When I was in second grade and living in Racine, Wisconsin, there was a rabies outbreak in the greater Chicago area that received extensive media coverage. Parents kept children indoors because of a perceived risk of marauding mad dogs, and stories about the horrors of having to undergo the treatment shots were widely discussed. Even though I loved dogs, I was petrified of being bitten by a rabid animal. A recurring image from the front page of the newspaper (which I still vividly recall) of a wild-eyed dog foaming at the mouth and fiercely biting the bars of its quarantine cage made it difficult to fall asleep many nights that fall. I’ve wondered whether that childhood experience of fearing a deadly illness I didn’t understand influenced my decision to go into medicine. I am certain, however, that a widespread concern about a scary disease, whether it’s rabies or Ebola, can affect children and adolescents in lasting ways.
While we can’t shield our children from everything that is worrisome, risky, or unpleasant, how we as adults react can have a greater impact on a child’s psyche than the actual reality of the situation. Nowhere is that more evident than in our societal response to the Ebola epidemic. The facts facing Americans (in contrast to many in West African countries) as I write this in late fall of 2014 contrast sharply with the anxiety, verging on panic, seen in some quarters.
The facts are fairly straightforward: Ebola is a viral disease we have known about for decades but not attended to intensely because outbreaks have only occurred in isolated areas of west and central Africa. It is contagious only from direct contact with bodily fluids (blood, vomit, diarrhea, etc.) of those showing symptoms of the illness; the sicker the patient, the higher the viral load and the more contagious he or she is. About half of those who contact Ebola will die, and they are especially contagious in the days immediately before and after their death. There is no specific treatment for Ebola, and effective vaccines, now being developed, will not be widely available for at least a year. Americans at the highest risk for Ebola are health care workers exposed to the virus when caring for sick patients; they comprise all of the handful of cases in the United States.
To judge from the media response and the way Ebola in the United States is consuming our consciousness way out of proportion to the current danger, facts seem to have little bearing on the American anxiety level. Scared parents, extreme governmental quarantine measures, and a national sense of panic are likely to cause unnecessary suffering for children; adult anxiety is more contagious than Ebola.
Instead of communicating dread and danger through what is said and through nonverbal communication (facial expression, affect, preoccupation), adults should present to children a measured and rational approach about Ebola. Knowledge is power, and helping children bolster their cognitive mastery skills goes a long way to allaying undue anxiety. The first step in this process is to create an open and supportive environment where children can ask questions and feel comfortable sharing what they know. Then we have to listen carefully and calmly to what they say. Youngsters’ ability to understand illness varies hugely with age, from a five-year-old’s magical thinking to many adolescents’ ability to deal with abstract concepts. It is critical to meet children where they are developmentally and to use words and concepts they can understand. Whatever the level of communication, it is important that the information we provide be accurate and honest, yet light on the graphic details. The horrible picture of the rabid dog stuck with me from my childhood because as an eight-year-old, I couldn’t understand the verbal explanations provided by the adults. We need to allow for repeated discussions of Ebola, as children can rarely process affect-laden information in a single session. Additionally, repeated questioning may be a child’s way of asking for reassurance.
As with any challenge, the Ebola crisis presents children with an opportunity for mastery and growth. Understanding the conditions in Africa — while differentiating them from the situation in the United States — can promote empathy for those less fortunate. Appreciating the heroism of medical workers on the front lines of the epidemic helps to define courage and self-sacrifice. If children can contribute some of their own money to a charitable organization fighting Ebola, it reinforces their developing social conscience and allows a sense of active mastery.
We know from other crises what helps and what hinders children’s efforts to cope with unsettling news. In our approach to Ebola, we should manage our anxiety, monitor our behavior, and make decisions based on equal parts of science and compassion. Our children will be the beneficiaries.