Supporting children exposed to Trauma

With thanks to the National Child Traumatic Stress Network (https://www.nctsn.org)

This advice has been developed for children in the United States but is very similar to the advice from Syrian Refugees in the UK (Section 3.0). It is provided here as part of the support materials for people working with traumatised children.

Introduction taken from NCTSN, 2010, pp. 2-3

Early childhood trauma generally refers to the traumatic experiences that occur to children aged 0–6. Because infants’ and young children’s reactions may be different from older children’s, and because they may not be able to verbalize their reactions to threatening or dangerous events, many people assume that young age protects children from the impact of traumatic experiences…A growing body of research has established that young children—even infants―may be affected by events that threaten their safety or the safety of their parents/caregivers, and their symptoms have been well documented…

Traumatic events have a profound sensory impact on young children. Their sense of safety may be shattered by frightening visual stimuli, loud noises, violent movements, and other sensations associated with an unpredictable frightening event…As with older children, young children experience both behavioural and physiological symptoms associated with trauma. Unlike older children, young children cannot express in words whether they feel afraid, overwhelmed, or helpless. However, their behaviours provide us with important clues about how they are affected…

Young children who experience trauma are at particular risk because their rapidly developing brains are very vulnerable. Early childhood trauma has been associated with reduced size of the brain cortex. This area is responsible for many complex functions including memory, attention, perceptual awareness, thinking, language, and consciousness. These changes may affect IQ and the ability to regulate emotions, and the child may become more fearful and may not feel as safe or as protected.

Signs of traumatic exposure in children

What you might observe in Preschool children (NCTSN, 2008, p.8)

Remember, young children do not always have the words to tell you what has happened to them or how they feel. Behaviour is a better gauge and sudden changes in behaviour can be a sign of trauma exposure.

  • Separation anxiety or clinginess towards teachers or primary caregivers
  • Regression in previously mastered stages of development (e.g., baby talk or bedwetting/toileting accidents)
  • Lack of developmental progress (e.g. not progressing at same level as peers)
  • Re-creating the traumatic event (e.g. repeatedly talking about, “playing” out, or drawing the event)
  • Difficulty at nap-time or bedtime (e.g. avoiding sleep, waking up, or nightmares)
  • Increased somatic complaints (e.g. headaches, stomach aches, overreacting to minor bumps and bruises)
  • Changes in behaviour (e.g. appetite, unexplained absences, angry outbursts, decreased attention, withdrawal)
  • Over- or under-reacting to physical contact, bright lighting, sudden movements, or loud sounds (e.g.bells, slamming doors, or sirens)
  • Increased distress (unusually whiny, irritable, moody)
  • Anxiety, fear, and worry about safety of self and others
  • Worry about recurrence of the traumatic event
  • New fears (e.g. fear of the dark, animals, or monsters)
  • Statements and questions about death and dying

Suggestions for Educators (NCTSN, 2008, p.5)

  • Maintain usual routines. A return to “normalcy” will communicate the message that the child is safe and life will go on.
  • Give children choices. Often traumatic events involve loss of control and/or chaos, so you can help children feel safe by providing them with some choices or control when appropriate.
  • Increase the level of support and encouragement given to the traumatized child. Designate an adult who can provide additional support if needed.
  • Set clear, firm limits for inappropriate behaviour and develop logical - rather than punitive - consequences.
  • Recognize that behavioural problems may be transient and related to trauma. Remember that even the most disruptive behaviours can be driven by trauma-related anxiety.
  • Provide a safe place for the child to talk about what happened. Set aside a designated time and place for sharing to help the child know it is okay to talk about what happened.
  • Give simple and realistic answers to the child’s questions about traumatic events. Clarify distortions and misconceptions. If it isn’t an appropriate time, be sure to give the child a time and place to talk and ask questions.
  • Be sensitive to the cues in the environment that may cause a reaction in the traumatized child. For example, victims of natural storm-related disasters might react very badly to threatening weather or storm warnings.
  • Anticipate difficult times and provide additional support. Many kinds of situations may be reminders. If you are able to identify reminders, you can help by preparing the child for the situation. For instance, for the child who doesn’t like being alone, provide a partner to accompany him or her to the restroom.
  • Warn children if you will be doing something out of the ordinary, such as turning off the lights or making a sudden loud noise.
  • Be aware of other children’s reactions to the traumatized child and to the information they share.
  • Understand that children cope by re-enacting trauma through play or through their interactions with others.

Provision (Debra Laxton)

  • For children who have been exposed to trauma the creation of an enabling environment that is both emotionally and physically safe and secure is vital.
  • Adults need to foster and maintain positive relationships based on mutual trust and respect.
  • Expectations for behaviour need to be agreed, consistent and clearly explained.
  • Spaces for quiet, personal reflection.
  • Provide safe spaces and time for children to talk.
  • Engage with parents, they know their children best and if you build positive relationships with them they are likely to discuss their child’s concerns and interests etc. with you.
  • Resilience is key. Promote the child’s sense of self in a positive light wherever possible e.g. valuing their input, listening, sharing stories that show how others overcome similar situations, play experiences that have no right or wrong outcome.
  • Provide consistent routines that can quickly become familiar.
  • Time to relax and ‘be’.

References

NCTSN. (2008). Child Trauma Toolkit for Educators. [online] Available from https://www.nctsn.org/sites/default/files/resources//child_trauma_toolkit_educators.pdf

Zero to six collaborative group, NCTSN. (2010). Early Childhood Trauma. [online] Available from https://www.nctsn.org/sites/default/files/resources//early_childhood_trauma.pdf

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