For Newtown, Connecticut, the pain is still fresh as the community gathers this week to say final goodbyes to each of the 20 children and six adults gunned down in an attack on an elementary school.
But for the children who survived, the hard part may just be starting.
"Children get very confused. Some little children might think that they're to blame. Some of them may think that they did it (that the shooting happened) because they didn't do the right thing in class," said Melanie Killen with the Center for Children, Relationships, and Culture at the University of Maryland
The attack on the Sandy Hook Elementary School was tragic and traumatic. But, the children who survived are not alone.
The same day tragedy struck in the United States, a 36-year-old man armed with a kitchen knife burst into a school in central China, injuring 23 children.
In October, Taliban gunmen in Pakistan shot and wounded 14-year-old Malala Yousufzai and a schoolmate while getting onto a schoolbus in the Swat Valley.
"In situations where a child is living in a war zone, so to speak, it may not be so surprising to experience violence. It is still very traumatic and obviously recovery and support is necessary... Certainly the pain and suffering is no different whether it is in China, the Middle East or the U.S.," said Elizabeth Carll with the American Psychological Association, who works with the United Nations on children and trauma.
Experts say in the weeks and months following such traumas, children may have difficulty concentrating, eating and may even exhibit changes in their personalities. But they point out children are resilient and with support from community, family and mental health experts, they can go on to lead happy and healthy lives.
Killen says that does not mean the pain of the shooting will ever go away. "This is a lifetime. This is a lifetime impact for the children and the families and that community. It was so direct, it was so immediate and it was so pervasive and so many children were affected by it," she said.
For now, the goal is to get the survivors back to school in a new location for a fresh start, with adults around to help at every step of the way.