Before you talk to your child, it is important that you take stock of your own thoughts, beliefs, and reactions. Children, especially young children, are keenly aware of their parents’ emotional responses. Your feelings and responses give children important cues about how they should react. If parents communicate a great deal of worry or fear, their children may react similarly. Because we as adults are likely to have strong feelings about these events, it is also important that we have support and connection with others so that we are not alone with these intense feelings.

Your relationship with your child as a parent or caregiver is the most important ingredient of help that you provide. Your ability to hear your child’s worries, to accept them, and to provide comfort is the foundation of any discussion about a scary event. If you as a parent or caregiver are able to keep the communication open and be available for your child, you have laid the foundation for providing the best support possible.

It is important to remember that young children communicate their thoughts and worries in more ways than by verbal expression alone. Children may draw pictures or use dramatic play or storytelling to tell us their thoughts. We can help by making sure that children are given multiple ways to communicate and that we are sensitive to reading cues from these different expressions.

All families are different. Families cope with stress in many ways, using strengths that are drawn from religious or spiritual beliefs, traditions and relationships.  There is no set script of words to use. The information we provide here is intended to give parents and professionals some guidelines to think about. It is not comprehensive, nor does it take into account every situation that you may face with a child.

Common Questions from Parents

Should I talk about the bombings with my child? Perhaps because he/she is so young, I should not mention it.

If your child is old enough to go to pre-school or kindergarten, it is likely that they will hear something about the bombings. Even a three-year-old may hear words or observe adults who are upset or worried. It is far better that your child get information about what happened from you than from another source. By initiating a discussion about it, you give the message that it is OK to ask questions and to talk about it again.

How do young children understand terrible events such as the bombings?

Children’s capacity to understand depends on age and ability to comprehend the world. They will not understand events in the same ways that adults do. They may know about an event because they hear adults talking or see the news, but they cannot really understand the complexities of these events. In the absence of information that is geared to their age level, they may make up their own version of the story. Here is a general summary of how children will think about the events like those at the Boston Marathon.

Toddlers: They will have no understanding of the events apart from the reactions of their parents or caregivers. They are sensitive to the emotions and stress level of their parents. The ways that parents manage feelings of anger, sadness or worry affect a child’s reaction.

Pre-schoolers: They have more ability to understand and if curious or concerned, are deserving of a brief explanation. However, they may question whether these events are real or not. Their capacities for distinguishing reality from fantasy are limited. Their main worry is likely to be about the safety of their parents and themselves: “Who will take care of me?”

Kindergarteners: They will have more understanding of cause and effect, but they still see the world in reference to themselves. Children will worry about safety, where the perpetrator is now and about whether the perpetrator has been arrested. They may worry about whether this could happen to them.

Young school-age children: They have a sense of right and wrong, good and evil, and will be more focused on why this happened. They think in absolute terms; there is no gray area as children of this age attempt to make sense out of these events. They will need more information. They, too, may voice worries about their safety and why the person or persons did what they did.

How or what should I tell my child?

Deciding what to tell your child is difficult. It is important to start by asking if the child has heard anything about what happened. This gives you an opportunity to learn what the child knows, how he/she knows it and what misunderstandings your child may have about the events. Children should have access to the basic information, but only as much information as they can understand. The decision about how much to tell a child depends on the child’s age and developmental stage. A three-year-old needs different information than does a six-year-old. For example, to a three or four-year-old, curious or concerned about the recent events, you might say: “I want to tell you about a bad thing that has happened.  It happened in a town that’s far away from here. Some of the people were hurt by a bomb and some died. Many people are very sad about this, but we are safe here.”

For a five or six-year-old, the explanation would be somewhat different. “This is hard to talk about. A lot of people are talking about a bad thing that happened. Somebody with a bomb hurt some people at a race called the Boston Marathon.  It is not close to us here. Some people were hurt and some died. The police and rescue workers are helping to take care of the people. We are sad about this. But we are safe here.”

For a seven or eight-year-old: “You may have heard about an awful thing that has happened. A lot of people are talking about it and it has been on TV. Somebody set off a bomb at a race called the Boston Marathon. It is not close to us here. Some children and grown-ups were hurt and some died. We don’t know why this happened.  We hope this never happens again. The President of the United States talked about it on television. He is working with police and other people to try to make sure that this does not happen again.”

All children need reassurance that we as parents and adults are doing everything we can to keep them safe.   Any discussion about violent incidents should include reassurances about the child’s safety and the safety of the parent/family. In addition, you may wish to add that the leaders of our country and many policemen and other helpers such as the FBI are working to make sure that this does not happen again.

How should I expect my child to react to this kind of information?

Children will react in a range of ways. The reaction depends on the age, personality, and developmental ability of the child to understand the complexities of the events. Some will ask many questions. Others may show little reaction. Common reactions may include: worries about safety, asking the same questions repeatedly, asking no questions and not wanting to talk about it, sleep problems or bad dreams, increased clinginess with parents or caregivers, increased preoccupation with the tragedy or daydreaming; or reverting to less mature behaviors (thumb sucking, for example). These reactions are normal reactions to abnormal events, and parents should not worry about them. It takes time for all of us to calm down from events like these.

Some children will be pre-occupied with worry or questions about the terrorists. “Who did it?” “Why did they do it?” “Has he/they been caught?” “Will this happen in my town?” These questions are normal because young children are in the process of developing morals and an understanding of right, wrong and consequences for behavior. In addition, these questions can reflect the basic fears of safety. The underlying question is “Am I safe?” or “Is my family safe?”

Some children will have no apparent reaction and seem unconcerned about what they are told. Others may laugh or make an inappropriate response to the news. They may seem to be callous or uncaring about the gravity of the situation. Children have different ways of taking in information and parents should not worry about these reactions. Parents should not push a child to talk about it, but rather leave the possibility open for future discussion.

When should I worry about my child’s reactions to traumatic news?

Remember that children’s responses to a terrible catastrophe are usually appropriate and understandable. Some children will be preoccupied for a few days; others may continue to talk about it for several weeks. Some children may not talk about it for days or weeks. If the intensity of your child’s reaction does not diminish or if your family has been more directly affected by the tragedy, you may consider outside help for your child. If your family has suffered other stresses or losses, your child’s reactions may be more intense. If your child’s reactions are noticeably different from those of his/her peers, you may want to seek advice.  Remember that you know your child better than anyone, and if you are worried, seek help. You may talk with other parents, your child’s teacher, the school psychologist or guidance counselor or your child’s pediatrician to get advice on how to help your child. Even very young children may benefit from therapeutic intervention if they are extremely distressed.

Summary: Do’s and Don’ts for Parents

• Take the time to be aware of your own feelings and reactions. Children are keenly aware of their parent’s emotions and worries. If you are too upset, anxious or worried about troubling current events, wait to talk with your child, or ask someone else who is close to them to do so.

• Be willing to talk to your child about the bombings particularly if you think he/she might know something about this event.

• Limit your child’s access to television, newspapers and magazines with graphic images of violence. For very young children, avoid exposure to the media altogether.

• Spend extra time with your children if possible. Be available to answer questions.

• Take your child’s questions seriously and be prepared to answer the same question repeatedly.

• Give your child enough information to answer his/her questions, but no more.

• Don’t worry if your child does not talk about this very much. Children have different styles and timetables for processing information.

• Pay particular attention to bed-time routines and take extra time for being close to your child.

• Maintain the daily routine. Predictability and routine are comforting for children.

• Offer your child opportunities to help or to do something positive. Children feel better when they can offer concrete assistance.

For further information or referral call the Child Witness to Violence Project at Boston Medical Center at 617-414-4244.

Resources:

The National Association of School Psychologists has prepared tipsheets for parents and teachers to help children, teenagers and adults cope with tragic situations. There are also fact sheets for parents available in other languages. Please feel free to share them with families who may find them helpful:

In Egnlish
In Spanish
In Arabic
In Chinese
In Farsi
In Korean
In Vietnamese

The National Child Traumatic Stress Network: resources on terrorism and psychological first aid in different languages

The American Academy of Pediatrics: www.AAP.org

The Child Witness to Violence Project: www.childwitnesstoviolence.org

American Academy of Child and Adolescent Psychiatry: www.aacap.org

Child Witness to Violence Project
Boston Medical Center

Robert Sutton, PhD wrote about bullies in “More Trouble than They Are Worth” (Harvard Business Review of February 2004) and later expanded his theme into a book, The No Asshole Rule.  He lists common everyday behaviors, the Dirty Dozen, that bullies use:

The Dirty Dozen

• Personal insults
• Invading one’s personal territory
• Uninvited physical contact
• Threats and intimidation, verbal and non-verbal
• “Sarcastic jokes” and “teasing” used as insults
• Withering email flames
• Status slaps intended to humiliate their victims
• Public shaming or “status degradation” rituals
• Rude interruptions
• Two-faced attacks
• Dirty looks
• Treating people as if they are invisible

Leah Harris PhD conducted a study of more than 175 four-year colleges to ask in-depth questions about workplace bullying in American higher education administration.  She found that 62% of respondents stated they had been bullied or witnessed bullying in American higher education.  This is 58 % higher than the rate reported by the general workforce.

Here are some of the types of bullies you might encounter at work:

Types of Bullies

• Garden variety bullies are like Nancy.  They can be male or female.  They engage in aggressive, abusive or abrasive behaviors.  Either intentionally or unintentionally, they threaten, intimidate, insult, isolate or humiliate their targets.  They may use emotional intensity to manipulate others to insure that they accomplish their goals.
• Queen Bees.  The Wall Street Journal of March 6, 2013 featured an article by Peggy Drexler, The Tyranny of the Queen Bee. She writes: ”This generation of queen bees is no less determined to secure their hard-won places as alpha females.  Far from nurturing the growth of younger female talent, they push aside possible competitors by chipping away at their self-confidence or undermining their professional standing.  It is a trend thick with irony: The very women who have complained for decades about unequal treatment now perpetuate many of the same problems by turning on their own.”   Drexler describes smart, high achieving women who are unkind to other women.  They can be verbally abusive, dismissive of new ideas, excluding women from meetings.  Their victims feel demoralized, humiliated, confused, angry and discouraged.
• Kiss Up/Kick Down is another form of bullying at work.  These bullies are charming, ingratiating and hard working for their peers or superiors.   But they treat their subordinates with contempt and the behaviors listed above.
• Good cop, bad cop.  An insidious form of bullying occurs when one person, often a boss, shares  his/her thoughts or beliefs about what’s wrong with the people or the workplace with a designated employee, who then picks up  the cues and may exert pressure on other employees, believing that is the desire of the boss.  Erin, a newer director, shared with Scott that she was frustrated at the slow pace of employees to adjust to change.  Scott wanted to help Erin and earn her good will.  He began to badger employees, insisting on deadlines for mutual projects and generally trying to enforce change.  Erin was the “good cop” while Scott was the “bad cop”.
• Genius bully.  Walter Isaacson writes about Steve Jobs as a genius bully.   Because of his extraordinary talents in design and marketing, people tolerated him bullying waiters, colleagues and girlfriends with name calling, tantrums and disrespect.  He would find weak spots in people and exploit them, often publicly humiliating them.  In some organizations, including academia,  these brilliant  bullies seem to get away with their behavior.
• Cyberbullies.  Technology has created more opportunities for bullying or cyberbullying.  Meek employees can become tyrants on emails and social media, involving bystanders with “reply all” or CC/BCC.  Rumors or disinformation about others may be circulated electronically.
• Harrassers. Sexual harassment is defined as sexual advances, requests for sexual favors, and any other verbal or physical conduct of a sexual nature, whether intentional or unintentional, that is not wanted.  If a bully targets someone because of their race, color, religion, sex, age, national origin, physical or mental disability, sexual orientation, gender identity, genetic information, military service, or because of marital, parental, or veteran status, they are subject to formal investigation and action through the Office of Equal Opportunity.
• Victim Bullies. They are self-absorbed, self-pitying people who believe that they have been mistreated or exploited.  They believe their demands should be met because they feel that they have been victims.  Rarely empathic with the views and needs of others, they may insist on their agenda.  Their sense of being wronged justifies that their expectations should prevail.   As a result, people feel intimidated and bullied.

Effects on target

Targets like Susan experience stress-related emotional and physical symptoms:

• Depression
• Anger
• Frustration
• Fear
• Distracted, poor concentration
• Loss of loyalty to organization
• Hopelessness
• Obsessional thinking about  the job
• Feelings of worthlessness
• Difficulty sleeping
• Lowered energy
• Tearfulness
• Increased blood pressure

Effects on Bystanders

How are bystanders and witnesses affected by bullying?  The ripple effect on people and organizations can be devastating, as bystanders are targets of bullies, too.  They lose trust in their colleagues.  Communication diminishes and creative avoidance increases.  People use emails and voice mails to avoid interacting with a bully.  Coalitions or cliques form.

Cost to organization

What is the business cost to an organization that has a bully?   Employees with bully or queen bee supervisors left their jobs more frequently, or had reduced job productivity and loyalty to their organizations.  For the organization, the cost of recruiting and training an employee is upwards of twice his salary, according to the Wall Street Journal.   High turnover damages morale and contributes to a negative organizational culture.   Certain employees in an organization spend inordinate amounts of time to deal with the financial, physical, emotional and legal issues generated by bullies.  These employees include the direct managers, HR professionals, EAPs, equal opportunity administrators, legal counsels, and senior executives.

What Can Individuals Do About Bullies?

If you believe that you are a target of a bully:

• Talk to people including your family and friends, and consult with the university resources listed below.
• Come up with a specific plan to talk to the bully.  Practice making your points.
• Describe the behavior objectively.  Tell him/her how it affects you and ask him to stop, that the behavior is unacceptable.  As an example that Susan might say: “Jim, when you stand over me and take off your glasses to look at me, I feel intimidated.  I’d like you to stop that behavior.”
• If you are fearful, you might ask someone else to be present.
• You may want to tell your supervisor about your concerns.
• Keep a journal of the bullying episodes with details of the behaviors.  Include dates and times.  Keep copies of emails, voice mails or other documents.
• Avoid being alone with the bully if you can.
• If the behavior occurs after you have told him that you are not comfortable, walk away from the situation.
• If a number of people are aware of or have been the target of a bully, they should inform the manager.  If the manager does not respond, people should consult with the university resources listed.

What Can Organization Do About Bullies?

Leadership needs to invest and believe in creating a culture of respect for everyone.  Although many organizations have written policies, leaders need to have their behavior be consistent with their stated values.  Intolerance for bad behavior should be consistent.  When hiring, references should be consulted about a recruit’s specific behavior.  On the job, managers should be trained on how to identify and deal with bad behavior.  Many managers simply avoid a confrontation with a bully because it’s unpleasant.   Employees should receive regular feedback on all aspects of their performance, particularly teamwork.   Performance evaluations should not be the first time an employee hears that his behavior is not acceptable.  Teaching employees how to fight effectively with programs such as Difficult Conversations or Constructive Confrontations empowers them and may reduce the corrosive effects of ongoing bad behaviors.

If you believe you may be the target or victim of a bully, please contact Employee Relations at 617-414-1704 (BMC) or Faculty Staff Assistance Office at 617-353-5381 (BU).

By Bonnie Teitleman, LICSW

1)      Take a Vitamin D supplement – Known as the “sunshine” Vitamin, taking a Vitamin D supplement in the winter time is crucial in helping our bodies adapt to decreased sunlight when we are unable to go outside.  Many Americans are deficient and think that even if they spend time outdoors in the winter that this will be enough. Unfortunately, we don’t receive the proper UV light at this time of year to allow our bodies to produce Vitamin D so a supplement is highly advisable!

2)      Participate in some sort of “mindfulness-based” activity each day – stress can really take root during the Winter and participating in activities such as meditation, Yoga, tai chi, and deep breathing may help reduce daily situational stress that can contribute to winter blues.

3)      Exercise – daily exercise, sustained for at least thirty minutes, helps to relieve stress, get your body moving, and release ‘feel-good’ endorphins in the brain.  It is easy to become sedentary in the winter time but winter is also the chance to try new activities, look into exercise groups and classes, or find a new workout buddy.

4)      Eat Well – when Winter or life gets us down, it’s easy to cave into cravings for sugary and salty foods.  Instead, you might want to try cooking a warm meal on a winter’s day.  Eating cooked food and drinking warm liquids helps support our bodies during the cold, dark months.  You may even want to search online for recipes that create a sense of health and satisfaction.  Think soups, stews, and porridges.

5)      Caffeine and Alcohol – The winter can be a time of wonderful celebration, but many people consume more alcohol and caffeine at this time of the year.  Alcohol and caffeine consumption adds stress to your body and can dehydrate you and it’s important to watch your intake of these substances so as to keep your body healthy and relaxed.

By Morgan Mako
Program for Integrative Medicine and Health Care disparities

Have you been looking for an easy way to eliminate excess calories from your diet?  Depending on your favorite thirst-quenching choices, cutting down on soft drinks or sugary drinks may be one simple way to do this.  Many of us may have heard stories from parents or grandparents about the good-ole-days when having a soda at the local soda fountain was a special weekend afternoon treat.  However nowadays, many Americans consume soda as part of their daily routine, a habit that is contributing to the ever expanding obesity epidemic and to the related health problems of diabetes, high blood pressure, heart disease and cancer.

What are sugary drinks?

It’s pretty simple, a sugary drink is one that has a sugar added to it which does not occur naturally in the beverage.  For example, soft drinks, such as Coke or Pepsi are in this category.  Sweetened teas, coffee drinks such as Starbucks Frapuccino, energy drinks like Monster Energy, and sports drinks like Gatorade are also included.  Juices that are 100% juice, such as Tropicana orange juice, even though they also contain calories, are not considered to be in this category.  However, there are certainly juice drinks on the market that have added sugar and therefore count.  They would be indicated by ingredients label such as: sugar, evaporated cane juice, and high fructose corn syrup.
According to the Harvard School of Public Health, the average sugary drink contains about 150 calories, almost all of which comes from sugar sources, usually high fructose corn syrup – the same as 10 tablespoons of sugar with each beverage.  People often don’t realize how many calories they are consuming with these drinks.  The problem with consuming these liquid calories is that the body does not feel full like it does after eating food.  The body registers fullness with eating solid food, and naturally regulates hunger.  Sugary drinks, however, don’t have this same effect, and will cause the calories (and pounds) to keep mounting.

Mayor Menino and the Boston Public Health Commission have recently developed an initiative called “Stop. Rethink Your Drink. Go Green“, guidelines on what kind of beverages are healthy to drink.  Green light (drink plenty) drinks are those recommended for healthy consumption and include water, sparkling water, fat-free milk, and unsweetened soy milk.   Yellow light drinks (okay to drink occasionally) include 100% juice, diet sodas or low sugar drinks, and red light (drink rarely if at all) includes regular sodas, energy or sports drinks and fruit drinks.  This initiative is displayed on signs in BMC cafeterias.
For those of you interested in weight loss, the BMC DASH for Health Program has some useful advice:  If you are frequent consumer of soft drinks you may have an easy way to lose weight. By decreasing your caloric intake by 500 calories per day (the amount in two 20-ounce sodas) you will lose 1 pound per week.  Imagine, after 3 months you could lose 12 pounds, just by drinking water instead of soda!

The Centers for Disease Control has a useful tool to see how many calories are in commonly consumed beverages, some of which may be sneaking their ways into your day: CDC rethink_your_drink.

By Jonathan Berz, MD MSc
Section of General Internal Medicine
Adult Primary Care- Shapiro Practice