By: Deanna Dahl Grove, MD, FAAP & David J. Schonfeld, MD, FAAP
If your community is prone to be hit by any natural disaster, it is important to
prepare ahead of time.
Tornadoes often happen with little warning. And while they can happen anywhere, families should be aware if they live in
higher risk areas for tornadoes.
Tornadoes can also occur as part of a major
hurricane. Listen to local news or NOAA Weather Radio to stay updated about tornado watches and warnings. It is important to follow advice from authorities regarding when to take shelter. It's also important to know where to get help after a tornado, when families may face different challenges. Here are some steps to help you protect and support your children during these times.
How to prepare for a tornado
Prepare a disaster supplies list and emergency kit. It should have at least 3 days of food and water, medications, important documents and other supplies such as first aid supplies, flashlights, radio, fire extinguisher, whistle and spare batteries.
Participate in tornado drills with the entire family. Practice where to go if family members are home when a tornado is approaching. Also make sure children and family members also understand school emergency procedures and how to get together if they are
separated in an emergency. If possible, get training in first aid and basic life support.
Identify a location where you can shelter in your house from a tornado. If you do not have a tornado shelter, then use your basement, or an interior room away from windows if you don't have a basement that you can use for this purpose. If you have time, bring your pets.
Make sure all family members know how and where to shut off utilities, including water, gas, and electricity. Review how to turn them off at the main valves and switches, in case you hear or smell gas or see a broken water line, or if instructed by authorities to shut off all utilities.
What to do after a tornado
If you are trapped under rubble, bang on a pipe or a wall. Use a whistle if available, and cover your nose and mouth with a cloth to protect yourself from dust. Only shout as a last resort.
Monitor local media and Wireless Emergency Alerts. Stay in your shelter until the tornado warning is over.
When you are advised it is safe to leave your tornado shelter,
immediately check yourself and family members for injuries.
Seek medical help & provide first aid
In the event of a serious injury
call 9-1-1.
If anyone is unresponsive or not breathing, begin
CPR. Do not move seriously injured persons unless they are in immediate danger of further injury (such as they are under a portion of a damaged building that is just about to fall on them).
Apply direct pressure to bleeding wounds and seek immediate medical care for serious injuries or wounds that will not stop bleeding with pressure.
Wash open wounds thoroughly with soap and clean water and cover them with bandages or clean cloth. Also consider applying antibiotic ointment if you have it available.
Seek medical care for any puncture wounds or wounds that are red, swollen, tender, or draining pus.
Know when it's safe to stay in your home or return after evacuating.
Stay connected to receive emergency information from battery-operated radios, TVs (if there is electricity), or text alerts to receive up-to-date advice on evacuation and return precautions. If you're away from home, do not go back until you are advised that it is safe to do so. If possible don't return until basic utilities are restored; it can be challenging to take care of children if there is no water and electricity or when drainage and sewage systems are not working.
Make sure your home and neighborhood are safe before bringing children back home. Check for safety hazards. Do not enter damaged buildings and stay away from power lines and
other electrical hazards. Damaged structures and other debris may have sharp edges and points that can injure children and adults.
Inspect your home if inside for damage and gas leaks. If you smell gas or see spills that could be flammable, leave immediately. If you are in a damaged building or if your home is unsafe, go outside and away from the building. Make sure to use flashlights and not candles or matches so you don't start a fire if there is a gas leak, and avoid any downed utility lines. Shut off utility main lines if you suspect broken lines or are advised to do so.
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Be aware of stray or wild animals, insects and pests after a tornado and
protect yourself from them. Mosquitoes and other insects can breed quickly in standing water and then spread illness. Follow CDC
tips on how to prevent mold growth and to clean up safely.
Be aware of other hazards once children return home
When it is safe for children to be back, they should dress in long pants and sturdy shoes. Apply sunscreen and insect repellent when outside. Avoid unsafe play areas such as damaged structures, or near downed trees and utility lines.
Be careful not to drive your car into floodwaters. Make sure there are no downed electrical wires. Floodwaters can contain hazardous chemicals such as oil, gasoline and pesticides. The water can be contaminated with sewage and germs which can infect cuts or wounds. Make sure you keep children away from any remaining floodwaters.
Throw out unsafe food such as perishables that have not been refrigerated properly or food with an unusual smell, color or texture. Do not use contaminated water to make baby formula, prepare or wash food, or for washing your hands and utensils. Use safe water such as bottled, boiled, or treated water for drinking, cooking and hand washing.
If you still do not have power and need to run a generator, make sure you keep the generator outside and at least 20 feet from your house, other structures. Keep it away from enclosed spaces to avoid
carbon monoxide poisoning.
Explain to your children about what's happening and talk about how they are feeling
Talk with your children about what happened, and what you expect to happen next, in simple, direct terms. Choosing not to talk about it, or avoiding discussion, makes the event more frightening for children and suggests the event is too horrible to think or talk about. Children may then feel uncomfortable asking questions or talking about their feelings.
Ask them directly how they are feeling and if they have any concerns or fears. If they are worried about another tornsdo, remind them of ways you can learn about future tornado warnings and what they should do to get to a safe location quickly. Share with them the steps that are being taken to rebuild the community.
Do not tell children they shouldn't be worried. Help them learn how to deal with distressing feelings rather than pretend that these feelings do not or should not exist.
Do not force them to answer your questions. In general, it is best to wait until they are ready to talk. Be present emotionally and physically so children know you are ready to talk when they are.
Provide honest reassurance and correct any misinformation. The amount of information you should share depends on their age, developmental level, and coping style. Do not provide too many details or share graphic images or emotional coverage (such as interviews with crying victims on news from television or online sources). It may be beneficial to limit media exposure such as seen or heard on television, radio, the internet or social media.
If they do see or hear upsetting media coverage, consider
viewing with them to provide reassurance and answer any questions. Observe your child's cues about how much information to provide. Generally, older children want and benefit from more detailed information compared to younger children.
Look for changes in behavior that suggest your child is having difficulty coping
Trouble sleeping. It is common for children to experience changes in sleep (difficulty falling or staying asleep, nightmares, trouble waking in the morning) or eating (such as decreased appetite or over-eating). They may struggle with fears or
anxiety (including a fear of returning to school), social withdrawal, sadness or
depression, new hyperactivity, substance use (alcohol, tobacco, or other drugs) or physical complaints (such as headache, stomachache or feeling tired).
Emotional triggers. In addition, future severe weather (or anniversaries of the event) may remind children of the disaster, which can increase feelings of distress. If these reactions continue over time, become severe or affect your children's ability to learn and socialize, contact your pediatrician or another professional. Most children who are experiencing distress, though, may not appear upset or show any change in behavior.
Consider sharing your feelings about the disaster with your children
Take the opportunity to role model how to cope with distress and disappointment. Share coping strategies that work for you. You might describe talking to friends or family, writing your thoughts in a journal or using art or music to express your feelings. Some people use exercise, dance, yoga, or relaxation techniques and
mindfulness to cope with strong emotions.
Monitor how you are doing and take care of yourself. Children depend on the adults around them to be and feel safe and secure. If you are anxious or angry, children are likely to be more affected by your emotional state or actions than by your words.
Help children grieve if they have experienced the death of someone close
Look to helpful resouces like
this free downloadable booklet and
this article. Find advice for parents and other caring adults on how to support grieving children.
Remember that children also
grieve other losses such as the loss of their home, missing a friend who moved away, or being unable to return to school. They may also grieve about changes in their normal structure, routine and peer support. These changes and loss may be present for weeks or months afterwards.
Recognize that recovery takes time
Cleaning and rebuilding a home after a tornado can take months or more. It often takes even longer for children and families to adjust. Expect that there will be ups and downs, celebrations, and setbacks along the way. The character of the community often changes from what it was before the disaster.
Contact your child's pediatrician and school
If you have concerns about your children's health, adjustment, or behavior, reach out to their pediatrician and teachers. Concentration and learning are often difficult after a disaster.
Make sure that children receive appropriate support and accommodations at school. If school expectations exceed children's current ability to learn, school can become a source of distress rather than support and assistance. Talk with your children's teacher or a school mental health professional about how to get support.
More information
About Dr. Dahl Grove
Deanna Dahl Grove, MD, FAAP, is a member of the American Academy of Pediatrics (AAP) Council on Children and Disasters and Section on Emergency Medicine.
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About Dr. Schonfeld
 David Schonfeld, MD, FAAP, is an Executive Committee member of the AAP Council on Children and Disasters and Section on Developmental and Behavioral Pediatrics. He also serves as Director of the National Center for School Crisis and Bereavement at Children’s Hospital Los Angeles, and Professor of Clinical Pediatrics, Keck School of Medicine of USC.
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Editor's note:
Samarth Rabadiya
and
Brian E. Costello, MD, also contributed to this article.