In the chaos of Hurricane Katrina, secure family ties unraveled. Teens were airlifted from rooftops while their parents stayed behind. Toddlers wandered unaccompanied on freeways. Mothers were forced to leave sick babies inside hospitals while they fled to safety with their other children.

For the first time in its history, the National Center for Missing and Exploited Children in Virginia has posted Internet photos of children missing not after abduction, but natural disaster; the photos range from a 3-year-old girl lost from her grandmother’s house in Alabama to a 17-year-old boy last spotted at the New Orleans Convention Center.

Fortunately, many missing children’s photos have been stamped “resolved” as more and more youngsters are reunited with loved ones in the days following the country’s worst natural calamity. But mental health experts tell WebMD that even when these families come under one roof again, some will need help to cope with the emotional fallout.

“Initially, there’s the relief and the recovery from the shock,” says Daniel Hoover, PhD, a psychologist at the Menninger Clinic in Houston. But eventually the euphoria wears off, and parents are no longer in sheer survival mode. That’s when trouble can start. “A lot of people are really focused on the ‘here and now,’ concrete realities of having a place to stay and handling the crisis. As that crisis abates and people are settled, there’s room for the kind of emotional aftershock that tends to set in.”

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Feelings of Guilt

For many families, the nightmare isn’t over yet. The National Center for Missing and Exploited Children ((888) 544-5475) lists 669 children from Mississippi, Louisiana, and Alabama who are either missing or are searching for lost parents. Separated youngsters and parents languish in a state of emotional limbo. They don’t know whether they’ll find their loved ones -- or how long it might take.

Besides agonizing over a child’s fate, “Parents may have feelings of guilt about how they got separated in the first place, even when things are largely out of their hands,” Hoover says. “That’s an important thing to address -- that tendency to self-blame.”

What are separated children going through? “Absolute terror and panic and concern about what will happen,” he says. “Children who are old enough to know what’s going on and young enough not to feel they have any control over the process -- it’s very difficult for them.”

“Younger children are solely dependent for the most part on their parents for food, shelter, water -- all their basic needs. And now they’re gone,” says Seth Allen, a family services liaison with the National Center for Missing and Exploited Children. “Also, the emotional issues that they trust their parents to deal with are not being addressed.”

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Emotional First Aid

For teenagers, losing a peer network compounds the pain, Allen says. “Not only are they unable to locate their parents, but their friends are missing.” What’s more, teens realize that they may never be able to resurrect their lives in their destroyed hometowns.

In the midst of the crisis, Hoover sounds a hopeful note. “There are family members being found every day. There are many people and many resources being expended to find those children.”

Hoover, who has counseled families affected by the Oklahoma City bombing, says ultimately most families can weather a traumatic separation. “Probably most people handle this reasonably well and are fairly resilient. But you do have a group of people who are really disposed to traumatic after-effects and will have vivid recollections of the event, intrusive memories of the loss, waking up with dreams about having lost the loved one, having difficulty with events that remind them of the loss,” he says.

For example, a father who sought shelter at the Houston Astrodome while searching for a missing child may suffer flashbacks every time he goes by the building again -- even though the child was found.

All families that suffer separation will fare better after “emotional first aid,” Hoover says, perhaps with counselors dispatched to shelters. “People do a lot better with these kinds of emergencies when they have a chance to talk through the trauma and tell their story -- sometimes repeatedly --in the first hours or days after it’s happened. That really can avert a lot of more traumatic responses later.”

People who tend toward a more serious response often have a personal or family history of anxiety or psychiatric and emotional disorders, or past experience with trauma, he says. They may benefit from antidepressant or antianxiety medication as well as support groups.

Mothers and fathers can help their children, too. After a traumatic separation, “Children are often panicky. They’re often prone to separation anxiety,” Hoover says. Some smolder at parents for losing them but feel ashamed of such resentment. Some remain so emotionally shocked that they avoid any mention of the separation.

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Expressing Feelings Through Behavior

Because children often don’t express feelings verbally, parents may assume that they are managing emotionally. That’s a mistake. “Children are more likely to express it through their behavior. They may be cranky and irritable and get in trouble, act out or resist or defy or try to control people around them,” Hoover says. Allen says that children may become fearful of the dark or of being alone, or they worry that a bad event will take their parent away from them again.

“A very important first step is to get the child talking. They need to feel safe,” Hoover says. Creating this environment can be tough because the hurricane ripped children out of familiar surroundings, he acknowledges. “Many of these kids are being thrown into school systems that are new to them and they need to feel safe and secure enough to work on these issues.”

Once parents have their own emotions under control, they can try play therapy with children too young to express themselves, Hoover suggests. Parents actually get down on the floor and watch their child draw or play with figures -- without directing the process or judging the results. Whatever feelings children harbor, “They often express it really eloquently through play,” he says.

In Oklahoma City, he treated one girl, about 5 or 6, who lost her father in the bombing. When her mother met a new man, the girl was furious but couldn’t express her anger in words. During therapy sessions, she was drawn to a dollhouse, where she enacted a drama about a father being “kicked out” by a new man in the household. “She was repetitively playing out the conflict and the anger at the mother and the new male figure in the family’s life,” Hoover says. Her mother realized that in the rush to rebuild a shattered life, she had overlooked her child’s sense of loss.

Parents shouldn’t assume that teens have an edge over younger siblings in recovering from traumatic separation, Hoover says. Teens who stomp around angrily, get into trouble at school, or show other behavioral changes may need professional counseling.

“Many people feel that teenagers are so caught up in their peer group that they’re not so attached to their parents, but that’s absolutely not the case. They’re often very attached, very needy. They are going to suffer as much emotionally as younger children.”

Parents should also encourage teens to risk forming new friendships, Allen says. “That’s a biggie. They never expected for their first friends to be taken away, and now, they have to weigh if it’s going to be worth it.”

By Katherine Kam, reviewed by Brunilda Nazario, MD

SOURCES: Daniel Hoover, psychologist, Menninger Clinic, Houston. Seth Allen, family services liaison, National Center for Missing and Exploited Children, Alexandria, Va. www.missingkids.com.