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Marathon bombing anxiety likely to return in children

Boston Medical Center staff looked over the Boston Prayer Canvas on display during a flag-raising ceremony Monday.

David L. Ryan/Globe Staff

Boston Medical Center staff looked over the Boston Prayer Canvas on display during a flag-raising ceremony Monday.

In a week that begins with the anniversary of the Boston Marathon bombing and ends with this year’s race, children may be vulnerable to having a recurrence of anxiety-related symptoms they experienced after the attack, mental health specialists caution.

Those directly affected by the events — because they knew someone killed or injured, attended the Marathon, or experienced the lockdown as police searched for the bombing suspect — are most likely to have nightmares, to worry about going into crowded places, or to feel sad in the next several days.

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The April 19 lockdown of residents of Watertown, Belmont, Boston, Brookline, Cambridge, Newton, Somervile, and Waltham may have had the broadest impact on children. In January, Massachusetts General Hospital surveyed 400 parents of children ages 4 to 19 who lived in these areas and found that 1 in 5 children experienced anxiety symptoms within the first few weeks after the bombing and that 11 percent had symptoms that lingered for several months.

“These symptoms reported in our survey were more of a reaction to the lock-down than to the bombing itself,” said Dr. Paula Rauch, a child psychiatrist at Mass. General who led the survey, which has not yet been published in a medical journal. “A far greater number of children in the area were affected by the lockdown than were directly exposed to the explosions.”

Public school students were at the end of a vacation week and were told to shelter in place as police conducted a door-to-door search for bombing suspect Dzhokhar Tsarnaev. “Parents may have been tense, which added to their kids’ anxiety levels,” Rauch said, especially as reports of the shootout and killing of an MIT police officer filled the airwaves.

‘This is a good opportunity to ask children what they remember.’

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Children who watched more than eight hours of news reports during the week of the bombing, according to what their parents reported in the survey, were more likely to have had anxiety symptoms. Older children were, as well. Nearly one-third of teens ages 15 to 19 reported negative behavioral changes, compared with one-fifth of younger teens and one-quarter of those ages 7 to 11. Only 1 percent of 4- to-6-year-olds had such symptoms.

Parents said they noticed abrupt shifts in their child’s behavior in terms of sudden separation anxiety, extreme fear of shopping malls and other crowded places, frequent crying jags, and acting overly worried about their own safety or their family’s safety.

Although those symptoms may have dissipated, they could rise to the surface again during the next few weeks. “This is a good opportunity to ask children what they remember from last year,” Rauch said, “and to tease out any concerns they may have that they’re not expressing.”

Preschoolers and young elementary school children may not remember the bombing nor the lockdown, but older children probably do and any fears they had associated with them.

Providing reassurance is key, specialists say. Parents can reiterate their “own personal sense of security, and the unlikelihood of last year’s event ever repeating itself,” Rauch and her colleagues recommended in tips they posted on their website, MGHPact.org. “Talk, too, about all the ways your family and community are ensuring that this year’s Marathon is safe.”

Parents and children who attend the Marathon, Rauch added, should have a plan to reconnect with each other in case they get separated and cellphone service is down. “This will provide them with a greater sense of security and control.”

Resilience-building activities can also help children gain some mastery over their worries. These might include making pictures or writing cards to send to survivors or making a donation to a runner raising funds to cover medical expenses of a bombing survivor.

“There are many things we can do to feel less helpless and to tap into our resilience, whether we’re adults or children,” said Dr. Monica O’Neal, a clinical psychologist who practices in Boston and teaches at Harvard Medical School. “We can find a lot of ways to be supportive in our community; it’s about giving space to say this anniversary is important and to find our own way to observe it.”

Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2.

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