What is trauma?
TraumaTrauma is a state caused by an event/series of events that overwhelms an individual and leaves them unable to process or cope with what has happened. Trauma comes from the Greek word 'wound' and it can be caused by a one-off occurrence, such as a natural disaster or a violent encounter, or by long-t... more is an emotional response to an event that is deeply frightening or distressStress describes the feelings we get when we are struggling to cope with a situation. Sometimes stress is a normal, healthy reaction to an external pressure, but at other times it can become overwhelming and difficult to manage. Physical symptoms of stress can include headaches, an increased heart r... moreing. It happens when a person feels so overwhelmed by difficult emotionsEmotions are the way we show how we feel inside. We might do this with words, how we look and how we behave. Sometimes the emotions we show match how we feel inside and sometimes they are used to cover up our feelings e.g. putting on a brave face when we feel sad. Emotions might also be referred ... more - such as fear or anxietyAnxiety is a feeling we get that is similar to fear or worry that occurs when we are in a situation that is uncomfortable or threatening. An anxiety disorder is when you experience the symptoms of anxiety over a long period of time or in situations that are not/were not previously uncomfortable or t... more, that their mind can’t make sense of it. These emotions stay with the person and can influence the way they feel in the future. For example, a loud noise might remind someone of a previous frightening experience such as a car crash, causing them to experience it as scarier and more overwhelming than it would normally be.
Acute trauma can occur if a person was exposed to one traumatic event. Chronic trauma can occur when a traumatic experience has continued over a period of time. Complex trauma can occur when someone has experienced many different traumatising events.
Trauma in childhood
Traumatic events in childhood might include, for example, being involved in an accident or natural disaster. Or they could include experiences of abuseThe illegal or excessive use of something that can generate damaging consequence, such as sexual or substance abuse. See also: Emotional Abuse, Physical Abuse, Sexual Abuse, Substance Use and neglect or witnessing violence.
Things that are frightening or traumatising for an adult are likely to be even more traumatising for a child. This is because the young child’s limited experience of the world and their developmental stage means they are not yet fully able to understand what’s happening to them or why.
Having a trusted adult around (ideally an attachmentAttachment is the emotional bond that develops between a child and their parent or guardian as they grow up. It starts at birth, when an infant is dependent on them for survival. The strength of this relationship determines the coping mechanisms the child needs in order to thrive. This attachment ex... more figure) can really help a child cope with frightening events. This is why the experience of abuse or neglect by a caregiver is always traumatising – the child is both traumatised by the abuse, and then again by that trauma being caused by someone they should be able to trust.
The experience of chronic and complex trauma in early life can have a lasting impact on an individual’s development and personality. However, with the right help, young children can be supported to make sense of distressing experiences, and any negative impact of these experiences on their life chances can be reduced.
- What are the signs of traumatic stress in children?
The most important thing to recognise when supporting a child who has experienced trauma is that the changes to their behaviour are normal and understandable reactions, which communicate that they need help to manage their feelings.
Children will react differently to different experiences, depending on their age and their individual personalities and experiences up to that point. But you will find that some of the behaviours listed below are seen in all babies and children. In thinking whether the behaviour could be linked to trauma, it is important to consider how persistent it is, and what else is going on for the child.
- Babies are likely to show feelings of distress in a physical way, for example: persistent crying, which cannot be soothed by their caregiver
- A baby might also become rigid, arch their back arch, squirm or look unfocussed, in an attempt to physically escape feelings of distress
- They might struggle with settling to sleep, or with feeding or playing
- They could have persistent hiccups or vomit
- When completely overwhelmed, infants may try to cope by cutting off from their feelings and the world. They might avoid eye contact and interactions with caregivers, or stare at lights or other objects for long periods. They might show a limited range of emotions.
Toddlers and young children
Toddlers and young children are able to express their feelings more directly than babies, but they may still experience and show their distress in a physical way. Behaviours include:
- An increase in crying, fearfulness or clinginess with or when separating from caregivers (this is sometimes called ‘separation anxiety’)
- Sleep difficulties, including nightmares
- Going ‘backwards’ in their development, for example in toilet training, speech, or self-soothing behaviours like thumb sucking
- Being more aggressive towards caregivers, peers or other adults
- Not being able to concentrate
- Complaining of physical symptoms such as headaches and stomach-aches
- Becoming preoccupied with thoughts and memories of traumatic events. Some children may express how they are feeling through play, perhaps by repeatedly re-enacting traumatic events or overwhelming feelings such as anger, fear or helplessness.
- Trauma in the context of the health crisis
The current health crisis may cause and exacerbate trauma in a number of ways. Babies and young children may experience the sudden death of a loved one (See also: Bereavement). During periods of lockdown and social distancing, they are likely to be more at risk of experiencing abuse or neglect.
- Strategies to support children and families
It’s painful for adults to think about children in distress, and the temptation can be to avoid or ignore these feelings in the hope that they will go away. But without support, children are left alone with difficult feelings which could continue to influence how they see the world.
Babies can’t talk about, or reflect on feelings, or tell us directly about traumatic events. What babies need most is for caregivers to support them with the impact of their experiences in the “here and now”:
Take the baby’s experience seriously.
Having an adult who is attentive to feelings and who wants to help, even when it is unpleasant or confusing, will help offset the negative impact of traumatic experiences.
Pay close attention.
A baby who stiffens or diverts their eyes when cuddled might need another source of comfort, such as a soft voice. Watching closely and carefully for these signals will enable you to respond sensitively and help the baby manage their feelings.
Put it into words.
It’s never too early to voice what you think a baby might be feeling. Although they may not understand what you are saying, this will help them feel understood, especially when you use a warm, gentle and reassuring tone of voice.
Toddlers and young children
Like babies, young children need help managing their feelings in the moment. However, once a child starts using words and play to represent the world, it is possible to begin helping them acknowledge and explore their feelings through play, stories or even talking about what happened to them. Crucially, how this is done depends on the child’s developmental stage, and must always be led by the child:
Show that you are interested
Listen, and show the child you are interested in making sense of their communications and experiences, even if you can’t understand everything straight away.
Ensure they feel comfortable to talk about it
Let them know that they can talk about their feelings, including scary or upsetting things that have happened to them, whenever they want.
Talk about your own feelings to show them how it’s done
Lead by example, by talking openly about your own feelings – but remember to stay calm, so the child does not feel they need to look after you.
Help them put names to their feelings
Help name feelings in simple language, such as being ‘cross’ or being ‘worried’. Some children may be able to name, draw or describe their emotions, such as feeling like an ‘exploding volcano’ when angry.
Suggest they think about the ‘physical effects’ of their feelings
Encourage children to think about how feelings are felt in the body. For example, some children get tummy aches when they are worried. Remember this will be different for each child, so it’s important to ask, not tell.
Let them know their feelings and behaviour are normal
Reassure children that their feelings or behaviour, which might feel confusing or scary, are normal reactions to difficult events.
Help with their understanding of a confusing event, in an age appropriate way
It is crucial to protect children from information or details that would frighten or overwhelm them. That said, children can be left confused about certain traumatic events, and sometimes they might tend to blame themselves. So, at times, giving a clear, age-appropriate explanation can be enormously helpful.
Don’t push children if they don’t feel ready
Go at the child’s pace. While it’s fine to ask about past events, or check in about feelings, it’s not helpful to push children to talk or think about things before they are ready.
Prevent a child from feeling overwhelmed or unsafe when exploring their feelings
Help children feel safe when talking or playing about difficult experiences. Becoming extremely upset or overwhelmed reinforces the sense that these feelings are unmanageable. If this happens, take a break and let the child know it’s your job to keep them safe, and to work out the best way to help them. You can find tips on when and how to seek help below.
- When and how to seek help
It isn’t easy to support a baby or young child who has experienced trauma. Witnessing children struggling with overwhelming feelings can be upsetting and scary for the adults who are caring for them. Adults often worry they will get something wrong and may need help managing their own feelings. There is never a bad time to get help, but it is especially important to seek support if the child’s upset feelings and behaviour seem to be getting worse over time, or if the signs of stress and trauma last for a month or more.
If you are concerned about a child at any time following a traumatic event or experience, consult your GP for help and support. If problems continue, your GP may suggest extra help from the local child and adolescent mental health service (CAMHS).
- Tips to share with parents
Where appropriate, the following tips can be shared with parents:
- Reassure your children that it is normal to feel frightened or angry after scary things happen.
- Try to put into words what you think your baby or young child might be feeling – it’s never too early to do this, even with very little babies, especially when you use a warm, gentle and reassuring tone of voice.
- Let them know that they can talk about their feelings, including scary or upsetting things that have happened to them, whenever they want.
- You can show them it’s OK to talk about feelings by doing it yourself - but remember to stay calm, so the child does not feel they need to look after you.
- Try to help children understand what happened to them. Children can be confused about traumatic events and can blame themselves. Try to give simple explanations but avoid any details that might be upsetting or frightening.
- Go at the child’s pace – if they don’t seem ready to talk, that’s OK.