Children who viewed the recent terror attacks on social media could be at risk of post-traumatic stress, health officials are warning.
GPs are being urged to watch out for symptoms which could indicate that patients are struggling to recover from a wave of atrocities.
NHS psychiatric advice recommends a period of “watchful waiting” after major incidents, on the basis that offering immediate counselling can traumatise those who would otherwise have recovered.
But today health officials have written to GPs, warning them that now is a crucial time to look out for patients who are struggling to recover from a wave of attacks, starting with the Manchester bombing six weeks ago.
In particular, GPs have been warned to look out for signs in children - such as shame, or a loss of self-esteem - which might not be obvious, but could indicate post-traumatic stress disorder.
NHS England said patients could suffer symptoms regardless of whether they themselves were caught up in events, given that so many witnessed the atrocities on social media.
Among those directly caught in up in attacks, around one in five are expected to seek help from the NHS.
But thousands more people who watched horrific scenes on social media could also suffer trauma, experts said.
GPs have also been warned that people with pre-existing mental illnesses could be destablised by the wave of attacks, closely followed by the Grenfell fire.
The letter from Dr Arvind Madan, the head of NHS primary care asks GPs to work with their communities to identify those in need of support.
And it warns GPs to look out for symptoms which could denote a struggle to cope.
Such symptoms include flashbacks, agitation, nightmares, palpitations and breathing difficulties
Parents are being urged to look out for more subtle symptoms.
“Children and young people experiencing symptoms which may indicate PTSD might think differently about themselves or other people,” the letter warns.
Such signs include lowered self-esteem, self-blame, thinking that they are a bad person or deserve bad things to happen to them, feeling unsafe or showing less trust in other people, the advice notes.
Those suffering trauma might also experience overwhelming shame, sadness or fear or avoid situations which remind them of the event, the letter continues.
Dr Sandeep Ranote, from the Royal College of Psychiatrists, urged parents to try to protect their children from social media.
He said: “Children will inevitably learn about incidents through news and social media so it is best to be open with them. However, we would not encourage reliving the experience in the immediate aftermath by repeated exposure to news and images.”
While most people affected by traumas would recover, it was important that specialist available was available for those in need, he said.
Claire Murdoch, national clinical director for mental health said: “We must remember that for those people who were affected by these horrific tragedies, the journey is not over and many will continue to face difficulties.”
“From day one of each of these incidents, staff have been working incredibly hard on making sure that mental health support is available for those who need it – we want everyone who has been affected to know that there is always support available and how and when they should access it.