Kids have a lot to deal with come September. Not only do they have to get back into the school mode after a summer off, but they will likely be inundated by the one-year anniversary of the Sept. 11 terrorist attacks. For many kids, 9/11 has faded into the depths of their minds. Yet, for some children who may have lost a parent, relative or neighbor, 9/11 is a constant in their lives. However, the tragedy has impacted them, children will almost certainly be reminded of the horror as images of the attacks are replayed as September approaches.

Parents, take note - by keeping communication lines open with your children, reassuring them and talking honestly about their feelings and concerns, children will be better prepared to cope with feelings of anxiety that may arise with the increased attention on the national tragedy.

Children pick up cues from their parents. They respond to a parent's outward expression of fear and anxiety. Let's face it, 9/11 shook everyone's perceptions of reality, making people feel more vulnerable, children included. Kids handle the truth better than most parents think. For children who are experiencing obvious signs of anxiety, it is important to talk to them honestly. Lies undermine trust and a parent's ability to reassure their safety. Explain the situation truthfully and reassuringly by keeping the focus on your individual situation.

Each child was affected by the Sept. 11 tragedy in different ways. A 2-year-old was certainly affected differently than a 15-year-old because of their ability to comprehend such events. Older children will need more information to help them understand why such an event occurred. Take your cues from your kids, they will let you know when they have enough information.

As a parent, it is important to be aware of Adjustment Reaction symptoms - changes in behavior after a specific tragic event in a child's life. These changes can tip you off to the fact that your child is struggling to deal with a troubling issue.

Some of the more common signs include:

* A toilet-trained child who suddenly starts to wet the bed at night

* Trouble sleeping

* Anxiety

* Depression

* Drops in grades at school

* Aggression

* Social isolation

In times of crisis or turmoil, children often regress. As the anniversary of 9/11 approaches, feelings of fear can resurface. Be supportive, listen to your child and be reassuring. Establishing and maintaining daily routines provides a sense of comfort and security for children and is especially helpful to those struggling with fears.

Most people witnessed the tragic events of 9/11 unfold on their television screens. Others listened as it happened on the radio. Newspapers and magazines printed the haunting images for weeks and months after the attacks. It is difficult to escape the media and its vivid images. Children who watched as the planes exploded into the Twin Towers process the scenes differently than adults, yet it is, nonetheless, a scary image.

Children pick up a great deal from television, whether they are watching Barney, Sesame Street, a peanut butter commercial or a teaser for the 5:00 news. It is quite likely that the media will rebroadcast many disturbing images around the Sept. 11 anniversary. Again, it is important to take your cues from your child as to what they are feeling. Many children may not exhibit any signs of distress. Parents should try to limit their children's exposure to television around this period, or, better yet, can play a more active role by watching with their children and then taking the time to discuss their feelings.

Most importantly, parents should just be real. Focus on how to help your kids now if they are experiencing anxiety instead of worrying about how your kids were parented last year, or about what might happen months or years from now.

On the whole, children are resilient. The average child who did not experience loss after the terrorist attacks will be able to deal with the revisit to this day just fine. On the other hand, many children who were directly impacted will need mental health services, if they have not received support already. It may be helpful to speak to your child's pediatrician who can offer advice and guidance about seeking mental health services.

Oftentimes, kids just need to talk about their feelings, whether it is with a parent, a trusted physician, teacher or counselor. Use community resources such as your school, outside clubs or organizations to help children cope with their questions and fears. Listening and talking is often the best medicine.

Ronald Marino, DO, MPH, is associate chairman of pediatrics at Winthrop-University Hospital in Mineola and has lectured on the topic of behavioral developmental pediatrics around the country.

**To pay tribute to those who lost their lives and loved ones on Sept. 11, 2001, Winthrop-University Hospital will be holding a special memorial service outside the hospital's emergency department at 8:15 a.m. on Wednesday, Sept. 11. Winthrop invites the community to attend the ceremony to find solace and strength during this day of remembrance.