Category: Left

Children’s Health After 9/11: The Physical Effects

Dr. Sandro Cinti is Clinical Associate Professor of Internal Medicine and Infectious Diseases at the University of Michigan Medical School and the Veteran’s Affairs Ann Arbor Health System. A specialist in infectious diseases, he has had a long-standing involvement in preparations at the national, state and local level for responding to biodisasters such as pandemic influenza and bioterrorism.

I am going to talk about is the physical health of children affected by 9/11.

The fact of the matter as we all know is that children are very versatile.  Children heal well. That’s why it’s no accident that I’m a panel of one. I called people at Mount Sinai, I called people at Columbia, and they said, we’d love to come but there isn’t anything to say. I was given some literature on the physical health of children and the things that can occur in a situation like the aftermath of 9/11, such as exposure to the potential irritants that were released when the buildings came down. I talked to another of the speakers here who was several miles away and he said paper was falling in that part of the city, paper from the offices all that distance away. You had all those irritants, wood, concrete, plastic, paper, alkaline dust, dust clouds containing heavy metals. You can imagine all this stuff, all this equipment in these huge buildings, the biggest buildings in the world, melting, and then being part of a big mass of gas and dust that is flowing outward.

So, as to the physical effects: an immediate effect of the dust is reactive airway disease. Then there are reactions that occur later, diseases such as inflammatory lung disease or sarcoidosis. The lungs over time degenerate and the immune response turns on the patient’s own body and causes a continued inflammatory state. Luckily, children don’t have a lot of these long-lasting problems.  They heal well.  They do have problems with asthma but some of these other illnesses they just don’t get.

So kids do pretty well, but I will talk about a few of the aspects here. For example, indoor dust is more dangerous — I didn’t know this but it is protected from rain, so it retains its alkalinity. Dust indoors has a higher alkalinity than anything on the outside because rain washes those substances off, and alkalinity can cause a lot more damage.  Smoke and other gaseous materials can also cause problems. You have asbestos, you have lead, volatile organic compounds, dioxins. They cause problems by inhalation, or by transdermal absorption.

There are some longer-term effects that include cancer — we probably still don’t know the incidence.  Are we going to suddenly start seeing kids who were born at that time, or who were young at that time, developing unusual cancers, particularly lung cancer (e.g. mesotheliomas, from asbestos exposure)? That still may be down the line.

The post-9/11 physical health effects in adults, particularly fire fighters and police, are clear. These include asthma, rhinitis and sinusitis, gastroesophageal reflux disease (GERD), and other pulmonary diseases including sarcoidosis and interstitial fibrosis. It’s less clear but there is a potential for future cancers. But effects in adults  don’t necessarily reflect what you’ll find in children. How do you assess children who were exposed, or potentially exposed?

Although as you know children heal well, there are certain problems.  Their living zones and their breathing zones are closer to the ground, so when there is exposure to things that are heavy — gases that are heavy, metals that are heavy — adults are going to have less problems with those.  Kids spend more time in a single place, so if that place happens to have a high concentration of poisons the child is going to be more susceptible.  Children consume more food and water per unit of weight and so they may ingest more toxin if that happens to be in the environment. Their skin has a greater surface relative to body volume, which leads to increased absorption through the skin if there are toxins in the air. You can think of kids as being sponges that are much more absorbent than adults, and so they might get higher doses of poisons in their body. Again, you have to take that with the other side, the reasons that kids do remarkably well. Their kidneys work better than ours, their livers work better than ours, and these are the organs that eventually clear these poisons.

The World Trade Center Health Registry looked at 3,184 kids who were less than 18 years old on 9/11 and they studied these kids for two to three years. [1] Two to three years afterwards they looked at five-year-olds because it appeared that kids five years and younger really were at higher risk than older kids. They found that kids five years and under had twice as much newly diagnosed asthma as the same age kids on an average in other parts of the northeast United States. Kids older than that did not have as many problems.  One thing about kids is that they are small, so they have small airways too. Because their airways are smaller a minor inflammatory response may cause increased symptoms in a kid that age. So they may just present to the physicians more.

The children at the sites also had a higher rates of sinus problems and heartburn.  The heartburn may be related to stress. The sinus problems make sense because again that’s an airway associated problem.

You have to be aware that a lot of these results are based on questionnaires.  They are not actually testing all these kids for asthma; they are asking the parents, reporting parents saying yes or no on whether the kids have asthma or not.  In some cases they may think their kid has asthma, but the doctor may not think so.  So you have to take some of this with a grain of salt, but these were large studies. They looked at more than 3,000 kids.  And there is some other evidence, such as a study of children in Chinatown that also showed a greater increase in asthma after 9/11 among those children who were closer to the site.

Finally, there are some studies that have looked at women who were pregnant at the time and were exposed to conditions after the 9/11 disaster. These are smaller studies because they could not capture a lot of women who were pregnant at the time of 9/11 and who were in the area.  It was really difficult to find these women.  They sent out fliers to OB-GYNs, they put out requests in newspapers to try and find those patients. Some results, but not all, showed that post-9/11 exposure did have an association with lower birth weight, intrauterine growth restriction and shorter length at delivery.

The good news is that not all those adverse effects showed up in the largest of those studies. [2] That study had a sample of 187 women; women who were pregnant and were in one of the five zones that were considered to have high rates of exposure. The women had been in those high exposure zones within three weeks of the 9/11 attacks  They were compared to 2,300 pregnant women on the upper East Side who never were in these zones at any point. The World Trade Center cohort had a twofold increase in intrauterine growth restriction. An intrauterine growth restriction is when they measure the size of the baby as it goes through gestation.  Interestingly, there was no difference in the mean birth weight, so these babies ended up at some point in utero catching up to be the same weight. So maybe it didn’t really matter that much.  There was no increased in preterm birth, no increase in low birth rate, no differences in mean birth weight, or mean gestational age.  They were all born essentially when they should have been born.

There can be problems with some of these studies. A sample of 187 is not that many; 187 women do not a prospective randomized control study make. And when you compare a group that had an exposure to a control group, those two groups should be the same in every way except the exposure, but unfortunately they could not achieve that in this one study because the women who were in those exposure zones were older, 34.6 years old on average, compared to 32.4 in the control group. That may not look like a significant gap in age, but for the study purposes it’s considered a significant difference. Maybe it did make some difference in the results, or somebody might criticize the study and say it is not because they were exposed that these kids had more problems, it is because these women were older.

So there is that question about this particular study, but in general, it seems to be good news. There were some problems but it looks to me like these women generally had pretty healthy babies. Even though there was the one finding that there was increased risk of intrauterine growth restriction, it did not register as a difference when the kids were born. When the babies were eventually born they did fine.


* See Thomas PA, Brackbill R, Thalji L, et al. Respiratory and other health effects reported in children exposed to the World Trade Center disaster of 11 September 2001. Environ Health Perspect. 2008;116(10): 1383-1390. Available online at;jsessionid=493F752891CF43CABA69EB3B299025D1?articleURI=info%3Adoi%2F10.1289%2Fehp.11205

See also City Health Information, July 2009 The NewYork City Department of Health and Mental Hygiene Vol. 28(4):29-40;

The World Trade Center (WTC) Health Registry  ( was established in 2002 by the federal Agency for Toxic Substances and Disease Registry and the New York City Health Department to monitor the health of people directly exposed to the WTC disaster. In collaboration with the National Institute for Occupational Safety and Health, the WTC Health Registry plans a long-term follow-up, tracking changes in physical and mental health in that population over the next 20 years.


Berkowitz GS, Wolff MS, Janevic TM, Holzman IR,Yehuda R, Landrigan PJ. The World Trade Center disaster and intrauterine growth restriction. JAMA. 2003;290(5):595-596.

See also Lederman SA, Rauh V,Weiss L, et al. The effects of the World Trade Center event on birth outcomes among term deliveries at three Lower Manhattan hospitals. Environ Health Perspect. 2004;112(4):1772-1778, and Eskenazi B, Marks AR, Catalano R, Bruckner T, Toniolo PG. Low birthweight in New York City and upstate New York following the events of September 11th. Hum Reprod. 2007;22(11):3013-3020



Children in Grief: A Close-Up View

Donna Friedman is an adjunct associate professor at the New York University School of Social Work and deputy executive director of the Riverdale Mental Health Association, an outpatient mental health clinic in New York City.  She has been a therapist and researcher in the Mothers, Infants, and Young Children of September 11 program.

I have been working with families of 9/11 for the last decade.

I was in New York on 9/11. I remember the day. My daughter was watching Barney on the television.  I lived on the 22nd floor.  I could see the towers from my balcony.  I, sadly, had just learned that my mother was gravely ill, I was talking to a friend and she said, oh my gosh, did you hear that a plane just crashed into the World Trade Center?  I went out on the balcony, I could see the smoke and what ensued that day still gives me goose bumps.

I had to go to work that day. My agency is in Yonkers, just over the line from the Bronx and there was a small police office there. And standing outside for the first time ever in my life I saw a police officer with a machine gun.  And we looked at each other, this young man and I, and I said, “This is really bad.”

My husband was working in a hospital.  What they did was they cleared out anybody who was well, thinking that they were going to get hundreds and hundreds of patients to come in and treat. And nobody came.  It was devastating. They waited and waited and waited and there were no patients.

At the time there was a group of us who were working with infants and parents and doing research and clinical work with them. Dr. Beatrice Beebe, who is a renowned infant researcher, and Dr. Anni Bergman, who wrote The Psychological Birth of the Infant with Margaret Mahler, were friends and colleagues. They bumped into each other on 9/11 and said, “oh my Gosh, what can we do?” And what came out of that chance meeting was the Mothers, Infants and Young Children of September 11 Primary Prevention project.

The project for mothers, infants and young children of September 11 represents ten years of involvement of a group of eight core therapists working originally with approximately 40 families who suffered the loss of husbands and fathers on September 11. The therapists are Beatrice Beebe, Phyllis Cohen, Anni Bergman, Sally Moskowitz, Rita Reiswig, Suzi Tortora, Mark Sossin and myself. The group specializes in adult, child, mother, infant and family treatment as well as nonverbal communication. And I won’t go into this in detail, but it was difficult and continues to be difficult for us to get funding to do this.  We have been doing this for ten years with basically no funding.

We focused our efforts on the families of women who were pregnant when they were widowed or women who were widowed with an infant born in the previous year. We sought out these families, which is not typical in a therapeutic situation.  We had to call them, we had to write letters, we had to remind them over and over again because they were so traumatized.  They would tell us the night before that they were coming, and then they would forget.  We sought out these families offering support groups for the mothers and their infants and young children in the mother’s own neighborhoods. Most of these people did not live in Manhattan.  They lived in Long Island, they lived in New Jersey, they lived in Staten Island, they lived in Westchester.

We brought the families to mother-child filming sessions at Columbia University, New York State Psychiatric Institute. We have been filming these families for ten years.  In 2011, our project continues to provide pro bono services for these mothers who lost their husbands, for their infants who are now approximately ten years old and for the siblings of these children. Some of us also continued to do individual treatment with them.  So I have a 10-year-old and an 11-year-old, a mother and I treated one of the adolescents who is now in college.

The degree to which this trauma continues to impact these families is not generally well understood.  Recovery from a trauma such as this is a long term process.  However, there is no one picture of the effects of this trauma.  The families with whom we have worked experienced and coped with the effects of this trauma in unique and personal ways and despite the magnitude of the ongoing suffering in these families there is also remarkable resilience and growth.

We started our pro bono clinical work in April of 2002. The project was conceived from the outset as primarily a clinical endeavor but with a research component.  At this point we have not yet conducted the analysis of all of the data that we have — ten years of video footage and also some assessments that have been done of these families.

An unexpected benefit of the project has been the effect the work has had on all involved.  The mothers and children have described to us how that they have been helped in manifest ways by our clinical interventions.  But as we stand now at the ten-year mark and reflect back on the progress of the work, another group of people touched and healed by the project has surfaced: the rest of us. We sought to empower and support those most directly and tragically touched by the attacks yet we were all affected in some way by the tragedy and healed by our involvement in the project.

Now I will talk about the group that I facilitated with Anni Bergman and Sally Moskowitz.  Our hope at the inception was to help prevent the effects of trauma and loss from disrupting the connections and relationships among the mothers, their infants and growing children.  Many groups were available to mothers or somewhat older children affected by the World Trade Center attacks but none that we knew of focused on the babies and their relationships with their mothers.

We wanted the mothers and children to be able to talk with each other as freely and naturally as possible as well as to have time with the therapist.  We designated an area where the older children could play with me and a separate room for the mothers and babies to be with Anni and Sally.  The rooms were within easy reach of each other so that the children could reconnect with their mothers as they needed.  The mothers could talk with one another, with their children and with us as they wanted.  We hoped the setting would feel as natural as possible despite the incredibly unnatural context.  We were a multigenerational group of therapists working with two generations of patients.  Anni was the mothers’ grandmothers’ age.  Sally was the mothers’ mothers’ age, and I was their contemporary.  The children and babies were a fourth generation.

In a short time, as much by circumstance as by design, the meetings took on somewhat of a feeling of a family gathering.  We met in the parlor floor of Anni’s brownstone home, rather than in her office.  We provided muffins, strawberries, juice and tea at the dining room table around which we all gathered as the mothers and children arrived.  We mingled, talked and ate for a while.  The atmosphere at least to us came to feel familial and to a degree normal.  Women talked about the events of the week, commented on how cute the children looked or on one baby’s new developmental achievement.  Once everyone had arrived and had a bite to eat we settled in the living room to talk, the older children milling around and playing with me and the babies nestling on the mothers’ laps or settled in infant seats.

Early on the therapists noticed the enormous importance of this casual format and atmosphere.  We worked to enhance it and to feel comfortable with it despite its considerable difference from usual setting of the work we do with patients.  We noticed and remarked with some humor and perplexity that we spent a lot of time, the therapists did, talking with each other about the strawberries and the muffins, making certain they were provided and finding the best ones.

The meaning the food and the casual atmosphere held for us at that time was not clear, but in retrospect we see it was important to provide some feeling of normality and pleasure.  We wanted to help the mothers and children feel that the pleasurable details and comforts of life were recoverable and available to them in the midst of their anguish.  If they could experience it a bit now, it might help them find a way back to more later without quite realizing it. We tried to be a link to normality, talking with the mothers about food, clothing, schools, and activities for the older children, trying to contain and stem the panic and dread.  The focus on normality was an important link for us as well.  We and our families were also New Yorkers, part of the attacked community, frightened and uncertain about our future safety.  We too needed to hold on tightly to what felt like familial customs and comforts.  This atmosphere was the backdrop against which the mothers talked about what seemed like unspeakable events, thoughts and feelings.

Sometimes during that arrival gathering a mother might quietly mention a new circumstance, and later in the actual group session, if the mother did not bring it up again, one of us might ask about it.  Talking about it ahead of time while milling around the muffins and strawberries seemed to be a way of testing the waters. So much of what the mothers experienced and wanted to speak about had been treated as unspeakable by many in their families and lives.  Other people didn’t want to know the details, or told them not to dwell on such painful subjects. Often people were mourning and unavailable themselves or simply denied and dismissed their experiences, saying time or God would heal their wounds and they would move on.  But we found the mothers needed to talk about and process the horrific events and to discuss what had occurred and was still occurring.  The themes the mothers brought up in the group are discussed more fully in articles that we have written for a special issue of the Journal of Infant, Child, and Adolescent Psychotherapy that is going to be published in September.

Themes include the mothers’ states of disbelief, denial and dissociation immediately following the World Trade Center attacks; their attempts to find their husbands whom they assumed must be alive and hurt; the gradual realization that the buildings had been incinerated; the uncovering of some bodies and body parts; the missing bodies; the funerals; the lonely and anguished births of the babies; rifts with or help from families, in-laws and friends; feelings of envy, disappointment, overwhelming fatigue and sadness; and fears about their children’s futures.

I am going to talk about two siblings who I worked with who were the older siblings of a post-9/11 baby.  Some details of their identity have been disguised to assure that the family is not recognizable, but the account of what happened is real.

Elly and Sue came to our group with their mother and baby sister who was born shortly after September 11. They were 2-1/2 and 3-1/2 at that time. Their father was killed in the World Trade Center and like the other mothers in this project, their mother was faced with mourning the loss of her husband while caring for a newborn and two preschoolers.  The preschool years are a critical stage in early psychological development.  When all goes reasonably well, a child is launched into the school years with confidence and a strong sense of self. Having a sibling close in age also brings with it a range of both positive and negative possibilities.  The birth of an additional sibling before the age of 3 has its own special challenges.  Add to this the tragic death of one’s father and there is the potential for a developmental storm.

I will discuss our work with these two preschool aged siblings who were faced with all these challenges simultaneously.

In their early treatment the siblings spent a lot of time taking care of baby dolls in the play room.  They fed and bathed the dolls.  The dolls always needed taking care of.  In addition pregnancy and birth were central themes in the play.  The siblings, particularly Elly, pretended that I was pregnant.  She would stuff my belly with pillows and reenact a delivery.  This was a very serious matter that required attention and concern.  Both siblings were involved in the process.  Their own births represented the time when their father was still alive.  Elly imagined his delight upon their arrival.  The birth of their baby sister however was associated with his death.

At one point when we were playing this game, their mother came into the room.  Elly, in particular, did not want her to see what we were playing.  She firmly instructed her mother to leave.  Perhaps she wanted to protect her mother from remembering the past and becoming sad.  In protecting her, she would be protecting herself.

Another early play was hide and seek.  Sue found that the way the shower doors in the bathroom opened up were like an elevator.  Sue put herself in the shower as if she were in an elevator.  In the game she was in the elevator and she pretended to slip behind as if being caught inside the elevator shaft.  During this time the mother had expressed concerns about what she had told her daughters about their father’s death and also how much they had picked up from what they had heard.  We did not know if the children knew about people being caught in an elevator during the World Trade Center attacks or if they imagined an elevator could have saved their father.

In several of the early sessions the theme of building and maintaining a structure was initiated by Elly, who built what she referred to as a tower out of blocks.  This tower was very high and she placed it precariously on the coffee table in front of us.  In one point in the session she asked me to read a book that she had enjoyed. We sat on the couch facing the tower. She wanted to sit very close to me.  Her sister quickly wanted to join in on this intimate moment.  I read the book with the girls.  At one point Elly looked up at me and said, “I love you.”  Her comment surprised me because it was early in our meetings. I began to feel that in erecting the tower, Elly felt her daddy was alive and she had arranged for herself and her sister to be happy with mommy reading to them.  I was the transferential mother available to play with them and feed them and nurture them.

In one session, Elly took a plastic toy piece and put it in front of the tower.  I asked her what it was, and she replied that it was an elevator.  She then took a little girl figurine and made it climb up to the top of the tower.  I asked her what the little girl was doing and she said she was looking to see if the tower would stay up.  She was very focused on keeping this tower up.  I wondered if this was the way of her keeping her father alive and undoing what had happened because the tower was so high, it kept falling down.  Her sister Sue knocked it over once on purpose and this made her very upset.  Another time Sue asked if she could knock it down, and Elly pleaded, “Please, no.”  And at this point I think Sue realized how important it was to Elly and respected her request. This was characteristic of their relationship.  Many times in the play they were quite supportive of one another.

A couple of times Sue bumped into the tower accidentally and Elly soberly asked Sue to fix it.  Then one time Elly herself bumped into the table by mistake and the whole tower crashed to the floor.  She got very upset and she looked to me and asked, “Why, why did it fall?”  I felt that she was asking me at that moment, why the real towers had fallen.  Upon reflection, I felt in that moment that perhaps what the mothers had felt — what do I tell them, how can I possibly explain?

Sue quickly interjected her own thoughts about the real towers falling.  They began to discuss what they knew about the events that occurred on September 11.  Elly explained that the way it was hit by the plane was what made the tower fall. She then put the tower back together and left it there.

The next thing Elly did was to take a cow and a dog and make them fall.  Now this was the other thing.  There were all these images of people jumping and falling, she wanted to save them but she could not save them by herself.  She had to use a string.  She asked me to tie it to them and hoist them up slowly.  It was not working well and they were slipping out of the string.  She was frustrated and I acknowledged this.  This was toward the end of the session and when it was time to go she took the harness that she had created, with the cow, and she ceremoniously put them up on the shelf and sadly said goodbye.

Sue often liked to play with the construction truck that made a sound like a real truck when it backed up.  Sue made the sound with the truck over and over again.  At one point she lost the truck driver in the play and was very distressed.  I was reminded of the trucks that were removing the debris from the World Trade Center disaster site. I later realized that every week on their way to our group meetings they drove right past the site of the World Trade Center where the trucks were picking up the debris.

In another session, Sue focused on a basket of figurines, many of which had missing parts. It was in Anni’s playroom and there were lot of old toys and some of them were broken.  And Sue asked, “Where is the head, where is the foot?”  She then took little plastic tools and tried to fix the toys. The play alternated between fixing and breaking the figurines.  Sue was interested in inspecting a figurine whose ear had fallen off.  We discussed how to fix it.  In the previous session we had looked at a puppet that didn’t have a nose and together we made one.  Elly later wanted to inspect the puppet and found that the nose was still there.  This was very important to her.  The repair had been maintained.  Elly tended to be much more verbal than Sue and was more focused on the repair.  Sue was more focused on the actual objects, their falling apart and breaking, on their vulnerability.

Sue needed to touch base more with her mother than Elly and this is probably due to the fact that when Sue was 18 months old she had a heart condition and she had surgery, so she was a little bit more vulnerable.  She often returned to her mother during the session.  She had a difficult time being separated from her.  She often needed to see that everyone was still there — this is typical of these children in general.  Then she would come back to the play room on her own.  When the group was first organized, I would go and check on her but eventually that was not necessary as she became more secure.

The siblings were very attuned to one another, this seems to have served them well as they grieved the loss of their father.  They willingly shared the muffins that we fed them and truly seemed to enjoy one another.  They played with one another and they rarely fought which was not typical of children that close in age.  They were sensitive to each other’s space and mindful of each other’s needs in a strikingly mature way, almost too mature.

And perhaps it was because they knew that their mother needed them to demand very little.  Six months after we started meeting, close to the one-year anniversary of September 11, Elly and Sue had a birthday celebration for me, although it was not my birthday.  Elly made a cake and imbued it with special powers.  She used it to destroy and fix things.  I wondered if it was their way of remembering the anniversary of September 11, which would be in six days, and also the impending birthday of their baby sister who had been born shortly after 9/11.  She made the cake with red bricks, it was a strawberry cake.  Each week we had served strawberries, so it was one of the treats for them.  We ate the pretend cake together.  The tower which Elly had rebuilt each week stood before us.

My overall impression of the older siblings of the babies who were in utero on September 11, was that they had a striking compassion for each other.  They seemed to understand that they were all in the same vulnerable position of having lost their daddies and having mommies who were very sad. For example, one of the therapists, Sally, was working with the mothers and babies and observed Elly come into the room that day, while she was making the strawberry cake. One of the babies was playing with a whisk on the floor, and Elly wanted to use it to make her cake.  The therapist noted that Elly was clever and sensitive in how she took the whisk away from the baby.  When the baby looked at something else, Elly was looking at him and looking at the whisk, she watched to see if he became distressed when she took the whisk.  When he looked at something else, she slipped the whisk away and then kept it hidden, still watching him closely.  When he was distracted and not upset, she slipped away and rejoined the play group.

The children were supported throughout the time we worked together to express all of their feelings, good, bad, angry or sad, both verbally and symbolically in their play.  Throughout their sessions I validated their feelings.  In each session they played out conflicts related to the loss of their father and they played out the effect that this loss had on their mother.

They were able to use me transferentially as a good enough mother.  I was someone who could tolerate the loss whereas their mother at this early point could not, and the children were aware of that.  I could hold everything together, like the building that we constructed again and again.  Facilitating play involving the birth and caring of babies by providing dolls, bottles, and diapers was crucial.  This gave the siblings the opportunity to explore their own births, a time when their father was still alive, as well as the birth of their baby sibling which was fraught with conflict because it was associated with the loss of their father.  Supporting the themes of hide and seek was an opportunity for the children to be in control, to find the loss of person and to be found.  The initial working through reflected their need to have some understanding of where their daddy was, what had happened to him and to have mastery over locating him.  They represented this when they talked about him watching over them.

Helping them to play at fixing broken objects and games of repair was important.  It was a need to go back to a time when the object was not lost.  This was a period of undoing, during which the entire event was undone.  The tower was erected and watched over so that it would remain intact.  The anniversary of the loss of the father was acknowledged in the birthday party.

Over the past decade, I have worked on and off with their mother, often serving as a sounding board or sometimes a substitute for the lost  father.  Elly and Sue are currently doing very well socially, emotionally, and academically.  They continue to express a desire for their father.  Their mother has not remarried.  Elly often used to state when she was a little bit younger that she wanted her mother to find a husband so she wouldn’t be so lonely.  But now as she is approaching adolescence she is not so sure.

The siblings have had an opportunity to get to know their father and who he was as a person because their mother set up a charity which involved the children and family and friends every year.  Friends and family gather annually to celebrate his memory, to raise money for a particular health issues that had affected Sue when she was an infant, and Elly and Sue speak of that event as the most important day of the year for them.  They were asked once in school what’s the most important day and a lot of kids said, Christmas or their birthday, but to them that was the most important day of the year.

Elly and Sue’s ability and willingness to use me, each other and the play to work through the loss of their father, the birth of their sister and their mother’s grief made me feel hopeful for them.

Working with these children has shown us their incredible capacity to face the trauma.  Their amazing ability to master their fears, sadness, and loss demonstrates a remarkable resilience.  One other thing that I want to add was that with other children that I have been working with, a 10-year-old and an 11-year-old and an adolescent, I have learned that with each new developmental stage the loss of the father and the experience of 9/11 becomes different. There are new cognitive abilities to understand what happened.  September 11 and the World Trade Center attacks get discussed as a part of history in school and they are part of that history but it is part of their personal history too.

We are helping these families and will continue to help them.  It is our intention that we are all in it for life and being the youngest of the group, I will probably be the grandmother at some point.  It has been a remarkable experience to do this longitudinally.  We’ve struggled with trying to get funding to analyze what we have.  It has been difficult but there is a wealth of information to be uncovered. I hope you will all take a look at the special journal issue which eventually will become a book entitled Mothers, Infants and Young Children of September 11, 2001, A Primary Prevention Project by Dr. Beatrice Beebe and rest of our colleagues.