The United States has been consumed by the news about the flooding in Texas that accompanied and followed Hurricane Harvey. Many have been comforted by the relatively low levels of morbidity and mortality seen so far compared with disasters such as Hurricane Katrina. However, we should resist complacency. Unfortunately, most of the potential harm from the storm is yet to come, and much of it will fall on children. Although flooding is one of the most deadly types of natural disasters in the United States and worldwide, floods’ full physical and mental health effects, particularly in the long term, are still not well understood. However, some data do exist and have been summarized in a 2012 systematic review on floods and human health.1 Overall, mortality rates nearly double in the year after floods. Increases in disease outbreaks of hepatitis E and gastrointestinal infections are common, fueled by breakdowns in sanitation services and the contamination of potable water with sewage. The incidence of injuries is usually focused on the short term, driven by wounds from contact with debris. However, physical and mental effects of floods on children can be especially acute and worthy of dedicated, long-term attention. As with adults, children with chronic conditions are at increased risk for problems after a flood.2 In a crosssectional study of more than 500 children following Hurricane Katrina, those with preexisting conditions were significantly more likely to have a disruption in care (58% vs 38%), miss a visit to a physician (49% vs 38%), or run out of medications (34% vs 8%). They were also more likely to experience other conditions that could exacerbate their health problems. For example, they were more likely to live with flood damage afterwards (20% vs 11%) and to have mold in their homes (24% vs 16%). The link between disasters and posttraumatic stress disorder is well established in children and can be long term. After Hurricane Katrina, studies showed that more than half of high school students experienced symptoms of posttraumatic stress disorder and reactive aggression more than a year after the event.3 Although most children’s symptoms improve over time, even 3 years poststorm, about 28% of children still experienced significant mental health problems, meeting the criteria for a mental health referral.4 Even pregnant women and the infants eventually born to them are at risk.5 Researchers followed up a cohort of 301 women from Baton Rouge and New Orleans, Louisiana, to examine the potential effects of Hurricane Katrina on outcomes of pregnancy and delivery. Low birth weight was much more common in women who had high hurricane exposure (14%) than women who did not (4.7%). Preterm birth was also more likely among women with high exposure (14%) compared with women without that exposure (6.3%). This difference was large enough for the researchers to advise that pregnant women may need earlier evacuation to minimize their exposure to severe weather events. Evidence shows that we still have work to do to protect children from storms’ long-term health effects. A 2017 study examined the performance of TexKat, a Hurricane Katrina Medicaid Emergency Waiver program for evacuees from Louisiana to Texas.6 TexKat provided Medicaid coverage to about 60 000 low-income parents, pregnant women, children, and people with disabilities displaced by the flooding in New Orleans. Even with extended coverage from TexKat, prescriptions filled for children with asthma fell, while those for control children (who experienced no disruptions) did not. There were decreases in health care use as well. The conclusions of the authors were that “children in the program may have received inadequate care.”6 This highlights a pervasive problem in the US health system: coverage alone does not guarantee adequate access to care. Although access limitations are not always problematic for healthy adults, they can be life altering for vulnerable children after a large natural disaster. There are many things we can and should do to further protect children from the worst consequences of floods and other disasters. The Centers for Disease Control and Prevention has a thorough guide with suggestions.7 Children take their cues from adults, so the Centers for Disease Control and Prevention advises that those engaging with children, particularly parents, guardians, and other caretakers, act calmly and confidently. This will help reassure children that they will be cared for. The Centers for Disease Control and Prevention also recommends that families develop a disaster plan that includes the assembly of necessary supplies, which would include important health records and emergency medications. In the case of Harvey, it is too late for advanced planning, but there is always a next time, and preparing children for potential issues can reassure them as well as limit adverse outcomes. Parents are the first line of defense in monitoring for declines in mental health. Young children may regress behaviorally, even reverting to bedwetting, as well as becoming more clingy. This may be caused by feelings of helplessness or a fear of separation. Older children may experience sadness, anger, or fear that disasters could reoccur. Children of any age who experience traumatic events can develop posttraumatic stress disorder. Teenagers can act out through high-risk behaviors such as alcohol or drug use. They may become withdrawn or have difficulty getting along with siblings, parents, or others. In all cases, children need to know that their feelings are valid. VIEWPOINT

中文翻译：

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儿童健康必须成为飓风哈维灾后恢复的重点

美国一直被飓风哈维伴随和随后发生的德克萨斯州洪水的消息所吞噬。与卡特里娜飓风等灾害相比，迄今为止的发病率和死亡率相对较低，这让许多人感到欣慰。但是，我们应该抵制自满。不幸的是，风暴的大部分潜在危害尚未到来，其中大部分将落在儿童身上。尽管洪水是美国和世界范围内最致命的自然灾害之一，但洪水对身心健康的全面影响，尤其是长期影响，仍未得到充分了解。然而，一些数据确实存在，并已在 2012 年关于洪水和人类健康的系统回顾中进行了总结。1 总体而言，洪水过后一年的死亡率几乎翻了一番。戊型肝炎和胃肠道感染疾病暴发的增加是常见的，这是由于卫生服务中断和饮用水被污水污染所致。受伤的发生通常集中在短期内，由接触碎片造成的伤口驱动。然而，洪水对儿童的身心影响可能特别严重，值得长期关注。与成人一样，患有慢性病的儿童在洪水后出现问题的风险增加。 2 在卡特里娜飓风之后对 500 多名儿童进行的横断面研究中，那些已有疾病的儿童更容易中断护理（58% 对38%）、错过看医生（49% 对 38%）或药物用完（34% 对 8%）。他们也更有可能经历其他可能加剧他们健康问题的情况。例如，他们更可能在事后生活在洪水灾害中（20% 对 11%），并且家中发霉（24% 对 16%）。灾难与创伤后应激障碍之间的联系在儿童中已经确立，并且可能是长期的。卡特里娜飓风过后，研究表明，超过一半的高中生在事件发生一年多后出现了创伤后应激障碍和反应性攻击的症状。3 尽管大多数儿童的症状会随着时间的推移而改善，即使在飓风过后 3 年，仍有约 28% 的儿童仍然有严重的心理健康问题，符合心理健康转诊的标准。4 即使是孕妇和他们最终生下的婴儿也有风险。5 研究人员对来自路易斯安那州巴吞鲁日和新奥尔良的 301 名妇女进行了跟踪调查，以检查卡特里娜飓风对怀孕和分娩结果的潜在影响。与没有受到飓风影响的女性 (4.7%) 相比，受飓风影响高的女性 (14%) 的低出生体重更为常见。与没有接触的女性（6.3%）相比，接触高的女性（14%）也更容易早产。这种差异足以让研究人员建议孕妇可能需要提前撤离，以尽量减少她们暴露在恶劣天气事件中的风险。有证据表明，我们仍有工作要做，以保护儿童免受风暴对健康的长期影响。2017 年的一项研究检查了 TexKat 的表现，这是一项针对从路易斯安那州到德克萨斯州的撤离人员的卡特里娜飓风医疗补助紧急豁免计划。6 TexKat 为大约 60 000 名因新奥尔良洪水而流离失所的低收入父母、孕妇、儿童和残疾人提供医疗补助。即使扩大了 TexKat 的覆盖范围，哮喘儿童的处方量也下降了，而对照儿童（没有经历过中断）的处方量没有下降。医疗保健的使用也有所减少。作者的结论是“计划中的儿童可能没有得到足够的护理。”6 这凸显了美国卫生系统中普遍存在的问题：仅覆盖面并不能保证获得足够的护理。尽管对于健康的成年人来说，访问限制并不总是有问题，但在大型自然灾害之后，它们可能会改变弱势儿童的生活。我们可以而且应该做很多事情来进一步保护儿童免受洪水和其他灾害的最严重后果。疾病控制和预防中心有一份详尽的指南和建议。 7 儿童从成年人那里得到提示，因此疾病控制和预防中心建议与儿童接触的人，尤其是父母、监护人和其他看护人，要冷静而自信地采取行动. 这将有助于让孩子放心，他们会得到照顾。疾病控制和预防中心还建议家庭制定灾难计划，其中包括必要用品的组装，其中包括重要的健康记录和紧急药物。在哈维的情况下，提前计划为时已晚，但总有下一次，为儿童做好应对潜在问题的准备可以让他们放心并减少不良后果。父母是监测心理健康状况下降的第一道防线。年幼的孩子可能会在行为上倒退，甚至恢复到尿床，以及变得更加粘人。这可能是由于无助感或害怕分离造成的。年龄较大的儿童可能会感到悲伤、愤怒或害怕灾难可能再次发生。经历过创伤性事件的任何年龄的儿童都可能患上创伤后应激障碍。青少年可以通过酒精或吸毒等高风险行为表现出来。他们可能变得孤僻或难以与兄弟姐妹、父母或其他人相处。在所有情况下，孩子都需要知道他们的感受是有效的。观点 父母是监测心理健康状况下降的第一道防线。年幼的孩子可能会在行为上倒退，甚至恢复到尿床，以及变得更加粘人。这可能是由于无助感或害怕分离造成的。年龄较大的儿童可能会感到悲伤、愤怒或害怕灾难可能再次发生。经历过创伤性事件的任何年龄的儿童都可能患上创伤后应激障碍。青少年可以通过酒精或吸毒等高风险行为表现出来。他们可能变得孤僻或难以与兄弟姐妹、父母或其他人相处。在所有情况下，孩子都需要知道他们的感受是有效的。观点 父母是监测心理健康状况下降的第一道防线。年幼的孩子可能会在行为上倒退，甚至恢复到尿床，以及变得更加粘人。这可能是由于无助感或害怕分离造成的。年龄较大的儿童可能会感到悲伤、愤怒或害怕灾难可能再次发生。经历过创伤性事件的任何年龄的儿童都可能患上创伤后应激障碍。青少年可以通过酒精或吸毒等高风险行为表现出来。他们可能变得孤僻或难以与兄弟姐妹、父母或其他人相处。在所有情况下，孩子都需要知道他们的感受是有效的。观点 这可能是由于无助感或害怕分离造成的。年龄较大的儿童可能会感到悲伤、愤怒或害怕灾难可能再次发生。经历过创伤性事件的任何年龄的儿童都可能患上创伤后应激障碍。青少年可以通过酒精或吸毒等高风险行为表现出来。他们可能变得孤僻或难以与兄弟姐妹、父母或其他人相处。在所有情况下，孩子都需要知道他们的感受是有效的。观点 这可能是由于无助感或害怕分离造成的。年龄较大的儿童可能会感到悲伤、愤怒或害怕灾难可能再次发生。经历过创伤性事件的任何年龄的儿童都可能患上创伤后应激障碍。青少年可以通过酒精或吸毒等高风险行为表现出来。他们可能变得孤僻或难以与兄弟姐妹、父母或其他人相处。在所有情况下，孩子都需要知道他们的感受是有效的。观点 他们可能变得孤僻或难以与兄弟姐妹、父母或其他人相处。在所有情况下，孩子都需要知道他们的感受是有效的。观点 他们可能变得孤僻或难以与兄弟姐妹、父母或其他人相处。在所有情况下，孩子都需要知道他们的感受是有效的。观点