Maui pediatrician Dr. Irene Papaconstadopoulos says she’s seen relatively few complaints of respiratory problems, burns or other physical issues among her young patients who survived the West Maui wildfires. It’s their mental and emotional health that worries her now.

Children who escaped the fires and possibly lost loved ones, homes and community in the Lahaina disaster could take weeks or longer to start showing signs of resulting anxiety or depression, she and other experts say. And even youngsters in other parts of Maui, across Hawaii or around the world could experience anxiety from exposure to vivid news reports and social media about the nation’s deadliest wildfire in more than a century.

For the survivors, “usually after a disaster, it’s several weeks later that you start seeing a spike in mental health (issues),” Papaconstadopoulos said. During the initial shock and focus on staying alive, kids sometimes just avoid talking about the crisis, but when “the new reality sinks in, especially for older kids and teenagers … that’s when they start really showing signs of depression.”

In the aftermath of disasters, including 9/11, researchers have found about 30% of children typically are diagnosed with psychiatric disorders from trauma, Maui pediatrician Dr. Melissa Kim said at a recent state Board of Education meeting. With 3,001 public school students in Lahaina, plus several hundred more Lahaina children in private schools, that could be more than 1,000 children and teens, which Kim said Maui is not equipped to serve.

Papaconstadopoulos says her offices in Kihei and Kahului serve about 116 families from Lahaina, and while she said she did not know how many have suffered losses, she has been fielding increasing questions from parents about how to help their children cope emotionally. Some are proactively asking how to prevent problems, but others report that “there are some younger kids that are not sleeping well,” especially those displaced to other homes and hotels, she said. “They will ask for a favorite toy they can’t sleep without.”

To help families everywhere learn how to talk with and support their children in the wake of the Maui disaster, the Honolulu Star- Advertiser consulted with Papaconstadopoulos, who is also affiliated with Kapiolani Medical Center for Women &Children and Maui Memorial Hospital; Dr. Shaylin Chock, a child and adolescent psychiatrist at Kapiolani, and assistant professor in the Department of Psychiatry at the John A. Burns School of Medicine; and Elizabeth Hartline, an assistant professor of early childhood education at Honolulu Community College who has authored a “social story” that parents can use for free to talk with young children about the fires (see accompanying story).

While each ohana and each child has a unique set of needs that might vary by how close to or distant from the disaster they have been, their general advice included:

>> Limit media exposure. The barrage of coverage on TV, radio, digital and print news as well as social media can overwhelm and traumatize children, especially when they’re too young to understand that the threat has passed or is far away, all three experts emphasized. Don’t allow youngsters unfettered access to watch disaster scenes over and over, they said. Also, discourage their viewing live coverage; Papaconstadopoulos suggests a parent can choose appropriate material ahead of time and sit together with the child to view and discuss.

>> Allow children to talk about the disaster and ask questions. Don’t brush them off or make the topic off limits. But also, “don’t force them to talk about issues they’re not ready to talk about,” she said. Drawing, writing and creative play can also help kids communicate and work through their feelings.

>> Provide concrete, complete explanations in age-appropriate language. For young children, Hart­line said, an explanation can be as simple as, “There was a fire. It was (fanned) from a hurricane, and the Fire Department tried to put it out … and this is what we’re doing now, and this is what you can do when you’re sad.”

Young children in particular have vivid imaginations and, if not provided with enough accurate information, can “fill in the blanks” with thoughts worse than reality, the experts said. Papaconstadopoulos recommends asking, “‘What did you see? What did you understand?’ … Give them a reasonable explanation of what happened and tell them that was in the past, help them file it away and tell them they’re safe now.”

>> Be honest. Children and teens often can tell if you’re bending or hiding truth, and that can affect their ability to trust you in the future, Papaconstadopoulos said. “You can say, ‘Our house is safe now.’ But … we can’t say no fire is ever going to happen again. We can say, ‘These are the measures we’ve taken, this is how we prevent fire and how we protect ourselves for the future.’”

>> Help children to recognize their protectors and helpers. Assure keiki that there are many adults working to keep them safe, including firefighters, police, paramedics, doctors and community volunteers. Chock said telling them about the steps that you’ve taken as their parent to protect them can also be reassuring.

>> For older children and teenagers, provide more information if appropriate. Start by asking: What do you know about the fires? What worries you? Mature teens may even be able to discuss how to tell facts from unfounded rumors and conspiracy theories. “If you’re a parent of a teenager, you might say, ‘Hey, you might hear some things or see some things on social media that really are not right. And if you have questions, please talk to me about it,’” Chock said.

>> For surviving children in West Maui, reestablishing routines, such as enrolling in a nearby school, sports and clubs when they are ready, can help. “We know this from COVID, that having the kids socializing in school or in sports activities … is better than keeping them away from everything,” Chock said.

>> Restore a sense of control. Children who’ve been displaced or suffered loss can feel powerless. Encouraging them to make even small decisions — “‘Do you want to sleep on Mommy’s left side or Mommy’s right side? What do you think we should have as our family meal tonight?’ … can give them a sense that they have an opportunity to have control over something,” Chock said. Youngsters who feel anxious even at a distance might feel their sense of control restored also by helping through volunteering or collecting donations, for example.

>> Watch for signs of anxiety or depression. Affected children might come down with headaches, unexplained abdominal pain, diarrhea, sleep problems. Some signs may be subtle, such as irritability or a change in school performance; or they may be more extreme, such as suicide ideation, in which case evaluation by a licensed medical professional is recommended. A small child might lose a newly gained skill or function, such as the ability to sleep alone or use the potty. “Just recognize that’s normal in this situation — don’t be critical about it,” Chock said. “Just say, ‘Hey, you know, we have accidents,’ kind of keep moving forward.”

>> Know that it’s OK to let your keiki see your feelings — to a point. Some tears or some anger “gives permission” to a child to feel those emotions, too, said Chock, who is a mother of three young children. But remember to also talk about how to handle strong feelings. A parent can say, “‘When I feel sad, I drink some cold water and I give you a hug. And that helps me feel so much better,’” she said. “‘And even if I don’t have all the answers and I can’t make it better right this moment, together we’re going to get through this, and we’re going to figure out how to make it better.’”