These past two weeks, I have been asking my primary care pediatric patients and their families about how they are coping after the tragic marathon bombing. Most of the younger school-aged children recounted watching how their parents and caregivers reacted to the news reports. My teenaged patients recalled what they were doing when they heard the news and how they used mobile phones and other media devices to reach out to friends and family for support. Parents talked about their initial anxiety about their loved ones’ safety and how, once the immediate danger had passed, they worked to reestablish family routines. I was grateful that none of the patients I spoke with were directly injured by the blasts or the subsequent days’ violence.

Before talking with each patient, I had prepared myself to respond to a range of expressions of stress, fear, and loss. The child that surprised me the most, though, lived closer to home. My wife and I had been careful to protect my two sons ages nine and six years old from the continuous news coverage and graphic images of the bombing.  This is why I was so surprised to hear my eldest’s first question after we sat down as a family to talk about the marathon tragedy.

“Oh, you mean like the movie theater shooting?” he asked, referring to the Aurora, Colorado, mass shooting on July 20, 2012. It was a terrible event that we had not discussed with him; one he must have heard about from his friends at school. My wife and I listened to him talk about his feelings of fear and uncertainty, answered his questions with information that would help him to be safe and feel secure, and reminded him of the many people in his family and community who are ready to support him.

My son’s question drove home the reality that children and adolescents are faced with the knowledge of numerous violent events.  In fact, nationally, more than 60 percent of children aged seventeen and younger have been exposed to crime, abuse, or other forms of violence either directly or indirectly. Depending upon how they hear about these events, their stage in development, and individual characteristics, including their own personal experiences, some children may feel overwhelmed after hearing even limited details of these tragedies. As we work together as a city to recover from the marathon tragedy, how can we help children to become resilient in adversity?

The National Child Traumatic Stress Network and the National Center for PTSD cite that individuals who are likely to cope better are those who maintain one or more of the following characteristics:

• Optimism (because they can hope for their future).
• Confidence that life is predictable.
• Belief that things will work out as well as can reasonably be expected.
• Belief that outside sources act benevolently on their behalf (such as responsive government).
• Strong faith-based beliefs.
• Positive belief (for example, “Things usually work out for me”).
• Resources, including housing, employment, and financial.
 
Achieving any of these characteristics is a difficult challenge when faced by the magnitude of the tragedy on April 15, but I see Boston’s unity and resilience alive in my patients and their families. And it is this collective effort that has inspired me and individuals and communities all over the world. 
To learn more about support services available to victims and their families as well as tips for building resilience in children and youth dealing with trauma, go to bphc.org.

Dr. Huy Nguyen is the medical director at the Boston Public Health Commission and a pediatrician at the Dorchester House Multi-Service Center.