Hey everyone! I am on the tail end of a week of holidays and have found the time to smash this article out and have a glass of wine at the same time.

So my last blog article was an “Introduction to trauma” because I felt that to be able to truly understand why some children behave in a certain way (for example, new foster children), you need to understand what happens physiologically when they are exposed to events that adversely affect the way their brains develop. 

So TODAY I wanted to talk about what exposure to past trauma can LOOK like in children and then what we can do to HELP a child who is dealing with this.  I have gathered information from a range of sources – and these are listed in the references at the end of this article.

In a general sense, I found that this list of symptoms given by the Raising Children Network, was a pretty good summary of how trauma can present in kids of all ages. These signs may not happen straight away, sometimes they can occur days, weeks or even MONTHS later.

If your child has been through a traumatic event, they might:

• Confusion, worry or self-blame
• Sadness, anger, irritability, guilt or shame
• acting out, disobeying rules, separation anxiety or avoidance of other people
• suddenly not being able to do what they could do before the traumatic event – for example, use the toilet or get themselves dressed
• physical signs – for example, headaches or stomach aches or startling easily
• problems with sleep or concentration.

When we learn about child development, we learn that an individual’s skills progress forward as they get older.  It stands to reason then, that children of different ages and different abilities (in language, social interaction, problem solving (or cognitive) skills, emotional regulation etc) could present very differently depending on where they are at developmentally.  In fact, even 2 children of the same developmental stage could present differently after exposure to the same trauma because of differences in individual personality traits and disposition, or even perception of the traumatic event. 

So the lists below are only meant to be a guide, do not expect that each and every child will fit the given description because we all know that in real life children do not conform to moulds, and most certainly not in the instance of trauma. 

Common reactions to trauma in babies and toddlers

When babies or toddlers are exposed to life-threatening or traumatic events, they become very scared – just like anybody else.  Some common reactions may include:

• uncharacteristically high levels of distress when separated from their parent or primary carer
• a kind of ‘frozen watchfulness’ – the child may have a ‘shocked’ look and be somewhat unresponsive
• giving the appearance of being numb and not showing their feelings or seeming a bit ‘cut off’ from what is happening around them
• loss of playful and engaging smiling and ‘coo-ing’ behaviour
• loss of eating skills
• avoiding eye contact
• higher levels of irritability and being much more difficult to soothe
• regression their physical skills such as sitting, crawling or walking and appearing more clumsy.

What can we do to help?

Structure, predictability and nurturing are key to helping a baby or toddler who has been traumatised. There are a number of things parents and carers can do to help their baby or toddler cope with and recover from trauma.

• Seek, accept and increase any support you need to help you manage your own shock and emotional response – this is extremely important, because if you are stressed, the child will sense this and become heightened also.
• Get information and advice on how the baby or toddler is going from a trained professional
• Learn to recognise early signs of stress and manage these, understand triggers/cues for this response and anticipate and prevent them
• Reduce the intensity and length of the initial stress reaction by helping the child settle and to feel safe and cared for as quickly as possible.
• Try to establish and maintain regular routines around sleeping, feeding and interaction.
• Create for the child a calm atmosphere and engage them in soothing activities.
• Avoid any unnecessary separations from important caregivers.
• Avoid exposing the child to reminders of the trauma, where possible; limit exposure to television, pictures, stories or media.
• Expect that the child may temporarily regress (go backwards) in their behaviour or become ‘clingy’ and dependent. Don’t panic if this occurs – it is one of the child’s ways of trying to cope with what they have been through. 

How trauma can present in children aged 3-5 YEARS:

Common reactions to trauma in a pre-schooler:

• New or increased separation anxiety
• New problems with every day functioning like eating, sleeping, toileting or being able to follow directions
• Mood changes
• Withdrawal from social interaction and decreased enjoyment in preferred activities.
• Increased in fear/anxiety:
  • The appearance of new fears/phobias
  • Startling more easily or being more jumpy
  • Nightmares
  • Being harder to reassure when they are fearful of something
  • Asking the same thing repetitively
  • Having the frightening event come out in play or drawings, or talking about it frequently
• Physical symptoms – tummy pain, headaches, tiredness, lack of appetite, nausea

How we as parents/carers can help:

• Stay calm and listen to the child, even if they retell the event multiple times
• Seek and accept support for yourself to manage your own stress, shock and emotional reactions.
• Reassure the child (as many times as is necessary) that they are safe and that the event is over. 
• Restrict the child’s access to TV programs, stories, movies or other media that might remind them of the location or situation that traumatised them
• Accept and help the child to name strong feelings during brief conversations, but remember that little children cannot talk about these feelings for long
• Expect and understand that you may see a bit of developmental regression (the child may act like a younger child) and although you may need to make allowances for this, you need to keep basic house rules so that the child has boundaries and  knows basic expectations.
• Expect difficult or uncharacteristic behaviour, and troubles with emotional regulation.

Common reactions in SCHOOL-AGED children

Remember, every child reacts differently and typical reactions change with age. Your child may not react the way you expect. Depending on their age and stage, they may not have acquired the skills to articulate their thoughts and feelings to those around them. Depending on their level of distress, they may not be able to make use of their language skills to articulate their thoughts and feelings to those around them. Sometimes, distress reactions surface weeks or even months after the event.

Common reactions include:

• Physical reactions – children often react to distressing or frightening events in physical ways
• Sleep problems such as not wanting to go to bed at night or difficulties getting to sleep, staying asleep, staying in their own bed and with nightmares
• Changes in eating habits
• Going back to behaviours from earlier developmental stages – becoming more ‘babyish’ and attention seeking
• Becoming more clingy, demanding or difficult
• Fear at being separated from their parents or carers
• Changes in their relationships with siblings, such as becoming more competitive or aggressive
• Needing to ‘relive’ the trauma, for example, they may draw pictures of it or act it out
• Mysterious physical ailments, such as headaches and stomach aches
• Not wanting to go to school
• Behavioural problems at school
• Drop in academic performance
• Withdrawal – for example, the child may not want to discuss their thoughts or feelings in case it upsets their parents or carers, or they may spend more time alone, perhaps in front of the TV or computer.

What parents and carers can do for their school aged child

Children look to their parents and carers to gain understanding of a situation and find appropriate ways to deal with it. General suggestions include:

• Give your child the facts about what happened and why, using age-appropriate language.
• Assist your child to play or talk about their thoughts and feelings. This also helps you to gauge whether or not they understand what actually happened or whether they have another interpretation.
• Keep children busy – if daily activities have been disrupted, then organise playgroups and activities with other children and parents; encourage kids to lend a hand – it gives kids a sense of accomplishment and purpose at a time when they might feel helpless.  Younger children can do tasks around the house to help you, older children might like to volunteer.
• Allow your child to express their feelings to the person of their choosing and in whichever way they need to. Demanding that they do what you want will lead to friction and misunderstandings.
• Limit their exposure to TV, radio and newspapers. The more bad news they see, the more they will worry.  Avoid letting them see graphic images.
• Reassure them that their feelings are normal.
• Tell them how you’re feeling too, but keep it brief – don’t ‘overload’ or burden them with the details of how you’re going.  Sometimes sharing a little about your own feelings (but limit the detail!) can help a child who does not talk.  For example, “I found this scary.  Sometimes I wake up at night because I am thinking about it.  How are you feeling?”
• You may need to explain adult reactions to stress. For example, your child may feel distressed by a crying parent or carer unless they know the reason for the upset.
• Keep up regular household routines, if possible.
• Make time for pleasurable family activities.
• Remember that your child’s distress reactions are usually short-lived

Common reactions to trauma in TEENAGERS

Again, it is important to remember that every young person is different, but common symptoms of distress may include:

• strong emotions such as sadness, anger, anxiety and guilt
• overreacting to minor irritations
• repetitively thinking about the traumatic event and talking about it often
• disturbed sleeping patterns
• withdrawing from family and friends
• wanting to spend more time alone
• being very protective of family and friends
• returning to younger ways of behaving including giving up responsibilities or a sudden return to rebellious behaviour
• increased need for independence
• self-absorption and caring only about what is immediately important
• loss of interest in school, friends, hobbies, and life in general
• pessimistic outlook on life, being cynical and distrusting of others
• depression and feelings of hopelessness
• difficulties with short-term memory, concentration and problem solving.

Tips to help teenagers resolve traumatic reactions

The adolescent years are often the most challenging for parents to manage, even in the absence of trauma.  There are a number of different ways that parents/carers can help their teenagers’ reactions to trauma:

• Encourage your young person to communicate without judging or advising them until they ask for your feedback.
• Show them that you really care for them and are genuinely interested and enjoy being with them.
• Negotiate changes in roles and responsibilities during recovery and be flexible. Don’t try to stick rigidly to the way things were before the event.
• Continue to give love, support and trust, even if things are extremely difficult (and they often get extremely difficult)
• Remember your teenager is the same person they were before the event, even if they seem different.
• If asked, gently let the young person know that they are having a ‘normal’ reaction to a frightening experience and that in time these very strong reactions will eventually go away.

When should you seek help for your traumatised child?

• If you are concerned about how your child is coping
• If your feel you are not coping yourself
• If you feel that the traumatic event has affected your ability to feel connected or loving towards your child
• If your child has a lot of symptoms and things are not settling after a few weeks
• If they seem persistently depressed or anxious
• If the child talks about harming themselves or tries to harm themselves
• If you notice persistent regression or loss of previously acquired developmental skills
• If the family unit is significantly disrupted or finding it difficult to cope following the event
• Several family members are affected and there is not enough attention to go around
• Your family is struggling to re-establish routines or predictable pattern in the household
• IN teenagers – if their behaviour becomes dangerous, reckless or harmful
• If your child will not communicate about how they’re going or feeling

WHERE TO GET HELP

• Your GP
• Your paediatrician or Child/Adolescent Psychiatrist
• Your local community health centre (and community health nurse)
• Lifeline 131114
• Parentline 1300 30 1300

I really hope that this article (and the one before it) has given you a better understanding of trauma and the variety of ways it can present in children over time.  Most of all I hope that there are some practical strategies here that you might find useful, or that you can pass onto someone who might find it useful also.

Looking for topics to blog about, so post me a message on the page to let me know what you want to hear about.

Until next time, stay well!!

xxDr Megs

References

1. https://raisingchildren.net.au/preschoolers/connecting-communicating/coping-with-trauma/trauma-first-response

2. https://raisingchildren.net.au/preschoolers/connecting-communicating/coping-with-trauma/trauma-support-for-children

3. https://www.helpguide.org/articles/ptsd-trauma/helping-children-cope-with-traumatic-stress.htm

4. https://childmind.org/guide/helping-children-cope-traumatic-event/

5.  https://www.betterhealth.vic.gov.au/health/HealthyLiving/trauma-and-children-two-to-five-years