Child Mental Health After Earthquakes and Disasters

The first question families ask after an earthquake is usually this: "Will my child get through this?"

Largely, yes. The fear, disturbed sleep, clinginess and regressive behaviour seen in the first days and weeks after a disaster are not the reactions of an abnormal child but ordinary reactions to an abnormal event. Most children recover without needing formal treatment when supported properly.

In a proportion, however, symptoms become entrenched and impair functioning. This article sets out which reactions are expected, when professional support is needed, and what families can concretely do.

Key Points

• Early reactions after a disaster are reactions, not symptoms; most subside within weeks.
• The strongest determinant of a child's recovery is the caregiving adult's own regulation.
• Where symptoms persist beyond a month and impair functioning, post-traumatic stress disorder is considered.
• Single-session debriefing is not recommended; it has shown no benefit and in some cases causes harm.
• Repeatedly watching disaster footage on television and social media increases symptoms.
• Re-establishing routine is more healing than talking.

Ordinary Reactions Seen After a Disaster

The most common reactions in children after an earthquake are:

• Difficulty falling asleep, frequent waking, nightmares
• Refusing to separate from a parent, being unable to sleep alone
• Startling at small sounds, panicking at a door slamming
• Abdominal pain, headache, loss of appetite
• Regression: bedwetting, thumb sucking, baby talk
• Re-enacting the earthquake repeatedly in play
• Irritability, anger outbursts
• Being unable to concentrate at school
• Repeatedly asking "Will it happen again?"

None of these alone indicates a disorder. What matters is their course over time, how long they persist and how far they restrict daily life.

When Do Symptoms Begin and How Long Do They Last?

Most reactions begin in the first days and diminish markedly within two to four weeks. Fluctuation is expected during this period: a good day followed by a bad one does not mean deterioration.

In a proportion of children symptoms emerge not immediately but weeks or even months later. Delayed onset is seen particularly where the family was occupied with pressing practical problems in the early period and the child "caused no trouble". Monitoring should therefore not end because the first month passed without difficulty.

Symptoms persisting beyond six months without diminishing require assessment rather than waiting for spontaneous resolution.

Why Does Repetitive Play Matter?

Young children process what they have lived through in play rather than in words. Knocking down blocks and rebuilding them, playing rubble-and-rescue, re-enacting the earthquake with toys are expected and should not be prevented.

What needs attention is the quality of the play. Play that is working changes over time: the child alters the ending, and themes of rescue and repair appear. Frozen play stalls at the same point; the child does not become calmer while playing but more tense. The second requires assessment.

Reactions by Age

Preschool (2-6)

The most prominent reaction at this age is regression. A child who had completed toilet training may start wetting again; one who slept alone may return to the parental bed. Tolerance of separation decreases markedly.

This age group cannot understand the event through cause and effect; magical thinking such as "it happened because we were naughty" is common. A simple and accurate explanation therefore matters.

Primary School (7-11)

Physical complaints come to the fore: abdominal pain, headache, nausea. School refusal is common and usually related to fear of separation from a parent.

At this age the child grasps the permanence of the event and asks detailed questions about "what if it happens again". Knowing a safety plan — where we will go, who will collect us — concretely reduces anxiety in this group.

Adolescence

In adolescents the picture approaches that of adults, with two differences. First, an adolescent may express anxiety through withdrawal or, conversely, through risk-taking. Second, survivor guilt is pronounced at this stage: "I am here and my friend is not."

Adolescents also tend to take on the family's burden, saying "I'm fine" rather than admitting they are struggling. This silence usually means postponement rather than recovery.

Who Is at Higher Risk?

Children who lived through the same earthquake do not all follow the same course. The factors that increase the likelihood of symptoms becoming entrenched are known, and they form the first step of assessment.

The nature of exposure: Being trapped under rubble, being injured, witnessing death or serious injury directly increase risk. As exposure increases, so does symptom severity.

Bereavement: The loss of a family member, particularly a caregiver, is the strongest risk factor. Here the picture is not only trauma but also grief, and the two must be addressed together.

Displacement: The loss of the home, moving city, losing school and friendships. These losses added on top of the trauma delay recovery.

The parent's mental state: Where the caregiver has marked depression, trauma symptoms or loss of functioning, the child's recovery slows appreciably.

Previous psychiatric history: Risk is high in children who had an anxiety disorder, depression or a history of trauma before the earthquake.

Weak social support: Lacking extended family and peer support removes a protective factor.

Carrying a risk factor does not mean symptoms will certainly develop; it means these children need closer monitoring.

Grief After a Disaster

Where there has been a bereavement in the family, the process divides in two. Trauma symptoms relate to the event itself, grief to the person who died. While trauma symptoms are intense the child often cannot grieve; images of the moment intrude whenever they try to remember.

Sequence therefore matters: trauma symptoms are settled sufficiently first, and grief work can follow. In explaining a death to a child, euphemisms such as "went to sleep" or "left us" should be avoided; in a young child these lead to fear of sleep and a belief in abandonment.

When Is Professional Support Needed?

A child and adolescent psychiatrist should be consulted in the following situations:

• Symptoms persisting longer than a month without diminishing
• The child not attending school or unable to take part in lessons at all
• Complete withdrawal from friends and from previously enjoyed activities
• Sleep disturbance that does not settle, nightmares every night
• Thoughts of self-harm or talk of death
• Marked hopelessness, statements that "nothing means anything"
• Markedly disrupted eating, weight loss
• A bereavement in the family with the grief process obstructed

Where symptoms are very severe within the first month and the child cannot maintain basic functioning, seeking help without waiting a month is right.

Post-Traumatic Stress Disorder

Where symptoms persist beyond a month and cluster in four areas, post-traumatic stress disorder is considered:

• Re-experiencing: involuntary recollections, nightmares, stuck repetition in play
• Avoidance: staying away from places, people and conversations that recall the event
• Cognitive and emotional changes: guilt, a belief that the world is wholly dangerous, emotional numbing
• Hyperarousal: startling, sleep disturbance, anger, poor concentration

In young children these symptoms are not described as in adults; they become visible through play, drawing and behaviour. For detail, see our article on post-traumatic stress disorder.

What Families Can Do

Your Own Regulation First

The most consistent finding in research on child mental health after disasters is this: the factor that most strongly predicts a child's recovery is the caregiving adult's own mental state.

This does not mean a parent must feel no fear. Nor does fear need to be hidden; the child senses it anyway. What is needed is to show that a feeling can be named and regulated: "I was frightened too. I feel a bit better now, because we are somewhere safe."

Re-establish Routine

Bedtime, mealtimes, school, playtime. Routine tells a child without words that the world is predictable again. In post-disaster interventions, re-establishing routine works earlier and more powerfully than therapeutic conversation.

Physical Closeness

In young children, contact is more effective than words. Holding, sleeping together, holding hands. Allowing a child to sleep in the parental bed temporarily is not wrong in this period; it is withdrawn gradually afterwards.

Do Not Force Talking

A child will talk when ready. Pressure to "tell me what you felt" causes most children to close down. Leaving the door open is enough: "If you want to talk when it comes to mind, I'm here."

For the same reason, single-session interventions that have people recount the event in detail are not recommended after disasters. This method has been shown not to help and to increase symptoms in some people. The approach that replaces it is psychological first aid: safety, basic needs, calming, connectedness and hope.

Limit Screen Exposure

Repeatedly watching earthquake footage on television and social media increases symptom severity in children. A young child may believe the event is happening again each time they see the same images.

The news should not be left on at home, and adolescents' social media use should be limited through discussion.

How Should You Talk to a Child?

Be age-appropriate and accurate. Do not say "it will never happen again"; a promise you cannot keep damages trust. Instead: "Nobody can know when it will happen, but we are prepared and I am here with you."

Give concrete safety information. Where the assembly point is, who will collect whom, where the bag is. Uncertainty feeds anxiety; knowing a plan reduces it.

Keep it short and wait for the question. Answer as much as the child asks. Recounting detail that was not asked for imposes an unnecessary burden.

Name the feeling. Saying "you were frightened, I understand" turns what the child is living through into something that can be regulated.

The Role of the School

After a disaster the school is a direct part of treatment. Returning to school accelerates recovery in most children: it provides peer contact, structure and predictability.

What needs to be agreed with the school:

• Identifying a person the child can go to when struggling
• Temporarily relaxing academic expectations
• Giving advance notice of earthquake drills — an unannounced alarm can retrigger symptoms
• Planning how the event will be discussed in class

The school's pressure for "everything to return to normal" is as unhelpful as the stance of "let's not touch this child at all". The balance lies in increasing support without lowering expectation.

How Is Return to School Planned?

For a child who has been away from school for a long time, returning to a full day at once may be unrealistic. A graduated plan works: half days first, then full days beginning with favoured lessons, then the usual routine.

Making this plan jointly between school, family and clinician and putting it in writing in advance markedly improves how workable it is. How classmates will receive the child should also be discussed beforehand; well-meant but intense attention is difficult for some children.

Treatment

Psychological First Aid

This is the approach of the first days and is not therapy. It covers establishing safety, meeting basic needs, calming, reuniting families and practical support. Any adult can provide it.

Trauma-Focused Cognitive Behavioural Therapy

Where symptoms become entrenched, this is the method with the strongest evidence. Its core components are building the child's emotion-regulation skills, gradually constructing a narrative of the event, and parental involvement. In Assoc. Prof. Mehtap Eroglu's approach, parent sessions are an integral part of the process.

EMDR

A method directed at processing the traumatic memory, applicable to children as well. In suitable cases it is used as an alternative or complement to trauma-focused therapy.

Medication

Medication is not the first step after a disaster. It is considered where there is accompanying marked depression, severe sleep disturbance, or anxiety at a level that prevents participation in therapy.

How Is Progress Monitored?

What is monitored is not the complete disappearance of symptoms but functioning: is the child attending school, seeing peers, has sleep settled, is there an activity they enjoy during the day.

Recovery does not follow a straight line. The anniversary of the earthquake, aftershocks, or a similar event in the news can cause temporary increases. These increases are expected fluctuation and do not by themselves mean treatment has failed.

A simple record kept by the family makes the process visible: noting sleep, school attendance and prominent symptoms once a week is enough. In day-to-day observation change may be too slow to notice; looking back a month makes the difference concrete.

Expert Opinion

According to Assoc. Prof. Mehtap Eroglu, the most frequent misconception among families in post-disaster referrals is taking a child's silence as a sign that they are well. The child may not be speaking because they lack the words, or because they are avoiding distressing their family further. In assessment, play, drawing and behavioural observation therefore matter as much as verbal account.

Assoc. Prof. Mehtap Eroglu also draws attention to a second point: parents postponing their own difficulty. Families often say "let the child get better first". Yet a child's regulation depends on the adult's; if the parent's support is postponed, the child's recovery is delayed too.

Assoc. Prof. Mehtap Eroglu further emphasises that exempting a child from all responsibility in order to protect them does not work in the longer term. Maintaining small age-appropriate responsibilities tells the child that life continues and that they are still capable; a child exempted entirely often feels more fragile.

Third is timing. Making a hasty diagnosis for the intense reactions of the first weeks is not right; equally, waiting out symptoms still present six months later on the assumption that they will pass is not right either. The criterion is functioning alongside duration.

Assessment and Appointment Process in Ankara

Post-disaster child mental health referrals in Ankara come from two distinct groups. The first are families who experienced the earthquake directly and moved to Ankara; here displacement, change of school and loss of social network are added on top of the trauma. The second are children in Ankara who did not experience the earthquake but developed intense anxiety through images and the wider social atmosphere. The second group is often underestimated; yet sleep disturbance and separation anxiety can be marked in these children too.

In the assessment conducted by Assoc. Prof. Mehtap Eroglu in Ankara, the nature of exposure is established first: did the child experience the event directly, was there a bereavement, was there displacement, is there ongoing strain in the family. The duration of symptoms and their effect on functioning are then assessed.

For families who have moved to Ankara, a further dimension is the process of adaptation. A new school, a new environment and often temporary housing become intertwined with trauma symptoms. Separating the two in assessment directly determines the treatment plan.

What families in Ankara find useful to bring: any previous assessment reports, school observations, and a simple two-week record of changes in sleep and behaviour.

If you would like to arrange an assessment of your child's mental state after a disaster in Ankara, you can find information about the child psychiatry service and request an appointment.

In Summary

Early reactions after a disaster are ordinary, and most children recover with the right support. Symptoms persisting beyond a month and impairing functioning is the threshold requiring professional assessment.

The family's most effective contribution is their own regulation, re-establishing routine, and keeping the door open without forcing the child to talk. Limiting screen exposure and making a joint plan with the school are the other two determinants.

For persistent symptoms, trauma-focused cognitive behavioural therapy has the strongest evidence; medication is not the first step.