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Uh firstly, blast injury can really be a very frightening experience, not only for the child but for their caregivers as well for people who are dealing with those cases. In addition to the physical impact of blast injuries, also there is the psychological impact, there is fears anxieties. And so the way Children react to these experiences depends on their uh development stage, but also depends on the people around them. So therefore, the support of the frontline medical staff play an important role not only in the life saving of these Children, but also in reducing the psychological impact by the care that they provide. And so this session is going to give some tips on how we deal with these Children and how we can actually support caregivers. So really the aim of this webinar to uh to provide some tips on as we said, what to do and to say uh to help Children but also what not to say and to do. In order to avoid causing further harm. We look at some basic principles of working with Children of different age and how we do that safely and in a supportive matter, we look at common stress responses and support strategies for Children of different ages. Because based on the age and based based on the child development, they will be reacting in a different way. So it's really important that we understand those uh developmental stages and how we can actually eat respond based on that we will, as we said, uh we look at some tips to give for caregivers and the family's supporting Children uh to, to also help them overcome the impact of the blast injury. Uh We look at how and why it's important to create filed friendly and supportive environment in medical facilities and how that also help Children cope and recover and better. And finally, uh and this is really one of the most important thing that we need to look after is the critical importance of self and team care for front line medical staff in general, but especially for those who our working with last engines. So when we are talking, we started by saying, we want to look at some principles of working with Children. So one of the first principle when we're working with Children is really to relate to the Children according to their age and to their development stage because as we said, Children grow in different ways and their mind or they're thinking changes based on those stages. So it's very important that we communicate with them and explain what's happening in a way that they can really understand which also helped them both better. The other thing, it's really important that we avoid separation of Children from their caregivers. And if they were already separated, that we should do our best to reunite them. Being in a hospital is very frightening, frightening experience. So this is why we're talking about ensuring that caregivers are around and they are supporting their Children in this treatment. And this journey. And the other principle of working with Children is to show Children respect by listening to them, by relating to them by ensuring that they understand it's happening again based on their age, but also by safeguarding them. Uh The other principle is supporting caregivers to care for their Children. I mean, the primary carers are there caregivers. So it's very important that we empower them, that we help them to take the lead. So we are supporting them to support their, their their Children. The other principle is creating child friendly and healing environment in the hospital and to make sure that the child feel as much as possible, comfortable that they can distract their thoughts and their emotions from the treatment all the time. And last year, as we said, it's very, very critical that you take care of yourself in order the best care for the Children and their caregivers, but also to be able to process all these stressful uh and and sometimes go some uh images and you know, dealing with very, very difficult situations. So um So what are some common stress responses and support strategies that we can provide for Children of different ages? Now, there are some uh common stresses amongst all the Children, regardless of their age. For example, uh we can look at fear or as we said, um disbelief or anger can see the Children sometimes have a self blame or shame that they have survived, not others. Other reactions could be, especially if you're with younger Children to be more clingy. Uh you know, cry a lot, a lot. They just want that physical comfort while others might become more withdrawn, unable to concentrate, confuse, unable or have the difficulty sleeping or eating. It's really very important to remember that uh the child injury and hospitalization is not only stressful for the child but also for their caregiver. So part of what you can do as we said, uh supporting their Children, but also supporting their parents and the caregiver to look after their Children and give them some concrete tips and supporting strategies. And this is just a little recap. That's very important that we understand the reactions of those Children based on their age and their mental development. Because every stage has different, the actions though there are some common uh stress responses, but there are things that are related to every stage. And and therefore it's important by understanding those we know how to respond uh and how we can support Children deal and cope while they are in the hospital. Okay. So if we divide uh my Children developed from 0 to 18, 230 to 6, 7 to 13 and 13 to 18, you find there are some generic or uh you know, a distinct development, uh let's say factory stick for each stage. So for 0 to 6 Children, we talk about egocentric uh thinking. So when we talk about egocentric thinking, it's a tendency that young Children have to think of everything that's around them uh in relation to themselves. So for example, if a young child, a girl, for example, is angry with her brother, she's so mad and she wish he, he disappears and suddenly or later something happened to him, he gets sick and he got to hospital. She might really believe that it's her fault that he got illness and he was hospitalized. So why we're giving this example? Because Children between zero and six might actually think that the injury and the treatment is a punishment for something that they've done wrong. And as you said, there's a natural uh or a tendency that they might have, but it's very important that we are aware of it. So we can actually know how to talk to them about the injury and about the treatment and how we can support them, not to really believe that they are causing that to themselves or they have done something wrong to deserve it. And the other important characterised for this age group. It's the reaction really depends on how their parents then can give a react. So if the parents are screaming, scared, have anxiety, they will exactly feel the same that their parents are trying to calm them. They're trying to assure them that will uh they will have a positive impact on them. They can really absorb it and uh utilize that and, and, and mostly, and the last thing is they are very, very sensitive as well too, how others react, including the medical stuff. What can medical uh staff do? There are some, as we said, we're not talking about treatment were just talking about very, very basic considerations that you can do. So definitely the first thing we, we need to ensure whenever possible that the child can stay close to their, their, their caregivers whenever possible, you need to be great if it's the mother and the father there, and that would be ideal. But again, we know in sub context you have more than other, more than Children. So maybe uh the other caregiver had to be back home, they might be themselves affected. But as long as we have one of the main caregivers who is really attending, looking after the charges and the child trust, that's uh that's the most important thing. The second one is, as we said, try not to discuss uh any procedures in front of black Children. And if you have to be very, be very sensitive to their feelings and try not to frighten them again, maybe than using their calm voice, trying, you know, to make sure that your physical body is not in any way is just awful. So, uh it's better not to discuss it in front of them. But if you have to then be very, very aware that they are sensitive and they can sense your, your reactions and your, now again, we know in many contexts, the child might be coming immediately to the emergency room and many of those steps cannot happen. But if possible and one possible, you still need to tell the child in a very, very, very simple way that they are going to have a procedure that that's going to help them LSE recover, feel better without going into any details. But in a very simple way and trying to reassure them again, without lines, if the child is going to lose their leg, you can't just say, are you coming out with two legs, you know, just be very careful of what other messages, but also in a very simple way and ensuring way I'm just, I'm going to say the last three together, one, you know, Children really uh like to have those comforts. We know a lot of Children have uh teddy bears or uh blankets that they feel safe. So whenever possible, again, ask that diverse to bring this home because that can really help them uh feel safe. Uh and as well. We talk about Children uh and the importance of place. So really encouraging not general play, but also magical play where the Children, for example, can use that Status Cope or syringes without needles that can also make them feel more comfortable with these two and not be frightened when they come. And lastly, uh probably if it's possible to read books with pictures that can explain the procedure and equipment that might make the child feel more safe and comfortable in that setting that they are in. For Children are between age seven and 13. There's another developmental characteristic and around age of six or seven Children start having what we call the logic mind where they really think of course an effect. So it's very important for them to understand the logic of things. So what they might feel or think at this stage, they have a very strong feeling, fear of needles and pain. They talk about the event in a very repetitive manner. So they keep talking about what happened in a way that sometimes uh might be or can be perceived in a very annoying matter for their caregivers. But it's very, very important to understand that this is their way of processing and understanding what has happened to them. They also can have difficulties with memory, concentration and attention in addition to psychosomatic or physical complaints related to their emotional distress, so we can feel they have had experience joint aids and these are not necessarily uh physical but actually can be uh what people psychosomatic, they eventually also might feel very guilty. They can help day medication. As we said, they feel that they have maybe survived another friends or they self blame that it might have been, especially if they were playing outside. For example, they were the one who initiated that, that was because of them uh that they post hard to the other friends or families and that also can produce get. Now what can medical stuff do? Uh You can explain the procedure in advance. As we said, they have a lot of fear of needles, blood, uh you know, cutting. So try to avoid words like cutting or making a hold and try to explain it but avoid using those terms. Now we took the before this, that this stage of this development stage is characterized by cause the effect kind of logical in mind. So it's really important for them to understand how their body works and and explain why they need to be something that it's there or the procedure without going into so much details in a way that they can understand they're talking still about age 7 to 13. So they can understand enough, but you don't need duty to frighten them. So they need to understand the logic of what's happening in their bodies. Now, while you are explaining, you really need to encourage them as much as possible to ask the question they have because if there are any gaps in the information, they will tend to fill it in fantasies that might be really frightful to them. So if they better get the facts and understand what's happening than having gaps, they're trying to fill themselves. And I lost, really try to encourage them to express their feelings, verbally and through drawing. And now we said that this uh this uh group tends to repeat uh to talk about the, the events in a very repetitive way. So you need to expect that they might talk about it again and again, again, but you should really give them that room, but as well give them maybe materials to be able to express themselves still playing or through playing with other kids. Now, the last age group, we're talking about adolescence from the age 13 to 18 and this age group is characterized by wanting to be independent as a peer pressure. Um There is feeling that they want to be in control. So, again, it's very important that we understand how their brain is working and their emotions to be able to actually support them uh overcome these uh situations. So what might these Children uh feel of things? They would be worrying more, for example, about their experience after the injury, they will worry about the relationships with peers. For example, if they used to play football or have their own uh you know, groups and stuff. So they will be worried about what is the impact of that on their relationship with their difference. They worry about lots of independence and control, have intense greet. And again, they might be consumed with gifts and shape. Lastly because of that, they might feel very self absorbed and chief self city bad for themselves. And, and we might see, uh, in some severe cases, the Children start to, uh, think about suicide or express that they want, they do not want to continue their lives. What can medical, less cash. So it's very important for this age group that we explain any procedures, empties you really talk to them through it whenever it's possible. As we said, sometimes uh in mash mass casualty or if the or if the child in a very severe case, you just go straight into the, you know, to the theater so you don't have time to explain. But when possible, it's very important that we explain any procedures in detail whenever possible. Again, involved the child in taking as many decisions as possible related to their treatment, uh encourage the child to ask questions and try to allow adolescents as many privacy as possible. And as we said, include the child in every conversation about the treatment which is similar to the one before eventually, also encourage them to express their concerns and take time to listen and discuss. I mean, we discussed before that it's very important that we keep the caregivers as um uh forefront care for their Children. So it's uh it's important that we give some tips for the caregivers on how they look after their Children. And as again, if we look at the different age groups, so yeah, you can get some tips that can actually help those Children recover better then. So we're talking about infant, make sure that they are having that physical contact, having cuddles, hugs if possible or at least holding hands, keep them away from loud noises and chaos. Keep them warm and safe. Uh keep regular feeding and sleeping schedule when possible and speak in a very calm and soft voice because that all of this can really call the Children and make them feel safe. Um uh for other Children who are not, not infant but young Children, it's really very important that we give them extra time and attention uh that we remind them often that they are safe because Children will think for a while that you know, the bomb will happen or they are not safe. It's really very important to try to reassure them that they are, they are safe when they are safe because if they're still bombing in around the the the hospital, it might not necessarily be the case, but you can tell them uh as much as possible, the parents and the staff will be looking after them and they will ensure or try to ensure their safety. Um I'm not going to read every single one of these ones. But I'm going to focus on a couple of things and just to say, for example, these steps, something you can flint out, let's say, and give to the parents, we look later and do and do not. But that can be something that can be given out as a, as a print out for the caregivers. They know actually how to deal with their Children. Um And just uh here you remember when we started, you were saying that Children at this age, they have this egocentric thinking. So they might think that they are the reason of what happened. So it's really important that caregivers and the stuff can really explain and assured that Children are not to blame for what happened. And, and lastly, just to say Children at this uh this age uh can and it's normal or it's not an abnormal behavior for them to regress to a younger behavior, for example, suck their thumbs or stuff to what's their bets again. So these behaviors, if they happen, it's very important to explain to their parents that they are a normal reaction to uh to a stressful uh to a stressful situation and they just need to be patient and not react to those behaviors. So for the Children who are older Children, adolescent, uh similar to the other ones, it's really important. But again, we give them attention and time. Uh we talked about uh we haven't mentioned routine, but it's really very important that Children have uh as much as possible uh routine and uh schedule that they can follow. So they have more predictability about what's happening. And that again, make them feel safe. It's similar to what we're saying for the stuff. Also, for parents that they can provide facts about what happened, explaining what's going to, to happen. It's really important uh to allow Children to be sad. I think sometimes we have tendency uh to, to rush pain away. We just want our Children to be happy or we want them to be tough, but that does not helpful uh does not help. So it's really important when Children are sad or whatever emotion that are feeling, we should not judge them and we allow them to express these uh these students, whatever they are. So what, what are the things that we should do if we remember that we always make a contact when we're talking about making contacts about whenever possible. Again, we said sometimes it's not possible to introduce ourselves because the child might even have arrived in a state that they are unconscious. But whenever there is the possibility arrives, it's very important that we introduce ourselves by name, explain who we are and ask the Children about their names. And so, you know, and they're making conduct. It's very important that you ask the Children about their concerns, what they need. And most importantly that we they call and try to calm the parents and answer the question that the Children might help. But the second one we said is about supporting caregivers. And in that we want to talk about a few things for one to make sure that Children uh and the caregivers are reunited with each other if they were separated and make sure that they have never separated. Also, as we said, it's very important to remember that the caregivers are at the forefront of care of four Children. And by that, we really need to also support them, cope with their stresses, but also understand what is going on with their Children and the different treatments in a way that they are able to understand and uh give them, as we said, some practical information about how they can themselves help developing Children and and if and whenever possible, it would be really important if you can prepare and have available information materials. For example, the tip, the tips that we talked, we were talking about how to, how for how caregivers can deal with their, their Children based on their age group can be helpful. In addition to that, we can have information about, for example, what are the effects of blast injury care treatment and what they can expect in the short and long term. Uh In addition to the conflict information for available magical rehabilitation and other services, for example, psychological abuse uh typical and how as we said Children can reactive distressing events based on them uh age of development this stage. Uh So at least is when we're talking about uh you know, the duo's, there's still two more one about respecting children's dignity, right, and strength and one about creating supporting uh environment. So when we're talking about respecting Children, dignity and write what we mean is safeguarding the dignity of Children at all times. And that means never, for example, uh never to show them to shame them of how they are feeling or uh be honest about when we're speaking with the Children and help them cope with the negative ways when you're speaking to Children. It's very important that we also help them cope uh and finding adaptive ways to the challenges that are facing. And also remember that Children have uh stem. So we want to uh kind of help them regain control over their functioning and uh decisions that will also promote their own. Uh Okay, respecting Children also means that we offer them copying strategies on how they can count themselves. Uh find out what kind of coping strategies they usually use their work for them as well, taking consent. So it's very important whenever possible that especially for a dollars in to take their consent and for younger Children to take consent from uh from the parents whenever possible. And lastly explaining and answering a question in a very, very simple way and the way that they can understand. OK. Lastly, by the dues, it's really important that we try to create a supportive and comfortable environment for the Children. Now, we know Children really feel uh safer in an environment that is child fundi that has toys that have colorful uh you know schemes. So here are just some examples of what we can do including uh providing some uh let's say medical toys, helping the child using the stethoscope and explaining to them. What are the procedures? All of these can really create an environment where the child can cooperate and cope better. So they do not do not give a child or their caregivers, any false reassurances or promises just to find them down. It's really very dangerous that we say something that's not going to happen just because we want to calm the family. It's better to give realistic reassurances, an honest information, do not separate Children from their caregivers. It really can be very traumatic experience, especially sometimes uh when Children are taken to theaters before being given anesthesia. So they are really taken away from their caregivers and that might be very traumatic. So as much as we can keep the caregivers involved, it's really helpful for the child to, to cope and not to have a very traumatic experience in the hospital as we saw. So in the pictures, do not discuss procedures with other adults in front of little Children because that would be very, very frightening and eventually do not let Children witness or here other Children receiving painful procedures or changing addressing, for example of other Children and do not do not let Children witness gruesome scenes in the medical facility. So so far we have covered, you know, how to respond to Children and what are the tips that we can give to caregiver. But one of the really important thing is the political importance of self and team care for the front line medical staff dealing with, with blast injuries. And in context like that can really bring a lot of emotions to uh to the to the front line medical stuff. Uh And you know, we know that life saving treatments that you offer to Children can be uh can bring very special meaning to your life, but also witnessing other suffer can bring distress, paying grief to you. Um And it's really important that we do self care. So some of the techniques that we use is as we said, try to exercise, to socialize and connect with others. Uh look after yourself by taking breaks, even if it was a quick stretch or fresh air eat regularly, make healthy food, get enough sleep whenever possible. Uh enjoy cultural, spiritual and social activities, know your limits. And when to say, you know, I can't do it because I think if and when we are working in devastating context like that, especially uh and sometimes very difficult treatment, sorry and very difficult conditions, we might reach a point where we are burned out. So it's just important that we create a very balanced schedule, try to keep a sense of humor. And finally, if you can on a daily basis, right down, three positive things that happened during the day. For example, you know, a child has smiled to you or, uh, someone that your donuts, but just really try to look after yourself because I know what you're doing is, uh, is very, very important and very amazing, but also can have an impact on you and your families.