Updated March 22, 2022 at 3:59 PM ET

Hanna Usatenko's 10-year-old daughter, Kate, is afraid the war in Ukraine is making her lose her memory.

She's heard the deafening sound of rocket attacks. She had to flee her home in Kyiv with her father and 12-year-old sister – while her mother, a psychologist, psychotherapist and nurse, stayed behind to volunteer at local hospitals.

About a week after the war started, Kate called her mom and told her that she had a hard time concentrating when she was reading her books. She even "downloaded an IQ test to check whether she's less clever than she used to be," says Usatenko, 40.

Usatenko, who treats both children and adults in her psychotherapy practice, explained to her daughter: "You've got high anxiety. And when people have high anxiety, it's normal to be forgetful." She keeps a notebook with her at all times to write everything down – and told her daughter to do the same.

And although Usatenko isn't physically with her daughters, she calls them several times a day to check how they're doing. "We talk a lot. I ask them how they feel. What they see," she says.

"They miss me, but they are safe now," she adds. "Children who stay here [in parts of Ukraine under bombardment] really suffer from more severe things — violence, bombing, loss, physical pain, insecurity."

The power of parental presence

In times of crisis, parents and caregivers play a vital role in protecting children and helping them cope. But even providing the simplest acts of care to a child in an emergency can be a challenge.

The advice is exactly what you might imagine: If possible, the parent or a close guardian should be by their side.

Research has shown that that kind of reassuring presence can minimize post-traumatic issues later in life. In their 1943 book War and Children, psychoanalysts Anna Freud and Dorothy Burlingham studied preschool children at three nurseries in London who were orphaned or evacuated during World War II. They found that during traumatic events, the presence of a caregiver who paid attention to a child and attended to their needs was a key source of stability.

If an attack, such as a bombing, occurs "when small children are in the care either of their own mother or a familiar mother substitute, they do not seem to be particularly affected by them [in the long run]. Their experience remains an accident, in line with other accidents of childhood," write Freud and Burlingham in their book.

"[Parents and caretakers] provide this layer of protection between the child and this awful world that's going on around these kids," says Charles Nelson, a professor of pediatrics, neuroscience and psychology at Harvard Medical School who researches child development in the face of adversity.

The consequences when parental protection falters

But the chaos of war can make parental protection an unachievable goal. In Ukraine, adult men ages 18-60 have been banned from leaving the country after President Volodymyr Zelenskyy declared martial law and instituted a mandatory military conscription. Many fathers have volunteered to enlist in the army. Even Usatenko felt the need to stay behind in Kyiv, away from her husband and two young daughters, to help others as a medical volunteer.

Without a parent or guardian to offer love and support, children can experience the kind of stress that often leads to serious mental health and development consequences.

Conflict-related traumas can trigger "elevations in heart rate, breathing and stress hormones related to the fight or flight response. Repeat exposure to toxic stress in that way can affect the developing brain of children, and it has lifelong consequences for learning, behavior and health," says Theresa Betancourt, a professor at the Boston College School of Social Work and director of the Research Program on Children and Adversity.

Nelson says that those impacts even include a heightened risk of developing heart disease and diabetes.

For parents and caretakers trying to "buffer those experiences for children," Betancourt recommends UNICEF's guidance for parents on how to talk to children about conflict and war. Developed in conjunction with mental health experts and child psychologists, the advice includes making sure to ask children how they feel, not minimizing or dismissing their concerns and gently talking to children about what is happening.

A mother whom Betancourt saw interviewed on CNN on March 16 is a role model, she says.

Olena Gnes spoke about what it's been like living in an underground shelter in Kyiv with her three young children, who were also on camera.

During the interview, Gnes "demonstrated the tremendous ability to stay calm but present for her kids," says Betancourt. That includes "calming and holding them, letting them snuggle next to her as she spoke."

It also seemed that the mother had been "sharing age-appropriate information that was honest," she says. Gnes told the CNN interviewer that her older children, ages 5 and 7, understood that their country is in a war with Russia — and that the explosions they were hearing all around them were dangerous to their safety.

Panicked parents

But during a time of crisis, everyone struggles to cope.

The ability to solve problems "breaks down very quickly when we experience trauma, says Laura Murray, a senior scientist at Johns Hopkins University who specializes in child trauma in disasters and has worked on mental health initiatives in low-resource countries. "Your brain just works differently."

For those in distress, a practice called "psychological first aid" can be helpful, says Murray. Ideally it's provided by a mental health professional or a trained volunteer who takes the person aside and provides basic guidance on coping and survival.

Volunteers can help "reorient a parent" by holding their child for a moment while they calm down — and check in to see whether they're "in a healthy place to interact with their kid," says Murray.

"They're an ear, they're a calm voice hooking them up with the support they need" such as food, water and shelter, she adds. The volunteers also ask questions like: "Is your child warm? When was the last time you ate?"

But such questions may be unanswerable in a crisis. In Ukraine, Russian forces have destroyed sources of power, heat and water. The U.N. refugee agency UNHCR is unsure whether its shipments of blankets, sleeping bags, canned goods and other emergency aid can get into Kyiv, Mariupol or other cities under siege. Even shelters to keep children and families safe are have been attacked by Russian forces.

Despite all of these hardships, some children in Ukraine are showing incredible resilience, says Anastasia Lebed, a licensed child psychologist and psychotherapist who fled Kyiv with her family to their summer house in Bila Tserkva, about 2 hours by car from the capital. She has been checking in with some of her patients.

She says her 15-year-old son has been quite calm, even though he woke her up on the 24th before they fled, saying that the Russians were bombing Kyiv.

"The new thing that's happening to him is that he's writing songs and he's drawing stuff that he hasn't before," says Lebed, who encourages him to express his emotions through his art.

She proudly holds up a pencil drawing of a shape on a sheet of computer paper. At first glance, an observer might think it looks like flames erupting around a tall building — but it's not, says Lebed. Take a closer look, she says: It's the soft, shaggy fur of their pet cat.

Yura Rudenko served as an interpreter for interviews conducted for this story.

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Tags: children's mental health  advice  trauma  parents  Ukraine