with frequent check-ins.

How can parents reassure their children if they are struggling themselves to feel that everything will be OK?

Remember that to be the best parent to your child, you have to take care of yourself first – just like the airplane scenario with oxygen masks when parents are told to put their mask on before their child. It is important to model healthy coping as children take their cues from you. They need to see we care, and it is OK for them to see you express emotion, however, you do not want to overwhelm them. 

Effective ways to cope include speaking with other parents at school, forming/joining a parent support group, leaning on family members for support, eating nutritious meals, exercising, meditating, praying and speaking with your child’s school counselor for advice on resources or books on supporting yourself and your family through a school-related tragedy.

How do parents know when their child’s anxiety is beyond what they are able to help with and they need to pursue professional counseling?

Watch for these symptoms – an increase in physical complaints such as stomachaches or headaches, change in appetite, nightmares, sleep disruptions, separation issues, panic symptoms, not wanting to participate in social activities, and increased anger.

If any of these persist for more than a few weeks, seek professional help.

How do we shield our children from too much information with social media, TV, etc.?

Do all you can to limit your child’s exposure to the news, and even adult conversations, as children are always listening. We know from trauma research that violent images can cause secondary trauma. And parents need to model that as well by limiting exposure.

What if children do not want to go back to school after hearing the news?

Let your child have one mental health day and do a lot of pouring into them and making memories together. Talk with them about how to handle problems and let them know we can still find joy. Do not let it be more than one day or it will only exacerbate the fear.

What are some tangible ways parents can provide comfort to children?

Keychains with a small photo frame where you can place a family photo have helped many of the parents I see comfort their children. Attach it to your child’s backpack or lunchbox so they feel close to family while at school. Matching bracelets they can wear also help – anything that makes them feel connected to you and your family.

“We went to PE, and we were playing on the playground like normal,” Crystal said. “I didn’t know they were gunshots, the popping sounded like fireworks.”

On that fateful day, a car filled with teenage boys opened fire on the playground. When Crystal noticed a friend was bleeding, she ran over to help. Quickly after, another classmate told her that she too was bleeding.

“All I remember was my granddaddy being the first person there, and my mom was out of it,” Crystal said. In “Once the first responders got there, I was in and out of it.”

Crystal was rushed to Cook Children’s Emergency Department with a gunshot wound to her hip.

“We got to Cook Children’s and the hospital was amazing for us to be in such a trauma state,” Crystal remembered. “They made us feel like we were having fun in trauma if that makes sense.”

Crystal recalls the medical staff at Cook Children’s making her and her family feel like they were the only family in the entire hospital. “The nurses and the doctors made sure we were good around the clock. I have never seen anything like it,” Crystal said.

Still, Crystal’s mother was afraid she wasn’t going to make it. She remembers the fear in her mother’s eyes as doctors and nurses were yelling orders and pulling tubes. She says she kept repeating, “God you’re going to have to work this out and keep me alive.” Even at a young age, she remembers her faith playing a big part in the whole experience.

Crystal and her mother spent several days at Cook Children’s. Because of where the bullet went in her hip, doctors did not perform surgery because they were afraid it could do more damage than good. They worried she could be paralyzed from the waist down because it was so close to her tailbone.

“The bullet is still in me 31 years later,” Crystal expressed. “They kept an eye on it for several years to make sure it didn’t go near my tailbone or to see if it would surface, but neither happened.”

Crystal says she periodically still feels a sharp pain in her hip.

After the incident, Crystal did not return to finish her school year at Sunrise Elementary. Her mother, a police officer at the time, was afraid of anything else happening to her child. Crystal says it wasn’t unusual to hear gunshots in her neighborhood, and it took a long time for her to adjust to hearing the “popping” sound.

“It took a long time for me to get over it and suppress it in the back of my mind and for everything to be okay,” Crystal said. She spent several years in counseling to process the shooting, deal with sound triggers and move past the event.

Years later, Crystal became a wife, mother, and nurse. She credits the care she received at Cook Children’s to pursuing a career in nursing, as well as her love for serving others. She says her biggest challenge was overcoming the fear she had when her children started school.

“I feared my daughter going to school and something happening to her. Especially now that people go into the schools and shoot students,” Crystal said. “It was especially hard for her going into third grade. I started praying every day for God to protect her and I’m doing the same for my son now who is in second grade.”

Crystal says the increase in school shootings over the years does trigger flashbacks. She always asks the question, “How do we protect our children in school from the playground to the classroom?”

While her shooting was an isolated incident, she believes children in every community deserve better. She also says ‘thank you’ would never be enough for the staff at Cook Children’s that saved her life.

“I appreciate the care that was given to me and my mom,” Crystal expressed. “I’ve never seen a staff work in unison the way they do at Cook Children’s, even over the years when I’ve brought in my children. There’s a culture at Cook Children’s that can’t be beaten, they set an example of what all hospitals should be like across the country. The nurses and doctors care about their patients and that’s something I have always appreciated.”

Crystal says the care she received at Cook Children’s is something she has always reciprocated in her nursing career.

“I always think back to how well they took care of me, and I value that and make sure to model that in my work.”

Dan Guzman, M.D., a Cook Children’s emergency physician, called the day gut-wrenching for the victims, their families, and the medical staff that took care of the kids, ranging from ages 3 to 14.

Gun awareness and gun safety is a passion for Dr. Guzman. He is the medical director of the Aim for Safety program at Cook Children’s, which promotes firearm safety for children. The program is a multi-step interactive experience that provides parental awareness and teaches children the steps they should take when they encounter a firearm.

“I think most people think this ‘won’t happen to us’ because we’ve taught our kids to never touch guns,” Dr. Guzman said. “But if you aren’t taking the proper precautions as the adult and parent, it’s probably only a matter of when, not if, your life may be affected by an unintentional discharge involving someone you know, and maybe even your child.”

Firearm-related fatalities are a top 3 cause of death among children in the United States.

Dr. Guzman said before the weekend, the medical center staff sees about one child per week. Already in 2019, three gunshot wounds treated at the medical center have been fatal.

“Unfortunately, the tragedy of children falling victim to unsecured firearms continues to happen daily,” Dr. Guzman said. “These preventable incidents and the pain and suffering they inflict can be reduced by properly securing your firearms.”

As part of the program, Dr. Guzman offers these safety tips to follow:

The 3 Ts of firearm safety and children

Talk – This includes your family, neighbors and friends. When your child visits other homes, ask the owners if there are guns in their homes and how they are stored. Dr. Guzman said this question is not to be insulting, but to keep your children safe from unsecured firearms.

Teach – Have a conversation with your kids about what to do if they see a gun:

• Stop
• Don’t touch the gun
• Run away
• Tell someone

Take – Dr. Guzman is asking gun owners to take action and store their firearms properly. And, to take personal responsibility for our children’s safety.

Dr. Guzman stressed that children are curious and impulsive which can be deadly when paired with a firearm. Storing a loaded firearm under the mattress, in a bedside table or a closet is placing your family at risk, Dr. Guzman added.

The most secure place for your firearm is in a safe with the ammunition stored separately. Unsecured firearms should always be in your possession. If you are unable to purchase a gun safe, then separating the ammunition from the firearm and using a cable or trigger lock will help reduce the risk of unintentional injury to your child.

“It’s important to assess and evaluate your home injury risk and find ways to reduce the hazards in your home whether it is related to firearms, water safety, poisonings or any other safety risks,” Dr. Guzman said. “Discussing with your children the importance of what to do when they encounter a firearm can help to reduce unintentional injury in your home.

It was the nation's deadliest school shooting since a gunman attacked an elementary school in Newtown, Conn., more than five years ago.

What makes the news more tragic is that these were students, and children, who were killed by a fellow student. By the time your child returns home from school today, he or she may have questions about this tragic event.

So how do you talk to your child about the shooting?

Joy Crabtree, Psy.D, a licensed psychologist for Cook Children’s Behavioral Health in Southlake, said parents must set the example for their children to follow. Crabtree encourages a discussion of the events, but only if your youngest children have learned about the incident elsewhere. If they haven’t heard about it, don’t share information with them. If they already know about it, answer their questions and most importantly, reassure them.

Crabtree said that in the cases such as what’s currently in the news, parents need to think through whether their child can handle any news about it at all. Depending on their age and maturity level, it might be best to shield children from the news entirely.

“Parents have to stay calm and cannot be glued to the TV,” Crabtree said. “If you have an elementary-aged child, and they haven’t learned the news, there’s certainly no reason to sit down with them and show them the story. There’s no need to cause fear in your children. By the time children are 7 or 8 years old, they can distinguish fact from fiction and will understand the consequences of what they are watching. If they have heard about it, take as much time as needed to sit down with them and have a discussion/answer session, providing reassurance and support. Answer their questions, but only their questions. There’s no need to add more information that may scare them even more.”

For older children, such as middle school and high school, Crabtree encourages parents to again determine if their child is mature enough to handle the information. If parents feel they can handle it, use the DVR as your friend during the news. Watch it with your child and pause the TV to answer questions. Gauge your child’s emotions and turn the TV off if your child becomes too emotional or the news is too intense.

Children may not understand the distance of the events on TV, make sure to calm their fears and let them know they are safe. If they continue to be fearful of their own safety, it may be helpful to get out a map and show them how far away they are from the incident that happened today. You can reassure them that the police have the situation under control.

“This news can be very scary to many children,” said Crabtree. “Parents need to realize this can really raise anxiety levels. They may feel that if it can happen there, it can happen anywhere. I can’t stress enough the importance of just being there for your child right now to support them, listen to them, and reassure them. Again, for younger children, only discuss it if they are already aware of the situation.”

Teens may have more questions and concerns because they can find information on the Web and discuss it with their friends at school. The event may hit even closer to home because they may be fans of the artists who were performing at the festival. They may have been to some of their concerts themselves and think, “that could have been me.” They may wonder why something like this happens. Share with your child your own fears and anxieties about the events. Let them know it’s Ok to feel scared or frustrated, but it cannot overtake them. Also, share with them ways that they may help by donating monetarily or giving blood in some instances. Sometimes when tragedy happens it helps them to work through their anxiety by becoming active and helping others.

Listen to your teen, or older child, regarding their fears and concerns. How an adult manages their own feelings can also provide a positive example for them.

Crabtree advises parents to watch to see if their children restrict activity, for instance if they don’t want to go to school or to the playground because it is too far away from home, or simply because they are afraid. Also notice if your child becomes withdrawn or more clingy than usual, and constantly wants to sleep in your bed. For older kids, if you see them avoiding social events, or larger gatherings, that might be something to discuss.

“It is common for children to have a mild fear, but if you see an overwhelming fear, it’s important to start by talking to their pediatrician,” Crabtree said. “If it continues to be a concern, then it may be time to get professional help.”

The frightening footage from downtown Dallas Thursday night is difficult to watch for even the most hardened adult. So how do you explain what has happened to your child?

Joy Crabtree, Psy.D, a licensed psychologist for Cook Children’s Behavioral Health in Southlake, said parents of young children should encourage discussion, but only if they have learned about the incident elsewhere. If they haven’t heard about it, don’t share information with them. If they have, answer their questions and most importantly, reassure them.

Crabtree said that in cases such as the Dallas shootings, parents need to think through whether their child can handle any news about it at all. Depending on their age and maturity level, it might be best to shield children from the news entirely, if at all possible.

“This is difficult for all of us to grasp. For children, the Dallas shootings may spur questions about race, protests, etc. These topics can be difficult to talk about," Crabtree said. "The overriding messages we need to be sending to our children right now is reassurance, love and peace.”

Crabtree said this topic may be especially difficult to talk about because of how we talk to children about police men and women or other people of uniform. We teach them to respect law enforcement because they protect us. It may be difficult to explain how something like this could happen.

It may also stir emotions for children of law enforcement officers. This may be the first time they have thought of their parent as a ‘target’ for violence. Crabtree says the key here, again, is reassurance.

For older children, such as middle school and high school, Crabtree encourages parents to again determine if their child is mature enough to handle the information. If parents feel they can handle it, use the DVR or TiVo as your friend during the news. Watch it with your child and pause the TV to answer questions. Gauge your child’s emotions and turn the TV off if your child becomes too emotional or the news is too intense.

“Parents have to stay calm and cannot be glued to the TV,” Crabtree said. “It's easy to get lost in the 24-hour news cycle. If you have an elementary-aged child, and they haven’t learned the news, there’s certainly no reason to sit down with them and show them the story. There’s no need to cause fear in your children. By the time children are 7 or 8 years old, they can distinguish fact from fiction and will understand the consequences of what they are watching. Answer their questions, but only their questions. There’s no need to add more information that may scare them even more.”

Children may not understand the distance of the events on TV, make sure to calm their fears and let them know they are safe. 

“This news can be very scary to many children,” said Crabtree. “Parents need to realize this can really raise anxiety levels. I can’t stress enough the importance of just being there for your child right now to support them.”

Teens may have more questions and concerns because they can find information on the internet and discuss it with their friends. They may wonder why something like this happens. Share with your child your own fears and anxieties about the events. Let them know it’s OK to feel scared or frustrated, but it cannot overtake them. Crabtree said take this opportunity to talk about issues that normally may not be brought up and find out what your child thinks about the police, violence and race relations.

"These are complicated times we live in and even as adults we are having a hard time grasping all the violence in today's world," Crabtree said. "We may not know all the answers. But the most important thing is to simply listen and offer support and love to your child."

Listen to your teen, or older child, regarding their fears and concerns. How an adult manages their own feelings can also provide a positive example for them.

Also, share with them ways that they may help by writing a letter to police, making a monetary donation or giving blood. Sometimes when tragedy happens it helps them to work through their anxiety by becoming active and helping others.

Crabtree advises parents to watch to see if their children restrict activity, for instance if they don’t want to go somewhere because it is too far away from home, or simply because they are afraid. Also, notice if your child becomes withdrawn or more clingy than usual, or reverts to wanting to sleep in your bed.

“It is common for children to have a general fear, but if you see an overwhelming fear, it’s important to talk to their pediatrician,” Crabtree said. “If it continues to be a concern, then it may be time to get professional help.”

About the source

Joy Crabtree, Psy.D. is located at 2727 E. Southlake Blvd. Southlake, TX 76092. To make an appointment with her, call 682-885-6000