With great tragedy often comes great heroism. And in this sense, Hurricane Katrina is no exception. While heroes come in all shapes and sizes, many children seem to be rising to this occasion.

Whether it’s the poignant image of a 6-year-old boy holding a 5-month-old and leading a group of five toddlers to safety in downtown New Orleans, or the lemonade stands run by children popping up on street corners and country roads across the U.S to raise money to help hurricane survivors, growing numbers of children seem to be pitching in however they can.

But what effects will this tragedy have on the mental health of those children who have been most affected?

“Most people when faced with trauma feel that if there is something they can do to feel more constructive, they will do it,” and children are no exception, says Stuart Goldman, MD, a child psychiatrist at Children’s Hospital in Boston.

“The majority of children faced with trauma do try to rally, but many can’t rally that much,” he says. “The images of young kids taking care of younger children are probably the marked exception, not the rule.”

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Resilient Kids

For kids who do pitch in, “there will be no change long term if they can go back to the way they were before the tragedy,” he explains. “Resilient kids are surrounded by supportive adults that guide them and they feel as though they have the capacity to make a difference in their life.” For example, the 8-year-old who is helpful to younger children has a positive resiliency factor.

“If you cope well that probably sets you up for being in a better position later,” agrees Gail Saltz, MD, a psychoanalyst at the New York Psychoanalytic Institute in New York and the author of Becoming Real: Defeating the Stories We Tell Ourselves That Hold Us Back.

“A child who is able to do something that helped will be in a better place down the road because they were able to exert control and not be a victim,” she says, adding that such behaviors take away helplessness.

Kids who didn’t lose a parent or their home will get back on track as the school year starts and things return to some semblance of normalcy, Goldman says. However, “kids know being sheltered in the Houston Astrodome who will be there for the next three months and whose families have lost everything and will have to relocate are at the greatest risk for ‘nonresilience,’” or the inability to bounce back from tragedy or adversity.

“Poverty and disadvantage are all risk factors for nonresilience,” he says, “and that is the population that took it on the chin with Katrina.”

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Echoes of 9/11

After Sept. 11, 2001, many children were affected psychologically -- especially in New York and its surrounding areas. But “as soon as things calmed down, younger kids stopped worrying about it if they hadn’t been directly affected,” Goldman says.

“The number of children affected by Katrina is 100 if not 1,000, if not 10,000, times the number of children affected by 9 /11,” he says.

A study commissioned by the New York public school system six months after the 9/11 attacks found that city school kids had a higher rate of mental problems than would be expected under normal circumstances. In fact, more than 10 percent of the students surveyed had symptoms of post-traumatic stress disorder (PTSD), which can be marked by flashbacks to the event, feelings of numbness or detachment from everyday life, irritability, angry outbursts, and trouble concentrating.

As with 9/11, the children who have lost the most as a result of Hurricane Katrina will struggle the most down the road, Saltz says. The best way to protect these children form lingering emotional problems is with support from loved ones.

“Parents or other relatives need to emphasize to the child that ‘we are OK,’ ‘we are going to stay together,’ ‘nothing will happen to us’ and ‘yes, we will have to find a new place to live, but we will,’” she says. “Reassure them of this often.”

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Have a Poker Face

Remember that “children are looking to you [the parent] to gauge their own emotional reaction and if you are crying and hysterical and saying a lot of doomsday things, they will pick up on it and will have a similar feeling,” Saltz says.

She also suggests that parents minimize children’s exposure to news of the disaster when possible. “Let them talk about how they feel, let them play, and always remind them that you are there,” she says.

This may not be enough for children who have lost parents as a result of the hurricane, she says.

So far, parents displaced by flooding have reported 220 children missing, but that number is expected to rise, according to the National Center for Missing and Exploited Children.

“Lost kids need surrogates to step in and reassure them that people are looking for their parents and not to leave this kid feeling like they are all alone in the world,” she says.” It is likely that the child who has lost parents in a hurricane and has been dislocated will probably need professional help.”

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By Denise Mann, reviewed by Michael W. Smith, MD

SOURCES: Stuart Goldman, MD, child psychiatrist, Children’s Hospital, Boston. Gail Saltz, MD, psychoanalyst, New York Psychoanalytic Institute, New York; author, Becoming Real: Defeating the Stories We Tell Ourselves That Hold Us Back.