Basic tips for the emotional well-being of children and adolescents affected by armed conflict situations

Children from 0 to 3 years old

• Are more clingy than usual with their fathers and mothers.
• “Regress” to behaviours they had when they were younger.
• Suffer from changes in sleep and eating.
• Cry more or are more irritable than usual.
• Are afraid of things that did not scare them before.
• Are more easily agitated and have difficulty concentrating.
• Have little or no interest in playing or play only for short periods.
• Play repetitive games or play more aggressively and violently.
• Can be more oppositional and demanding.
• They can be very sensitive other people’s reactions.

Children from 4 to 6 years old

• Begin to cling to their parents or other adults.
• “Regress” to behaviours from earlier stages of childhood, such as thumb sucking or bed wetting (enuresis).
• May stop talking.
• Reduce or increase their activity.
• Stop playing or start playing repetitive games.
• Feel anxious and worry that bad things will happen.
• Suffer from sleep disturbances, such as nightmares, and changes in eating habits.
• Are easily confused.
• Have difficulty concentrating well.
• Sometimes take on adult roles.
• Are more irritable than usual.

Children from 7 to 12 years old

• Engage in reduced or increased physical activity.
• Show elevated levels of confusion.
• Avoid social contact.
• Talk about an event in a repetitive way.
• Are reluctant to attend school.
• Feel and express fear.
• Have reduced memory, concentration, and attention.
• Show changes in sleep and appetite.
• Are more aggressive, irritable, or restless than usual.
• “Somaticize”(physical symptoms related to stress).
• Are concerned about the other people affected.
• Feel guilt and self-reproach.
• Accidental urination (urinary incontinence).

Adolescents

• Feel self-conscious, guilty or ashamed.
• Are concerned about other people affected.
• Can become self-absorbed.
• Experience changes in their relationships with other people. They feel hopelessness.
• Have increased emotional sensitivity.
• Engage in risky behaviour.
• Show aggression and defiant behaviour towards authorities and caregivers.

Some basic guidelines for self-care are:

• Give yourself space to rest and disconnect and allow yourself to express your emotions.
• Ask for help when you need it and delegate to other adults when you don't feel strong enough.
• Try to maintain basic care habits that will give you stability and health (take a walk, go out in nature, spend time with your friends...), sort out ideas and understand that "I'm doing my best".
• As much as possible, focus on practical information and try not to overexpose yourself to bad news.

The foundations for good support

Adequate support from family members and caregivers in their immediate environment is the most important factor for children and adolescents to develop and recover from difficult experiences.

Keep in mind that emotions are contagious, and the adult is the emotional reference point for children.

The foundations for good support are:

• Sense of safety: As far as possible, make him/her feel safe, secure, unafraid, and out of danger (both physical and psychological) in his/her relationships and physical environment.
• Stability: Again, circumstance permitting, do what you can to increase stability,predictability and consistency at social, emotional and physical levels. Being a consistent and caring person with the child or adolescent will help him or her gain confidence.
• Care: Whenever possible be available and responsive to the needs of the child or adolescent with sensitivity and consistency.

Children from 0 to 12 years old

• Provide them with space to cry and express distress.
• Create moments for rest and relaxation (reading a story, taking a bath...).
• Name their emotions and conveying to them that it is normal for them to feel this way.
• Engage and participate in activities with your children.
• Give them control of small tasks.
• Establish routines (mealtimes, exercise...) and involve the child in their organisation. Engage the child in activities that he/she enjoys (e.g. reading, playing, drawing, etc.).
• Maintain physical activity and a balanced diet.
• Relax limits at first, but it is important that children continue to have limits.
• Give them information about what is happening and what will happen from now on, with easily understandable language, using short and simple messages, in a calm and unhurried way, but without lying.
• Maintain contact with distant relatives through technologies. Ensure a safe environment and positive objectives.
• Do not leave children with other caregivers you do not know and trust without first creating a safe environment.
• Protect children from disturbing memories and tragic images to avoid feelings of worry, alarm and fear.

Adolescents

• Benefit from family support as well as that of friends and peers (of the same age).
• Be available to them, but give them their space.
• Provide them with spaces to escape and spaces to let off steam.
• Talk to them about what happened, using accurate information and reassuring language appropriate to their age and abilities.
• Boost their optimism, sense of humour and sense of control.
• Establish daily routines with set schedules and let them be part of organising and the execution of activities (cooking, organising...).
• Accompany them in educational pathway.
• Allow the adolescent to help manage the situation.
• Facilitate their involvement in the management of some of the situations experienced by the family.
• Try, as far as possible, to ensure that he/she acts in accordance with his/her family role, i.e. that he/she neither takes on more (looking after younger siblings, legal formalities, translations...) nor less (infantilising him/her).
• Be physically active and maintain a balanced diet.
• Be understanding about the possible difficulty of adapting to the new circumstances.
• Be alert to risky behaviour (drug use, self-harm, isolation, etc.), in the event of which expert help and/or Primary Health Care Centre should be consulted.

Children from 0 to 3 years old

Have sleep problems, don't want to go to bed, don't want to sleep alone, or wake up screaming at night

• If possible, do not let him/her sleep alone.
• Follow a bedtime routine: a bedtime story, a prayer, cuddling, etc.
• Communicate that the routine will be daily so that he/she is already looking forward to it before going to bed.
• Convey safety messages (verbal and physical).

Worries that something bad will happen to their caregiver or to a family member

• Remind them that they are safe "now", and if not, let them know what is being done to keep them safe.
• Engage in positive activities to divert their attention (reading, playing, etc.).

Does not want to play or do anything. Apathy

• Let them know that it's OK to feel sad, angry, or worried: "You don't seem to want to do anything"; "I wonder if you're sad"; "It's OK to feel sad"; "I'll stay with you".
• Engage in fun and engaging activities to divert their attention (reading, playing, etc.).

Cry a lot

• Allow them to express feelings of sadness.
• Help them to express their feelings.
• Give them hopeful messages about the future (what they will play, plans, meals, etc.).

Children from 4 to 6 years old

Fear that bad things will continue to happen

• Explain the difference between the event and the memory of it.
• Give them current safety messages, talking to them about the basic needs that are covered.

Have doubts about death and bereavement

• Give them simple answers and space for questions.
• Understand that, at this age, they do not have a developed idea that death is irreversible (drawing is a good tool for children to channel grief).
• Enable them to participate in cultural mourning rituals.
• Do not lie to them about the death of a close person, explain it to them, but in a language they can understand.

Do not speak, remains silent or finds it difficult to express what is bothering them

• Use toys and drawings that help children express themselves.
• Use words that describe feelings to check how they feel.
• Encourage them to express themselves, but do not pressure them.

Children from 7 to 12 years old

Feel responsible for what happened

• Give them opportunities to talk about their concerns. Offer reassurance and explain why it is not their fault with rational reasons (political, historical, practical...).

Retell or re-enact the event repeatedly

• Ask them to tell/recreate what they would like their reality to be like from now on.

Are confused about what happened

• Clarify any misunderstandings and offer clear explanations of what is really going on whenever they ask.
• Avoid giving details that could frighten them and try to reassure them and reaffirm the current security situation.
• Do not lose patience with the repetition of questions or topics that the caregiver is also shaken by (their reactions are important for the development of their conceptualisation of the situation).
• Provide information about what is going to happen (e.g. where they will live, where they will go to school, what they will eat, etc.).
• Remind them that there are people working to keep families safe and that they can ask for more help if they need it.

Adolescents

Shows a defiant attitude and/or one of self-harm

• Help the adolescent understand that defying the world is a dangerous way to express strong feelings such as anger.
• Pay attention to risky behaviours such as drug use or self-harm.
• Avoid reacting with anger to their anger, as this will tend to further isolate the adolescent.
• Seek professional expertise and/or referral to the Primary Health Care Centre.

Are fearful of the memories of what happened and how to react to them

• Tell them that vivid memories are common and that memories can also be sounds, smells, sensations, or even emotions.
• Explain that memories can come back unintentionally, and it can feel as if it is all happening again.
• Explain that reading news and seeing recurring images in the media can increase fears.

Are concerned about other survivors and families

• Talk about their concerns and validate their suffering. Emphasise that it is not their fault and that it is out of their control/responsibility.
• Identify meaningful and age-appropriate projects that they can do.