By Linda Carroll

(Reuters Health) – What do children really need? The answers may be found in war zones and refugee camps, a psychiatrist and relief worker suggests.

Although being shelled or living in a squalid refugee camp may seem like worst-case scenarios for children, they’re not. But they do highlight what’s actually most devastating, according to an article published in the Archives of Disease in Childhood.

More than anything, children need to be with people who love them, writes Lynne Jones, a child psychiatrist, relief worker, writer, fellow with the FXB Center for Health and Human Rights at Harvard University in Cambridge, Massachusetts, and author of “Outside the Asylum: A Memoir of War, Disaster and Humanitarian Psychiatry.”

For Jones, the writing of the current article took on an extra sense of urgency as the United States began separating immigrant children from their parents.

“This article is based on talks I’ve given highlighting one of the worst things that can happen to a child: separation from those they love,” Jones told Reuters Health. “What made it particularly relevant was I was writing it at the time of the separation crisis. I think there are a lot of lessons that are pertinent to those children who are trying to escape extreme violence in Central America and find themselves separated from the people they love and trust.”

In her article, Jones tells the stories of children who have taught her lessons about what is most important to them. “Paradoxically I discovered in my Bosnian research that children who were separated from those they loved for prolonged periods, even though they were living in relative comfort, had more severe psychological consequences than those who had lived with parents they loved and trusted in relative danger and discomfort under siege,” she said.

Jones recalls meeting with children after the Kosovo conflict. Many did not want to talk to her about what happened, but “when offered the opportunity to testify to the War Crimes Tribunal, all the children wanted to be interviewed,” she writes.

Sometimes it’s just a matter of waiting for children to talk.

“One belief that is very common is the idea that you must get children to talk about their experiences in order to aid their recovery,” Jones said. “Some will want to talk, but some won’t. It should be up to the child. That is why I have a rule: don’t force talking but be able to listen to whatever they want to talk about.”

Jones has collected children’s stories for people to learn from (

“If you do listen to them, they will tell you what they need,” Jones said. “And if you do listen, pay attention and do something about it. There are children across the world in desperate situations.”

Jones also learned that what works for one child may not work for another. “Every child is different,” she said.

Another nugget: there was often a difference in the way boys and girls responded to the hardships faced in refugee camps.

That’s also seen in American children, said Kimberly Blair, director of the Matilda Theiss Early Childhood Behavioral Health Center at the Western Psychiatric Institute of the University of Pittsburgh Medical Center. “They’re equally as hurt,” said Blair, who wasn’t involved with the article. “But we often see this manifested a little differently.”

Blair isn’t sure that waiting for kids to talk is always the best route. “We want to talk,” she said. “But we are sensitive to when kids are ready. Part of the work is getting them there.”

Often the approach isn’t direct. “We do everything through play with the kids,” Blair said. “If they don’t want to talk about it directly, then we will watch them at play and see if we can pick up on some cues.”

Jones is right about the importance of connection with loved ones, Blair said, adding that many times she sees children who have been removed from their parents.

“When a kid gets separated they’re not just suffering from the trauma of the experience (that led to the separation),” Blair said. “Despite the fact that they might be safer somewhere else, that connection with the parents is so important. So, the separation is traumatic. Our parents are where we get our security from. Those are the people who provide us with a feeling of safety.”

SOURCE: Archives of Disease in Childhood, online August 13, 2018.