How to help children cope with war trauma

How does exposure to war – whether direct or indirect – affect children’s development?

War is one of the most potentially devastating events a person can experience, leading to a multitude of psychological and emotional consequences. More than one in six children worldwide – 468 million – live in active conflict zones, according to Save the Children. That figure doesn’t include fragile post-war zones, like post-genocide Rwanda, or wars that have broken out since 2022. 

For these children, the consequences can be great. One review found that, of 7,920 children exposed to war, 47% struggled with PTSD, 43% with depression, and 27% with anxiety – some during the conflict, and many after. Experiencing armed conflict is associated with higher levels of psychological and behavioral conditions including PTSD, depression, anxiety, ADHD, aggression, and risky behavior.

“More than one in six children worldwide – 468 million – live in active conflict zones.”

But effects go beyond mental health. Children who had been exposed to bombing and combat in Germany during World War Two, for example, were more than twice as likely to suffer from a severe illness in their early sixties, possibly a result of an overburdened autonomic stress system. Other studies on German children living through the same war found that traumatic stress came with a higher risk of multiple poor health outcomes including hypertension, cardiovascular disease, asthma, back pain and even cancer. Some research indicates that such illnesses may even be transmitted to the next generation of children through epigenetic mechanisms.

When typically developing, non-traumatized children experience stressful incidents, they gradually develop the ability to identify what they are feeling, and to use reasoning and communication to cope. But children who have experienced complex trauma, such as war, “show impairment in both of these skills,” researchers note. When they experience stress, they’re left “disorganized cognitively, emotionally, and behaviorally and prone to react with extreme helplessness, confusion, withdrawal, or rage.” This heightened emotional reactivity is seen in the brain: The amygdala – where emotions are processed – becomes more active in response to negative emotional stimuli in these children than in children who have not been traumatized.

Theresa Betancourt, director of the Research Program on Children and Adversity at Boston College and professor at the Boston College School of Social Work, has studied the impacts of armed conflict on children for many years. “Repeat toxic stress and trauma can affect the developing brain and the stress-regulation physiology of children,” she says, “and have lifelong consequences for learning, behavior, physical and mental health.”

“Repeat toxic stress and trauma can affect the developing brain and the stress-regulation physiology of children.”

Theresa Betancourt

Consequences may even be felt by children who are not immediately impacted by war – such as those with family living in a conflict zone, or those with no direct connection at all, but whose caregivers feel anxious about current events. Events like the 9/11 terrorist attacks heightened the risk of PTSD in children who weren’t directly affected, in particular through exposure to television footage. Children can also be affected by their parents’ emotions through a process known as emotional contagion. Even infants experience physiological stress in response to their mothers’ stress.

Caregivers shouldn’t underestimate the impact on children of even the mere discussion of war, experts say. “Usually, children can sense that their parents are preoccupied,” says Joerg Fegert, director of the Clinic of Child and Adolescent Psychiatry at Ulm University Hospital and co-author of a recent review of war’s impact on children’s mental health. “Children know quite well when something is different.” That’s why addressing the issue, rather than ignoring it, can be crucial, even for families that aren’t directly affected.

How can caregivers help children cope with experiencing or hearing about war?

There is good news: First, not all children who experience complex trauma, and even war, develop psychological issues. Second, there are many ways that adults can support them – both during a traumatic event and after – to soften the impact of that trauma.

Here are 15 proven strategies to help children cope:

1. Remember that the most important factor might be you

Protecting your child from the psychological harms of armed conflict might feel impossible. But one of the most important resilience factors for children experiencing trauma is their relationship with their parents.

Having a present, involved caregiver acts as a buffer for children. In one study of 710 adolescents who had experienced war, those who did not develop symptoms of poor mental health were more likely to have parents who spent time with them. A review of research on refugee children, many of them fleeing violent conflicts, showed similar results. And for former child soldiers, one of the most protective factors against developing depression, anxiety or hostility is feeling accepted by one’s family.

Selma Baćevac knows this first-hand. She was seven years old when the siege of her city of Sarajevo began. Her home was bombed, neighbors were killed, and there was limited access to electricity, food, and water. Once, as she went to buy a Barbie doll with her father, the marketplace was shelled and 68 people were killed in the first Markale massacre. Along with her family, she later became a refugee, displaced to Germany and finally to the United States. She now lives in Florida, where she is a therapist specializing in trauma.

“Children have a less intense fear response when their mothers are close by.”

The psychological impacts are lifelong. But her “saving grace” was her family, she points out. “Having your family nearby, no matter what is going on – that is safety for a child,” she says. This may be because children have a less intense fear response when their mothers are close by.

“When we talk about the kinds of experiences that children are exposed to in war zones, we often use terms like ‘toxic stress’ or ‘trauma’ – which kicks off that activation of the bodily stress response such as elevation in heart rate, breathing, and release of stress hormones related to the flight or fight response,” Betancourt says. “These are much harder to modulate when they occur in the absence of that soothing, supportive attachment figure.”

The benefits of having a caregiver close by can be long-lasting. Children who survived World War Two but were involuntarily separated from their parents were nearly four times as likely to be in poor health when they were in their sixties than children who stayed with their parents. A separate study found that German children who experienced long separations from their fathers during their first six years of life – especially common among children born in 1935, as many of their fathers served in the war – were more likely to exhibit psychiatric symptoms as older adults.

2. Reduce your own stress first

It isn’t just the proximity of a caregiver that matters, but also caregivers’ mental health, which isn’t always within their control. This is why, researchers say, parents affected by trauma also need support, not just for their own mental health but for the sake of their children.

Whenever possible, it is important for caregivers to use coping strategies to regulate their own emotions. That might mean focused breathing or meditation, or simply reducing consumption of social media and the news.

3. Be as nurturing as possible

An adult’s own stress or trauma can also lead to maladaptive parenting behaviors: Caregivers who have been exposed to war are often less warm and harsher towards their children, have poorer emotional regulation, and are even more likely to be physically abusive to their children. Yet these are precisely the children who need the most warmth and nurturing, researchers say.

Certain kinds of parenting practices – including expressing warmth and sensitivity — can be protective for children experiencing war. In contrast, punitive parenting practices tend to exacerbate problems, including child aggression. “The feeling of unconditional love is particularly important when children are feeling unsafe,” says Esther Deblinger, co-director of the Child Abuse Research Education and Service Institute, professor of psychiatry at Rowan University School of Osteopathic Medicine in New Jersey and a co-developer of Trauma-Focused Cognitive-Behavioral Therapy.

“The feeling of unconditional love is particularly important when children are feeling unsafe.”

Esther Deblinger

Again, this is why caregivers, not just children, need support. There are specific strategies parents can be taught. In the Trauma-Focused Cognitive-Behavioral Therapy approach that Deblinger helped design, psychotherapists help caregivers learn how to use praise and express love for their children more effectively. 

4. Seek out social support

In difficult times, it can be tempting to withdraw from the world. Yet one of the most important factors for children dealing with trauma is social support. In fact, while children’s relationships with their primary caregivers are important, the number of other “safe, stable, nurturing relationships” they have also affects children’s resilience after a traumatic experience.

Children may try to self-isolate by refusing to go to school, for example. But it’s better for them to go, according to Fegert. “Participation in the group is very important for a child’s development,” he explains.

“Participation in the group is very important for a child’s development.”

Joerg Fegert

5. Keep communicating

Children need to know that they can come to their caregivers with any questions or concerns. You may need to start the conversation yourself and ask children what they already know – or think they know – about what’s going on.

“Even for smaller children, it’s important to explain why we are worried,” says Fegert. “And then it depends very much on the age, regarding what kind of depth we go into.”

You can also correct any inaccurate impressions children may have. “Kids make things up in their minds that make no sense sometimes, and they need somebody to help them better understand what’s going on, and why,” says Deblinger. “Having that kind of open communication in a parent-child relationship is very important.”

6. Be reassuring – and age-appropriate

At the same time, it’s important not to overemphasize your own fear or worry. Children develop their sense of safety from what happens around them, and what they hear about. As the review co-authored by Fegert puts it: “It is important to find a balance between telling the truth about the adversities of war and still conveying hope and a sense of physical as well as emotional safety.”

For a family outside of a conflict zone, it can help to make it clear to the child that, yes, people are being hurt in one part of the world – but, where they live, there aren’t any attacks.

For those living with everyday violence, this can be more difficult. “Follow your child’s lead,” says Baćevac. “My parents never discussed the atrocities with us. If I heard about an atrocity happening, I would come to my parents and say, ‘Do you know about this?’ And then they would give me a PG version of what had happened.”

They also emphasized what they were doing to keep her and her brother safe, she says. During the war, her father frequently had to leave to fight. “The way that he would reframe this was, ‘I’m going to go to keep you safe – my responsibility is to keep you safe and keep Mommy safe,’” she says.

7. Don’t make promises you can’t keep

Baćevac remembers that one friend’s father used to tell her that he would keep her safe. “But I know he’s lying,” her friend told her. “How does he know when the bombs are going to fall?”

“That breaks trust,” she says, and means they might not believe other reassurances, either. “A parent should not promise safety.” Instead, she says, it’s best to say something like, “This is a dangerous situation, and I can’t promise that we are going to be safe, but I am going to do everything in my power to make sure you are safe.”

“Be realistic, and be genuine in saying, ‘I will do everything I can,’” she says.

“A parent should not promise safety.”

Selma Baćevac

8. Turn off the television

It might be tempting to keep the news running all day. Don’t, say experts. Children who witnessed the 9/11 terrorist attacks on television had higher levels of PTSD than those who did not, for example.

This is, in part, because children can make whole narratives out of single images they see, making the world seem even scarier than it is. “They don’t necessarily understand what they’re seeing on television,” Deblinger says. After 9/11, a young child came to her clinic who was intensely worried after seeing many news reports showing the Twin Towers collapsing. “He had the misimpression, because he kept seeing it over and over again, that numerous buildings were falling down all over the place,” she says. “Only when he started talking openly about it, and expressing what he was worried about, did it become clear” that he had these inaccurate, and anxiety-inducing, beliefs.

“So it’s important to create an atmosphere where your child can ask you questions, but it’s also important not to have the TV on all the time.” In fact, she says, “minimize TV exposure as much as possible.”

9. Limit children’s social media

Consider and limit other ways that a child might be exposed to graphic images and videos – such as on social media – even if they’re older than the platform’s minimum age.

Misinformation and disinformation is often shared about current conflicts, and the language of some posts (and the comments beneath them) can be violent or dehumanizing towards groups of people, religions, or ethnicities.

Particularly for older children and teens, “This is an opportunity to discuss how much time they’re spending consuming such news and information, and also what sources they trust and where they’re getting their information,” says Betancourt.

10. Help children feel in control

The more children have a sense of agency, the less likely they are to experience symptoms of trauma. For example, in the case of some Bedouin children in southern Israel who had seen their homes demolished or people shot, a sense of greater agency was associated with a higher level of life satisfaction – and better psychological wellbeing overall.

The catch, of course, is that very little might be within their control. But focusing on whatever is in their control can make a difference. For a child in a war zone, that could mean making sure they can still have opportunities to play or to continue with their other pre-conflict routines.

11. Keep to routines

“One of the problems that parents cause is, when something horrible happens to the child, they take away all the rules,” says Fegert. “These are non-verbal signals to the child that something completely horrible has happened. One important psychosocial reaction to a potentially traumatic event is to maintain order, to maintain regularity, to make no exceptions, because it’s normal life that makes us feel like we’re in a safe place.”

Junior high and high school students in Jerusalem who experienced the ongoing threat of terror attacks and continued their daily habits – such as using public transport and browsing in the shopping mall – experienced fewer post-traumatic symptoms than those who did not maintain those habits.

“New routines can offer a sense of stability and agency.”

For those living in an active war zone, many routines necessarily change. But new routines can offer a sense of stability and agency, says Baćevac. She remembers going with her younger brother to collect water from UN-run cisterns, using his bike to carry the load. “Children were primarily the ones who would go get water,” she says. “Collectively, it was like, ‘Let’s see how strong you are, pushing this BMX bike up this hill.'” Routine was important, in other words, but it was a routine that she shared with other children in the community – rather than necessarily continuing with all of the same routines she had followed as an individual before the war. 

12. Remember the power of helping

Encouraging children to take an active role in helping others offers them agency, says Betancourt. Moreover, altruism is connected to happiness and life satisfaction in general, which can make it a balm in difficult times. Children living outside of a conflict zone might volunteer or fundraise. Those living within a conflict region could help the family by fetching essential supplies, as Baćevac did.

There’s another benefit, too: Helping others can direct children’s attention to “the generosity and the shared humanity that so many individuals display, despite all the brutality,” Betancourt points out.

13. Introduce children to coping strategies

Even very small children can be taught strategies that help them cope with big, overwhelming emotions. These might include focused breathing, physical activity, or a simple hobby that is engaging and provides a break from their worries, says Deblinger.

Play is restorative for children. “Even in the scenes we’re seeing out of Gaza – even in hospitals where people are wounded – children are still playing,” says Betancourt. “There’s a developmental need for children to express themselves,” including through play. As a result, providing opportunities for children to have “safe places to play” – even in the most difficult of circumstances – is “critical,” she says.

14. Work on labeling, and talking about, emotions

When children can identify and understand their feelings and those of others, they are better able to cope with trauma.

Adults can support this process through emotion coaching – which involves empathizing with children’s feelings, and helping them talk about and reflect on them. This can help children as young as 18 months old.

15. If necessary (and if possible), find professional help

For children with clinical disorders, professional intervention may be the best way forward.

In one study of children living in Gaza and the West Bank in 2005-2008 who had experienced traumatic events, 26% suffered from PTSD, 18% from anxiety, 3% from depression and 6.5% from acute stress disorder. After short-term psychotherapy, the symptoms of nearly 83% of these children had improved.

Families affected by war need more support

Much more support for families is needed. In situations of armed conflict, the international community often focuses on a rapid response: resettling displaced people and providing aid, for example. But given the long-term health consequences of the psychological trauma of war, there also needs to be much greater emphasis on supporting families over the following months and years, experts say. And that should be part of the plan as early as possible when a conflict breaks out, rather than only considered later.

“Wider support can help children build resilience and have better lifelong outcomes.”

“How do you respond in nations that have experienced such collective violence and destruction?” asks Betancourt. “Yes, the acute humanitarian response is really critical. But from the very moment of that first response, we have to be thinking with a future mindset about how we can build systems of mental health and psychosocial support across the ecology around the child – rather than relying on brief, humanitarian responses, and then waiting for 10, 20 years for the development community to take action and say ‘Oh, you know, there’s really no mental health or social services infrastructure here,’ and having to start from scratch. We’ve seen, in our 20 years of research in Sierra Leone, that there are things we can modify about the post-conflict environment or the immediate, acute response that can make a difference.”

Research on past conflicts shows that wider support can help children build resilience and have better lifelong outcomes, perhaps by helping parents with their own stress or providing access to mental health services. As Betancourt and others point out, while there is plenty that individual caregivers can do to help protect children from the psychological fallout of war, it shouldn’t just be up to them. It’s a responsibility that falls on all of us.