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Neha Pathak, MD, FACP, DipABLM: Welcome to the WebMD Health Discovered podcast. I'm Dr Neha Pathak, WebMD's chief physician editor for health and lifestyle medicine. For many parents, dropping their child off at school comes with the expectation that they'll be safe. But in many schools throughout the United States, safety concerns, anything from lockdown drills to real threats, are now a common experience of childhood.

Today, we're talking about school safety concerns, what to do about them, and how to talk to your children about the impact that these experiences can have on their mental and emotional health. We'll also explore warning signs, common reactions children might have to these drills and real-life threats, as well as how to support your child in processing their experiences.

First, let me introduce my guest, Dr Adjoa Smalls-Mantey. Dr Smalls-Mantey is a physician scientist, writer, media consultant, and organizational leader. She currently practices emergency psychiatry in New York City and is assistant clinical professor of psychiatry at Columbia University Irving Medical Center.

She's the immediate past president of the New York County Psychiatric Society and co-author of the award-winning children's book, "Anjali the Brave: All About Vaccines." In 2024, she was appointed by the HHS secretary to the Interdepartmental Serious Mental Illness Coordinating Committee, which advises Congress on the treatment of serious mental illness.

Dr Smalls-Mantey speaks and writes on mental health, public health, and wellness, with numerous appearances on ABC News and Fox 5 DC. Welcome to the WebMD Health Discovered podcast.

Adjoa Smalls-Mantey, MD: Thank you so much for having me.

Pathak: Before we jump into our topic for today, I'd love to ask about your own personal health discovery, whether it's in your research or your work with patients. What questions or issues brought you to the work that you're doing today?

Smalls-Mantey: When I decided to become a psychiatrist, it was because in my grad school training, I was doing HIV immunology research. I started noticing a lot of people were having mental health issues, and a lot of mental illnesses start to pop up, like the serious ones, when you're in your 20s. So I started to become aware of people developing schizophrenia, having very serious depression, and it was hard to see people I know struggle in that manner.

So it piqued my interest in psychiatry, and then when I was in my third and fourth year of medical school and had a chance to do my psychiatry rotations, I really loved the work that we were able to do with patients on those units, and it felt like a home.

Pathak: Thank you so much for sharing your journey to your current work, and this really helps me start the conversation around our current topic, which is that we recognize that young kids, our children, are really suffering. There's a lot of mental health concerns that I'm seeing in the young people that I come into contact with.

And one of the big things that I often hear from parents, from students, is that they're really concerned and scared sometimes around school safety. They're worried about incidents that are happening in their schools, incidents that they hear about, or even sometimes some of these drills to prepare for some of the risks in schools today.

So what are the most common school safety concerns and incidents happening in schools that you're hearing about?

Smalls-Mantey: So if you're looking at the numbers, the more common incidences regarding safety are your individual instances of fighting or assaults, so a kid beating someone up on the playground, things like that, or even theft. Maybe also some drugs, and especially with the older children. And then a lot of parents bring up to me and how I see a lot of children in the emergency room as a result of cyberbullying as well.

Bullying in general, but cyberbullying especially. A lot of times we're thinking about school shootings because those are the high-profile events that make the news, but those are still relatively rare in terms of all the incidents that happen. It's definitely a very unique problem to America, the United States, but it's not the most common thing that happens to every child every day at every school.

But you can definitely find someone that's been in a fight or had something stolen or been bullied.

Pathak: Yeah, this really resonates with me, and one of the reasons we really wanted to talk about this is just a few months ago, as school was coming to a close, I have one daughter in high school and another daughter in kindergarten. And so, the shocking thing for me was my high schooler was texting me from someone else's phone because they were under lockdown because a student had approached with a backpack that they wouldn't allow to be opened.

And at that very same moment, I was in a kindergarten class with all of these innocent babies just happily playing and enjoying their time in school. And she really struggled with that because there are strict rules around having a phone on her, so she had to borrow it from someone who had kind of broken the rules and had the phone out.

And she was just worried about something like this happening again, and how would she get in touch with me. What do you see in terms of common emotional reactions from children after experiencing a threat like that, whether it's real, a weapon found at school, a fight, as you mentioned, or even a lockdown drill?

Smalls-Mantey: Definitely, a drill can be scary, and I didn't mention earlier, but you also have swatting where people are trying to just create that fear by calling in a threat even when there isn't one. But when you have that, there's the initial fear in that situation where your heart is racing, you might start to cry.

You're just getting heightened because your body is in a fight-or-flight mode. But then once that passes and you're also processing, okay, was this a real threat or not? Feeling comfortable returning back to that environment is something that you're really trying to process as an older teenager.

And then, as a parent, you're also trying to help your child process as well. I would say that fear is the most common thing, but then in terms of other visceral reactions, a younger kid might later on say that they are having a tummy ache or a headache, trying to express that they're not feeling well.

It's often somaticized. Or children might start to have a panic attack, and sometimes in younger children, they might even regress and maybe lose control of their bladder and m- they start wetting themselves a little bit more. So it can manifest in a lot of different ways. Sometimes people might be just too confused to understand, maybe for a very young child or someone that has a, that doesn't have that intellectual capacity to really understand what's going on. And then I think the other big thing that we have to think about is anger. People might be mad that someone is intentionally trying to invoke fear or that somebody did actually try to do something and maybe it wasn't caught and maybe other people said, "We saw the signs ahead of this happening."

And then other emotions that might be maybe people trying to calm themselves is they might try to make light of it, so that they're not that might be one way that people process it or a way that they're trying to almost numb the feelings as well.

Pathak: Now, that's a really helpful explanation around all of the various emotions that someone might be feeling. As you mentioned, sometimes parents themselves are processing their own emotions. What's the best way for a parent to start a conversation with their child after a frightening school event without increasing the fear, the panic, the anger, the emotions that you described?

Smalls-Mantey: A parent can first of all say, "Hey, what have you heard about what happened today?" We should be checking in with our children daily, but especially after an event like this happens, you want to mention it even to the very youngest child, three years old, four years old, if they're involved, your older teenager.

Just ask them what they know. Try to get their understanding of the event, and then if there's any misinformation that they are conveying, you want to correct it, but don't... You don't have to give too many details. You give the details based on their age and what's appropriate for their understanding.

And you also have to know your child, so if you know that knowing too much is going to make them even more nervous, then there might be certain details that you might want to withhold, especially if there are things concerning deaths. Maybe people know the people that already passed initially. Make sure that you have the resources and the emotional strength yourself to support your child if even more difficult information is coming afterwards.

And then the next thing after finding out what they know and correcting any misinformation is validating whatever feelings that the child is having because a lot is going to come up, some of the emotions that we described, and all of those are valid, and you just want to help them know that you're here to help them process that.

Pathak: That's really helpful, and I think you bring up a very important point around the tension between being really honest about the threats that your children may face in school, but then also using appropriate language depending on your individual child and just what their experience with the incident may have been.

So how do you sort of counsel parents to think about that tension between those two, wanting to be honest versus wanting to be protective?

Smalls-Mantey: It depends on the age of the child. So, for our younger kids that are elementary school age or younger, you want to understand what they know, but it's really important for you to provide reassurance to them that they're okay, and they may not be able to handle all of the nitty-gritty details. By the time a child is in middle school, they're talking among their peers about what has happened, and they're gonna have a little bit more concern about how they themselves can keep safe and maybe what the school is doing to keep safe.

They're more aware of the larger system issues, and if your—hopefully, your school is able to give you that information that you can pass on to your child. These are the new procedures that are going to be implemented or that have been implemented to prevent something like this from happening.

We'll definitely ask about new things when there's follow-up with our school. But that might be a conversation that's coming a few days after the event. And then, for your older teens that are in high school, you are probably starting to talk about larger societal issues beyond the details of the actual event, but more so like, "Why are people doing this? What's wrong?" And what you can actually do to prevent something like this happening. I know a lot of times it could be reporting if there had been signs that someone might do something bad. And I know right now our discussion has largely been focused on school shootings because that is a huge fear, and unfortunately, like I said, an almost unique problem to the United States.

But there are many other things, like if a child is being bullied or a peer is being bullied, or you notice someone has a problem with another area, just how you can intervene safely without yourself getting harmed as the person that might be reporting it.

Pathak: Let's pull on that thread in terms of making this a broader conversation for the older child around school violence in all of its manifestations, whether that's bullying or physical violence or all the way to school shootings. How do you sort of plant the seeds of taking action in a safe way if you're identifying a dangerous situation or a situation that could become dangerous?

Smalls-Mantey: So the very important thing is we want to recognize patterns, but we also don't want to stigmatize people as well. And one thing that we're trying to help kids develop is empathy, so they can just recognize if they're having different emotions, but also recognizing the emotions of others. So, in terms of what can you do to help people or help a child to know how they can prevent the really bad situations from happening, the data does show that a lot of times there has been a history of embarrassment or social rejection sometimes in the perpetrators of mass shootings or of violence or people that are bullies.

So helping children first identify their emotions or, even if they're feeling one way, being able to talk to their peers and to an older adult that can help them is important. And then, once you're able to name those emotions, helping people realize what to do with that emotion. So name the feeling, but then also take a break, whether that's in your interpersonal reaction with another child, another teenager.

You can tell your child, "Okay, this person hurt your feelings. Do you have to say something mean back?" Or you can just literally tell them, "You hurt my feelings," and walk away. And that will often, when reflected to the person that hurt your feelings, make them feel ashamed for doing that because a lot of times we want to think of ourselves as good for the most part, especially young children once they become seven, eight years old. So helping people name a feeling and then reflecting that back in day-to-day interactions and taking a break from a situation is very important. And then, when a child needs more support, identifying that trusted adult that they can go to and realizing you're not tattling.

It's a sign of strength to seek help, and we all need help. Even adults, when we're having issues, go and get help from our boss, someone in HR, things like that.

Pathak: What are some of the warning signs, red flags that your child or another child that you see regularly is experiencing something that goes beyond sort of processing emotions? What are some of the signs that you'd want us to look out for?

Smalls-Mantey: So, for someone being affected by a negative situation, you're going to probably see their temperament is off. Either they could be more withdrawn, they could look more sad, or they might try to deflect and act more silly and joke like something isn't wrong. That could happen. A child might have less sleep.

They might wanna avoid certain situations. That's a person that's affected by a negative thing. But when we're also thinking about warning signs of a crisis, like somebody might become violent, I want to really emphasize that there are certain behaviors that have been identified, but we don't want to stigmatize people that are having some of those behaviors.

And the most common thing is somebody might be that loner, or unfortunately, in this society, race is often—if you're the lone person of a certain background in another large minority-majority group, you can be seen as the troublemaker or someone to watch out for. So we don't want that, just being someone that's more quiet, to be a problem.

But the real warning signs are if someone starts to talk about, "I feel like I wanna just punch somebody," or, "I just wanna shoot someone when people do this," definitely that needs to be reported. Or they start idolizing people that have committed violent crimes. That needs to be reported. If they become extremely, extremely withdrawn, seem secretive, or it seems like they are hiding something, all of those are warning signs that need to immediately be brought to the attention, because sometimes these are w- the signs of a potential perpetrator crying for help.

They want someone to intervene because they're struggling and they're having a lot of hurt, and it's almost like in their mind, "I'm waiting, I'm waiting to see if somebody cares." And then they have a certain point where, "Okay, I've gotten no validation. No one cares." And so that's when they, sort of g- wild.

So recognizing those cries for help. We've heard of the very sad incidents of there was, I believe, a six-year-old child that brought a gun to school and shot their teacher, and in that case other students were aware of it. Other times when there have been the s- school shootings, people have said, "This kid is talking about this. We know they have access to these weapons." And parents are made aware a- and nothing is done. So a lot of times this doesn't happen out of the blue. So if those really just plain clear-as-day signs are out there, tell your children, "You need to report this immediately," because really, you have minutes sometimes to intervene.

And that's not stigmatizing. That is definitely keeping you safe. No one should bring a weapon into school or be threatening people with weapons.

Pathak: This is a really important, I think, critical red flags, signs. I'd love to ask you, what should a parent do if their child tells you that they feel unsafe returning to school after an incident that may have involved themselves or something that they've seen? What are, one, coping strategies or routines that we can do within the family, and then where should the parent take that information?

Smalls-Mantey: You want to really pinpoint what the child feels unsafe about. You don't have to guess. The child will tell you. So if they're feeling unsafe about just being in school in general, that's very broad, and that's, then you have to try to pinpoint a little bit more with the child what is the issue.

Is it a specific person? Is it that, you know, people are able to bring things in that shouldn't be there? Bad behavior such as bullying? What, what is the sense of the lack of security that they're experiencing? If they're worried about the school's response, you can learn about what that response is and then try to convey it back to your child.

"This is what your school is doing. Is there anything else that would help you feel more safe in your school environment?" And then when it comes to coping strategies, when something has happened, trying to get your child back to a normal routine is paramount. You really emphasizing going to school, maybe one day at home, two days at home might be appropriate if they're experiencing a lot of emotion.

But helping ease them back, even if they don't make it through the entire day, having them go back to that environment is important because the more you avoid something, the harder and harder it gets to reintegrate into that environment, and it's not only for just these school safety incidents, it's when you're experiencing other things, grief, bereavement—the, it runs the gamut.

Helping children learn how to self-regulate is also important, so grounding techniques. We talk about deep breathing, or is there something that you can hold that makes you feel better, or a picture of your family that you can have and that you look at and it reassures you. And then also having a plan of what your family will do in certain emergencies.

So growing up, my family would talk probably about once a year just casually, "All right, if there's a fire here, what are we going to do? We gotta get the pets. What are the, what exit are we taking if we're upstairs? How are we gonna get out? What exit are we gonna take if we're downstairs or in the basement?"

So talking with your child about what you would do in a school safety situation, which, of course, there are drills there, but helping them recount it with you can be more reassuring. "If this happens, we know your phone might be locked away. Is there another adult that you can talk to, a phone that you can get to?

If you just have to run somewhere, who's the first person that you're gonna call? Memorize one or two numbers where you can go." Those are important things.

Pathak: And when would you suggest that parents should consider seeking support from a pediatrician, therapist, school counselor after concerns around safety in school?

Smalls-Mantey: If someone's functioning is severely impaired, that is the definition of a mental illness, and that's when you should start to seek help. And I'm not saying that they have a mental illness, but that's how we, for every diagnosis in our DSM-V that we use to assess whether someone has a mental illness, they can have so many things going on, but if they're still able to function, we're saying it's not necessarily an illness.

So if your child, they're not able to perform well in class or in other activities, if they're really staying away from school, not returning, if they're withdrawing from their activities, don't want to hang out with friends, that is a time that you want to seek a pediatrician, a therapist, psychiatrist, school counselor.

And also, if these symptoms, even if they're low grade, but they last longer than a month, we have an acute stress reaction. That's how you respond to something that has happened, and our timeframe for that is four weeks, a month. But if it goes beyond that, that's when we start to say, "All right, this might be lasting.

We want to break that cycle before it happens." And then just trust your gut. Even if it's been a week or so, but your child really has not gotten back almost to where you think that they should be, reach out for help.

Pathak: And as we come to a close with, for our time together, you've given us so much practical advice. But in our last few minutes, I'd love for you to speak directly to our audience so that they can think through the best ways to prepare their children, talk to their children about some of the fears that they may have around these school safety incidents, and then the what they should do.

Smalls-Mantey: When speaking with the fears, have an open-ended conversation. Ask the child, how are they feeling during a time when you have, you know, a good 15, 20 minutes maybe to really talk in depth about something. And then if you want to, if you're finding very specific things that they're mentioning and you're able to help reassure them or to talk to them about, "These are the ways that your school is trying to make you safe.

These are the things I can do for you as a parent to ensure your safety," you want to reinforce that. And if there's just a level of anxiety that a child has, more stress, there are grounding techniques like simple breathing techniques. When I've worked with children, that has been very helpful for them.

One other thing I would like to mention is whenever there is a big event that has happened, especially if it's on a national level, whether it was at your school or somewhere nearby or somewhere else, it's gonna be reported on a lot with the news. So you can sit down with your child, watch the news once or twice, schedule a time to watch it together, and then turn the TV off.

You don't wanna have that going on and on in the background because that can just raise your anxiety about a certain situation. A lot of times, there aren't going to be new details in the same day, and you wanna be able to figure, filter out what information the child needs to know, especially based on their age.

And like I said earlier, of course, kids, depending on their age, have more access to information if they're middle school and teenagers talking to other people. But we really want to be mindful about how much exposure our kids are getting to certain things on social media and from their friends and, who they're talking to about something really scary.

Pathak: That is such helpful information. You've covered the gamut of everything that we can do to prepare ourselves and what we can do if our family experiences one of these incidents. So I wanna thank you so much for your time today.

Smalls-Mantey: Thank you so much.

Pathak: Thank you for being with us today. We've talked with Dr Adjoa Smalls-Mantey about school safety. My key takeaways from this discussion are, first, school safety incidents can vary from shootings that dominate the headlines to what our children might actually experience day to day, from daily bullying, fights, theft, or even cyberbullying.

Even safety drills or perceived threats can trigger real fear responses in our children, ranging from anxiety and fear to physical symptoms like headaches or stomach aches, and parents should take all of these reactions seriously.

And that leads to my second takeaway, which is that how parents respond shapes how children process fear. Bringing awareness into how we respond in stressful situations can help us help our kids. A simple place to start might be by asking questions about their experience, validating their emotions without overwhelming them with scary facts or details, and to remember that our emotional responses set the tone for how safe and supported our child feels.

And finally, it's important to always watch for changes in behavior and act early. Warning signs like disrupted sleep, social withdrawal, school avoidance, and discussing violent topics shouldn't be ignored. They're opportunities for interventions, for opening communication, and developing grounding techniques to help in moments of crisis.

So it's really critical that if our child starts to show some of these signs, that we take action and try to connect with our child, try to talk to them right away. To find out more information about Dr Adjoa Smalls-Mantey and school safety, make sure to check out our show notes. Thank you so much for listening.

Please take a moment to follow, rate, and review this podcast on your favorite listening platform. If you'd like to send me an email about topics you're interested in or questions for future guests, please send me a note at [email protected]. This is Dr Neha Pathak for the WebMD Health Discovered podcast.