NAIROBI, Kenya (AP) -- When the shooting began at the Nairobi mall, Cynthia Carpino and her husband hid in the parking lot. But their 1-year-old daughter wouldn't stop crying. To muffle her cries, her father placed his hand over her mouth so hard she almost suffocated. Little Azzurra fainted in his arms, and three weeks later she's still not right.
"Now when I try to put a sweater on her, and it goes over her mouth, she starts screaming and screaming," says Carpino. "I know this is because of what happened at the mall. But I don't know what to do about it."
Nor do other parents whose children were caught in the Westgate Mall horror on Sept. 21 in which 67 people were killed. The parents are now struggling to help their traumatized children at the same time that they themselves are grappling with signs of distress.
The attackers struck on a Saturday afternoon, a time when families flock to the mall. At least 1,000 people were inside the four-story complex, including many children. Couples pushed strollers through marbled floors that would soon turn red with blood. Mothers with toddlers in tow loaded groceries into shopping carts at the supermarket, the same carts which would be used hours later as gurneys to evacuate the dead.
When the assault started, parents threw themselves over their children to shield them, but they couldn't block out the sights and sounds. Now the psychological toll is becoming apparent. Girls draw pictures of grenades and machine guns. Kids who once played hide-and-seek are "playing Westgate," impersonating the terrorists. Yet some children who were directly in the line of fire are showing few, if any, symptoms, creating a confusing array of responses, sometimes within the same household.
Cynthia Carpino, a Kenyan, and her Italian husband, Livio, had just parked their car and were pushing their two-seater pram up the ramp leading to the mall's rooftop terrace. When the shooting erupted, Cynthia grabbed her 12-day-old baby while her husband held Azzurra. They ran in separate directions. Cynthia slipped under a parked car, the baby cradled in her arm.
Frightened shoppers tried to squeeze in after her. The terrorists spotted them and sprayed the car, until the young mother was surrounded by a buffer of corpses. The car began leaking water, drenching her. Her baby began to cry.
"Whenever they heard a baby cry, they would throw a grenade. Then you didn't hear the cries anymore," said Carpino. "I saw the feet of one go by. He said, 'We are al-Shabab. Your president has invaded our country. Our women are being raped. Our kids are being killed. So why should we spare your kids?' And then he opened fire."
Later al-Shabab, al-Qaida's affiliate in Somalia, would claim responsibility, saying the attack was in retaliation for Kenya's deployment of troops into Somalia, its neighbor.
Terrified that she might be spotted, Carpino opened her shirt and tried to get her baby to nurse under the chassis of the car. Each time the infant whimpered, she shoved its face into her chest, smothering the sound.
Meanwhile, her husband had ducked behind an enclosure and was struggling to calm their older daughter. When he put his hand across her mouth, she struggled, then went limp.
The family survived, but now find themselves in different worlds. Livio Carpino has gone back to his job as pilot for Kenya Airways, while his wife is afraid to leave the house. Even though both her children were smothered, her baby appears unaffected, while Azzurra struggles with tasks as simple as getting dressed.
Clinical psychologist Katie McLaughlin, whose research at the University of Washington in Seattle focuses on post-traumatic stree disorder, or PTSD, says trauma alters the chemistry of the brain. So Azzurra would associate something touching her face with her panic during the attack. "It's typical conditioning," McLaughlin says, and for most people it fades over time.
It's when this process fails to happen that PTSD can set in, she said in a telephone interview. PTSD is more than ordinary stress. It's associated with severe or unusual trauma. Those experiencing it may suffer from violent, intrusive thoughts. They have trouble sleeping. Once innocuous things, like a particular smell or sensation, can set off a flashback. In the community of Newton, Conn., for instance, signs ask people to close doors softly because loud bangs still bring on flashbacks, nearly a year after a gunman opened fire inside the Sandy Hook Elementary School.
A number of factors determine why even siblings can have diametrically opposed reactions to the same experience.