Treating children's emotional wounds
Routine, school, play can help heal psychological trauma
(CNN) -- As residents of tsunami-ravaged regions struggle for the basics of clean water, food and medical care, focus also turns to the less immediate, but still devastating, mental toll on children.
"The psychological effects are immense," explains Dr. Michael Wasserman, a pediatrician with the Ochsner Clinic Foundation in New Orleans, Louisiana. "Children understand sameness. And for reasons out of everybody's control, you've yanked that away. You've devastated their world."
Returning to a routine is an important step in helping children recover, says Charles MacCormack, president and CEO of Save the Children, an organization that provides emergency response, development assistance and advocacy of children's rights around the globe.
"We have trained Indonesian counselors available to meet with these children, but it's very important to create a sense of normalcy right away so we have established large tents where children can gather," MacCormack says. "And there are activities for them in Sri Lanka, too ... so they can have some sense that life is returning to normal."
Wasserman says re-opening schools is vital, even if the students are not necessarily learning.
"If nothing else, their routine is back to where it should be and back to what they're used to," he says.
At schools, missing students are a reminder of the devastation. In some cases, children are simply too young to understand.
Classes have resumed at Victoria (South Horizons) International Kindergarten in Hong Kong. But the school staff has not told students about two of their classmates who are missing after waves pulverized the Khao Lak, Thailand, hotel where their family was staying.
But some younger children, such as Xavier Lee of Hong Kong, have registered the scale of the tsunami tragedy.
"I feel so sad because so many people died," the 6-year-old says.
In the Thai resort city of Phuket, where some of the most ferocious waves crashed ashore, teachers are keeping a close eye on children returning to school this week.
"I'm looking for the children that might be withdrawn or something like that," says teacher Mike Brass.
Children worldwide affected
The stories and images of the tsunami destruction that killed more than 150,000 people can also have a psychological impact on children outside the areas hit. Stories and images of death and destruction may make children worry about their own safety and security.
"I think you have to be very careful to not expose children to information that they can't emotionally handle," says Wasserman, the pediatrician. "A 6-year-old can't handle something that maybe a 12-year-old could."
For the tsunami reports or any tragic news stories, Wasserman advises parents and teachers to talk about the situation and not avoid the topic. By using age-appropriate language, not giving too much information, listening and answering questions, adults can settle children's fears without over-alarming them.
Changes in a child's personality or sleep patterns can be a sign that they're upset, Wasserman says. Abdominal pain is also a common complaint in children who are emotionally distressed.
The Save the Children organization also recommends that adults watch their own behavior. Kids often take emotional cues from those around them. Also, adults should expect the unexpected, as no two children's responses will be exactly alike and some may not even be affected.
Those children with first-hand experience of the tsunamis will sustain the greatest psychological trauma. But MacCormack, of Save the Children, believes that they will recover emotionally, much like children around the world directly involved in past disasters have.
"They certainly understand that their lives have been disrupted and in many cases their families lost, but they're always very resilient," MacCormack says. "So as long as we can reunite them with their families, provide them with stability and a sense of normal life, our experience shows that they will revive and flourish again in the future."
CNN's Amy Cox and Andrew Brown contributed to this report.