Table 4 Statements accepted as mental health first aid guidelines for assisting children

Item:

Round:

Assisting the traumatised child

The first aider should protect the child from further harm.

The first aider should ensure the child's physical needs (food, drink and somewhere to sleep) are met.

The first aider should not make judgments about the child's feelings and thoughts.

The first aider should tell the child that it is okay to feel upset when something bad or scary happens.

The first aider should not say that someone who has died has "gone to sleep" as this may result in the child becoming fearful of sleep.

The first aider should not make promises to the child that they cannot keep.

The first aider should ensure that that they or another adult are available to take care of the child.

The first aider should tell the child that they or another adult will take care of them.

Children at large-scale traumatic events

The first aider should attempt to keep the child together with loved ones and carers.

The first aider should protect the child from traumatic sights and sounds (including media images).

The first aider should ask bystanders and the media to stay away from the child.

The first aider should not behave towards the child in such a way that the child feels they are still in danger.

The first aider should reassure the child that they won't be left alone, so far as this is possible.

If the first aider has to leave the child alone for a few minutes to attend to others, they should reassure the child that they will back as soon as possible.

The first aider should try to appear as calm as possible.

The first aider should direct the child away from very distressed people (e.g., people who are screaming, agitated or aggressive).

The first aider should ask the child what would make them feel better or safer.

Communicating with the traumatised child

The first aider should talk to the child using age-appropriate language and explanations.

The first aider should not coerce the child to talk about their feelings or memories of the trauma before they want to do so.

The first aider should be aware that child may stop talking altogether after a trauma, and that if this happens they should not try to force or coerce the child to speak.

The first aider should allow the child to ask questions and should answer them as truthfully as possible.

The first aider should not make the child discuss the trauma before they are ready.

The first aider should say that they can't answer a child's question if this is the case.

If the child knows accurate, upsetting details, don't deny these.

The first aider should be patient if the child asks the same question many times.

The first aider should try to be consistent with answers and information.

The first aider should allow the child to talk about their feelings.

The first aider should allow the child to write or draw pictures about their feelings.

The first aider should allow the child to express their feelings through playing with toys.

The first aider should not tell the child how they should or shouldn't be feeling.

The first aider should not tell the child to be brave or tough or not to cry.

The first aider should not get angry if the child expresses strong emotions.

The first aider should show the child that they understand and care.

The first aider should tell the child that they will do their best to keep the child safe.

The first aider should be patient with the child.

The first aider should encourage the child to do things they enjoy (for example, playing with toys, reading books).

If the first aider lives with the traumatised child

The first aider should try to keep their behaviour as predictable as possible.

The first aider should encourage the child to keep to daily routines.

The first aider should not get angry, critical, or call the child 'babyish' if the child begins bedwetting, misbehaving, or sucking their thumb.

The first aider should help the child to feel in control by letting them make some decisions (e.g. about meals or what to wear).

The first aider should tell the child that their loved ones and carers love and support them.

Dealing with avoidance behaviours and tantrums

The first aider should be aware that the child may avoid things that remind them of the trauma (such as specific places, driving in the car, certain people, or separation from their carers.

The first aider should try to discover what triggers sudden fearfulness or regression in the child.

If the child avoids things which remind them of the trauma, but does not appear very distressed, the first aider should assure them that they are safe.

If the child has a temper tantrum or becomes fearful, crying and clingy in order to avoid something which reminds them of the trauma the first aider should ask what they are afraid of.

Legal issues relating to child abuse

The first aider should know the local laws or regulations about reporting suspected child abuse.

If the child discloses abuse, the first aider should contact the appropriate authorities.

If the child discloses abuse, the first aider should remain calm and reassure the child that they have done the right thing by telling.

If the child discloses abuse, the first aider should seek expert advice immediately.

If the child discloses abuse, the first aider should not confront the perpetrator.

If a child has disclosed abuse, the first aider should work with the appropriate authorities to ensure the child's safety.

If a child has disclosed abuse, the first aider should assure the child that the abuse was not their fault.

If a child has disclosed abuse, the first aider should tell the child that they believe what the child has told them.

Getting professional help for a traumatised child

If at any time the child becomes suicidal, the first aider should seek professional help.

The first aider should seek professional help for the child if they display sudden severe or delayed reactions to trauma for 2 weeks or more.

The first aider should seek professional help for the child if the post-trauma symptoms are interfering with their usual activities for 2 weeks or more.

The first aider should seek professional help for the child if they are unable to escape intense ongoing distressing feelings for 2 weeks or more.

The first aider should seek professional help for the child if their important relationships are suffering as a result of the trauma (eg, if they withdraw from their carers or friends) for 2 weeks or more.

The first aider should seek professional help for the child if they are unable to enjoy life at all as a result of the trauma for 2 weeks or more.

The first aider should seek professional help for the child if they feel very upset or fearful for 4 weeks or more.

The first aider should seek professional help for the child if they act very differently after the trauma for 4 weeks or more.

The first aider should seek professional help for the child if they feel jumpy or have nightmares because of or about the trauma for 4 weeks or more.

The first aider should seek professional help for the child if they can't stop thinking about the trauma for 4 weeks or more.

The first aider should seek professional help for the child if has temper tantrums or becomes fearful, crying and clingy in order to avoid something which reminds them of the trauma for 4 weeks or more.

If the first aider is not a parent or guardian, they should not seek professional help for the child independently of the parent or guardian, except in an emergency.

The first aider should be aware of the types of professional help which are available for children.

The first aider should be aware that the symptoms associated with trauma may suddenly or unexpectedly appear months or years after the event and that if this occurs, professional help may need to be sought.