The are a national nightmare, experts say, and parents, neighbors and community leaders need to look out for the most vulnerable in the coming days.
The trauma of the shooting in which 20 young children died has affected the town hardest, of course, but neighboring communities will feel the effects and the country as a whole as people digest the images of children under deliberate attack.
Children need reassurance most of all – and it will be hard to give because the shooting took place at school. But psychiatrists say there are useful ways to cope, and they include sticking to routines.
“I think that clearly, that fact that every child goes to school across the country makes this something that they imagine can happen to them,” said Dr. Harold Koplewicz, president of the Child Mind Institute in New York.
Dr. Thomas McInerny, president of the American Academy of Pediatrics, called it a “day of sadness and grief for everyone who cares for children.” “As in any frightening situation, young children should not be exposed to the extensive media coverage of the event -- in other words, turn off the TV, computer, and other media devices,” he advised.
Parents will have to overcome their own fears and be calm examples to their kids, the experts agreed. “One of the things that we need to make sure of is that kids are reassured,” Koplewicz said. “The way to help kids is for parents to talk to them to model calm and to try to maintain routines.”
It may be hard for parents to do that.
“People will be thinking ‘schools are supposed to be this safe place that I bring my kids’,” said Melissa Brymer, director of terrorism and disaster programs at the UCLA-Duke National Center for Child Traumatic Stress.
“That feeling that where my kids spend the majority of their days may not be as safe as I imagined,” Brymer added. Many schools sent messages out over the weekend reassuring parents about safety routines.
Most anxiety experts have learned that it’s important to give people something to do in a time of crisis. In this case, families can help cope by reviewing their own emergency plans, Brymer said.
“If something happens at my kids’ school, where is the reunification location?” she said. “What is the emergency contact number that I can call to get an update? How will the school communicate with me? We know, frankly, that texting is a way that families can get in contact with each other. Sometimes the phone lines can get jammed.”
And gestures to offer comfort help giver and recipient alike.
“I just had a lady call from Montana,” said Scudder Smith, publisher of the Newtown Bee, the local paper. "She said she’s going to send me a box of bears to distribute when the time is right so the kids can hug some bears.”
People who have themselves suffered a tragedy – especially those affected by other mass shootings but also military families – may be getting a double jolt right now, said Brymer.
“They might need to have additional support," she said. "We know that military families might be having their own reactions and reminders.” Her organization will be posting advice at www.nctsn.org.
For the children who survived, providing comfort and a feeling of safety will be key in helping them recover -- and most, if not all, of them likely will, said Dr. Gail Saltz, a New York psychiatrist and TODAY show contributor.
These kids are at an age where this is going to be traumatic, and it may stick with them, Saltz said.
"You would assume some of the children would have some acute stress syndrome. They will be frightened, some may have difficulty sleeping. But many of them will go on ultimately to be able to bounce back,” she said.
Some of the children, Saltz said, may develop post-traumatic stress disorder. “The problem, is we don’t know which ones,” she said.
“Some kids are biologically predisposed to being anxious. They may go on to be more symptomatic," she said. One clue is past experience. “Kids who had trauma already in the past, they are more likely to go on and have more post-traumatic stress symptoms,” she said.
Survivor trauma – an unease commonly felt by people who barely escape a bloody event that claims other lives – likely will be seen in some of the third-graders and fourth graders who were at the school Friday, said Dr. Jeff Dolgan, chief psychologist at Children's Hospital in Denver.
After the Columbine massacre in 1999, Dolgan and his team worked with mental health experts in Jefferson County, Colo. to help the questions of local parents, advising what to say to their kids about the school shootings, and what not to say.
“Later on, I think the third and fourth graders will ask: Why are they alive and their friends are dead? That's an existential question. How do you explain that to kids? It's such a random event,” Dolgan said.
How do you help kids wrap their minds around such an unanswerable question?
"You tell them there was a shooter who should not have been there in the first place, who was obviously having terrible problems. If those survivors ducked down then they were saved. If the teacher pulled them down, they were saved. And others were not," Dolgan said.
Younger students don’t have the emotional or psychological means to fully understand death and, consequently, aren’t generally afflicted with so-called survivor’s guilt, he added.
Saltz notes that good, old-fashioned comfort can go a long way to healing, Saltz said. “The community pulling together and giving the kids a sense of safety going forward,” she said. “Those that have a better support system, whose families will be able to get more help for any symptoms they do have in the short term.”
Psychologist and TODAY contributor Robi Ludwig said the coming winter break from school may be helpful. “I think the good thing here is we have a lot of vacation time coming up,” Ludwig said.
“I think everybody is still in shock and a bit in denial and that’s not such a bad thing because the body has a way of numbing itself so that it is not overwhelmed and overstimulated with scary news, with horrific news,” Ludwig said. “Then at a later point, you can access those feelings under less threatening circumstances.”
And by all means, holiday preparations should continue.
“If there’s ever a time to go Christmas shopping, it’s this weekend,” said Koplewicz. “Or go to church, or exercise.”
Keeping kids home may feel comforting to worried parents, but it will send the wrong message that they are not safe, the experts agreed.
“On Monday, you put them on the school bus,” Koplewicz said. “If your kid says ‘no, no, no,” then it is all right to say ‘Ok, today I’ll drive you to school’. But you make sure they go to school.”
Sandy Hook Elementary will have to offer grief counseling, Ludwig says. “Some of the kids who survived will know those kids who are no longer there,” she said. “That could raise survivor guilt.”
It will be much, much harder for the parents, Saltz says.
“This is the worst,” she said. “This is the worst nightmare. There is not a magic psychiatric pill for this kind of horrible trauma.”
Again, community will help.
“There is the importance of the community support over what is going to be a long haul. The parents of these children, I would say, are at risk for at least the first year,” Saltz said. “When you lose a child it is the most devastating thing. Those parents, they really need some help, psychiatric, and otherwise.”
Now parents are going to be in the shock phase, Saltz said: “This is going to seem unreal. It may be some time before they even enter the grief phase.”
Neighbors can help protect the parents while they sort through their trauma. “It will be about trying to make the town feel as safe as possible,” Ludwig said. "It is about providing a safe place to grieve and have feelings. There are things beyond our control that don’t make any sense.”
And there will ultimately be no real explanation for what happened. “You can’t make sense of it because there is not going to be any sense to be made of it,” Saltz said. “This is a lot of loss for one community. Everyone is going to need to emotionally pitch in.”
NBC correspondent Bill Briggs contributed to this report.