Childhood trauma: Why trauma informed care matters?

Life is not always a bed of roses. Bad things happen as a child grows up.   Parents separate or divorce.  Children get bullied in school.  Chronic illness.  Death in the family.   Natural disasters like the earthquakes, tsunami or even the pandemic.   Some traumas destroy a home.  Others destroy their sense of safety and wellbeing for instance; racial violence, community shootings or even substance abuse in the family.   Unfortunate but true, at times, children end up being the scapegoats in a parents unending quarrel.  

Most children learn how to cope with stressors early in life.  They develop healthy coping strategies and grow resilience. But sometimes children get stuck.   When a traumatic experience occurs repeatedly in life; or the child is stuck in an traumatic household;  when a child feels unable to gain a sense of control over their lives or their circumstances, that’s when they get in the way of their continued physical, emotional, social or intellectual development. This is childhood trauma.

Most mental health professionals today will acknowledge that the traumatic experiences that a child encounters can leave long lasting scars prolonging in his adulthood.  According to SAMHSA, approximately 35 million children today are exposed to at least one type of trauma prior to their eighth birthday.  CDC statistics state that one in four children experiences some sort of maltreatment (physical, sexual, or emotional abuse).  Child abuse, domestic violence and neglect being the most common and major issues, other forms of trauma can result from falls, choking, and poisoning.   Natural calamities like the pandemic that we are in now can cause considerable trauma as well.  Adapting a trauma informed approach, acknowledging the presence of trauma and helping the child and the family adapt healthy coping strategies to deal with its impact can go a long way in helping a child develop resilience.

It is even more imperative now than ever before to discuss the impact of trauma on our most vulnerable generation-Now that we are in the midst of a pandemic. Pandemics do not differentiate; and neither do their adverse and long lasting effects.  Kids and adolescents are not spared the stress and the trauma that comes with the pandemic, its effects on the families and the social isolation.  The trauma itself is tragic, what is more tragic is the fear and the stress related to it.

It takes a village…

 “It takes a village to raise a child” says the African proverb.  And it’s relevance deepens even more during the pandemic where the children are drastically removed from their school environments, and forced to share in the fears of the unknown, the tragedies of their ailing families, the deaths, the loss’s and things that are out of their control and comprehension.  

Do you interact with children sometimes?  Do you work as a social worker, teacher, or a community health worker and deal with kids?  Are you a parent concerned about your child’s mental health?  This article is for you. This article is for the community.  This is for all the program facilitators, school administrators, bus drivers, food service workers, classroom assistants, administrative staff, volunteers, teachers, leadership, special education professionals, school social workers and psychologists and the families who wish to make a difference. This is indeed a time when an entire community of people must interact for those children to experience and grow in a safe and healthy environment.  And that is why, to know the basics about trauma informed care becomes even more relevant.

What is a trauma informed approach and why it matters?

Trauma-informed care is defined as practices that promote a culture of safety, empowerment, and healing.  It is the open-mindedness and compassion that all children deserve, irrespective of their past experiences or living conditions.

Generally, children’s reactions to trauma differ based on the nature of the trauma; the child’s individual, family, and neighborhood characteristics; and on their developmental stage.  While the teenagers and the youth may experience intrusive memories, nightmares, intense anxiety, flashbacks and avoid situations or people that remind them of the trauma; younger children may have difficulty eating or sleeping, experience excessive fear of strangers or separation anxiety.  School aged children may become withdrawn or engage in aggressive behaviors while fixating on their own safety or the safety of others.  If not stopped in its tracks, the unattended traumatic effects could continue into their adulthood in terms of substance abuse, delinquency courts and at times anxiety disorders.

How does trauma informed care look like?

The community in large, the families, school settings, and the individuals caring for children need to become aware of the impact of childhood trauma, help provide and promote safety and reliability; and be able to protect children from further traumas while providing them with options for recovery. Adapting a trauma informed approach to real-world settings begins with equipping oneself with the knowledge of trauma informed principles and applying four key elements—the Four R’s as described by SAMHSA .

The four R’s are:

Realize 

Each individual reacts differently to their life circumstances.  What may be tragic to one may be trivial to another.  For children who have experienced extreme neglect and abuse, the period of lockdown, being away from school and in their traumatic home environments may have heightened their stressors.  While for others, the extended lockdown period might provoke anxiety at the thought of going back to school.  What if the school environment itself was traumatic for the child?  Certain events like peer bullying, racism, sexism, and general prejudice toward certain students could make school itself full of trauma. 

Other traumatic childhood experiences include:

So, realize the circumstances.

Do not forget the adults while dealing with a child’s trauma

Someone once said, “when a flower doesn’t bloom, you fix the environment in which it grows; not the flower”.

When dealing with trauma in children, do not forget the adults.  Realize the impact of trauma on care-givers, family members, first responders, service providers, and others who may experience secondary stress (trauma-related to exposure to another person’s stressful situations).  Know that the adults surrounding the child maybe going through similar traumatic experiences like a community violence, racial violence, death of a family member or even a pandemic.  At such circumstances, the adults may need the same kind of intervention as the child. 

If you are the adult caring for the child, look within yourself and see if there is any unresolved childhood trauma there.  NOT ALL TRAUMA COMES IN THE FORM OF NEGLECT, VIOLENCE OR ABUSE.  Perhaps you had a happy childhood.  You were well fed, had loving parents, and had great schooling for the most part.  Most of the times, the easiest way children find a way out of trauma is to be in a state of denial.  Were you often labelled as ‘shorty’, ‘skinny’ or excluded from peer groups because ‘you are too brainy’ as a child?  How did you deal with it?  Perhaps you told yourself that is ‘okay’.  ‘It is okay to be labelled.  It is okay to be treated as the ’second best’.  It is better to just ‘deal with it’.  There begins a trial of unresolved trauma.  If this was your childhood, look deep within yourself for any signs of unresolved trauma.  You have a right to heal.  You have a right to gain back your sense of control, your sense of fulfillment and your sense of belonging.   When you have unresolved conflict within you, you unintentionally transfer these experiences in your children by telling them ‘It is okay’.  A distant relative once said to me “When a ‘uncle’ frequently touched me in a way that made me uncomfortable; I confided in my mother.  I was told to keep quiet and avoid creating family conflicts.  I was forbidden to ever speak about it’.  This attitude from a parent figure can leave disastrous effects in the tender minds.

Recognize

Recognize the signs and symptoms of trauma.  Trauma may manifest itself in many ways.  Does a child seem hyper vigilant?  Does the child throw tantrums at the mention of a doctor’s visit or a physical exam?  Does the child like to stay alone, away from peers, engaging in solitary activity?  Does the child seem excessively fearful or quiet with a particular individual?

Although not definitive, these are some of the telltale signs of trauma in children

-Difficulty in remembering or processing information

-Difficulty in eating or sleeping patterns

-Difficulty in maintaining trustful relationships

Lack of impulse control

Difficulty in expressing one’s feelings or emotions

Poor self-esteem

Lack of confidence

Problems related to attention and concentration

Heightened sense of guilt and shame

Respond

How do you respond when a child you associate with has been experiencing a traumatic event?

There is no one-size-fits-all approach, given the individual differences, the different perceptions towards the stressors, and the coping strategies.  Work through the Maslow’s hierarchy of needs.  Are the child’s basic needs of food, water and shelter being met?  Is the child’s physical safety (actual and perceived) being threatened?  Is the child’s self-esteem and confidence being challenged through bullying, peer shaming…..etc.?

Create an environment that feels physically and emotionally safe.  Teach them to express themselves through art, drawing or role play.  Re-enforce safety. Teachers, educators and others who associate closely with children should be trained to communicate with the kids in a safe and non-threatening manner.  Children may need professional help to re-learn emotional regulation, language and communication skills, to build trust and healthy relationships; to identify the early triggers and developing strategies to cope with them. 

Resist re-traumatization

What are the circumstances in which a child may be re-traumatized?

Re-traumatization maybe caused by stressors that may remind the child of the original trauma.  It could be the smell, physical space, lighting, memory, or even a new relationship that is similar to a previously traumatic one.  Eg: A physician or a nurse asking a child to undress for a physical exam can bring back flashbacks of a previous sexual abuse or being caught up in an enclosed elevator may bring back fearful responses of being locked up in a room.  Anniversaries of traumatic events, for instance death of a parent may cause flashbacks in some children.

Tips to avoid re-traumatization:

Act calm.   Provide reassurance.  If they are open to touch, hugs help.  Do not force affection on them but take it one day at a time. Do not panic in front of a child.  Do not discuss the details or repercussions.

• Make your child feel safe.   Immediately remove them from the traumatic environment.  Let them know you will stand by them no matter what.  Maintain a non-judgmental attitude.

• Avoid frequent questioning the child of the traumatizing experienceIf you need to ask questions for therapy or to gather information, provide sufficient time to recover and heal before proceeding further.  Let them know, that it is okay not to talk if it makes them feel overwhelmed

If re-current sessions are required, try to establish a routine and prepare the child well in advance

       Bring back the routine.  Amidst chaos and change, routines reassure children that life will be okay again. Follow through with your house rules.  Establish new routines. 

         Help the child and the care-takers identify potential triggers.  Let the child describe what feels safe or unsafe.

        Teach them mindfulness, deep breathing or explore healthy coping strategies according to the child’s developmental stage.  Understand that children cope in different ways. Some need more time to heal and recover.  Let them know it is okay.  If they experience anger, guilt or shame, let them know that emotions to an extent are a normal part of healing. 

     Know the resources available.

a)            Child help Hotline:  1-800-4-A-CHILD (1-800-422-4453) Text, Call or Chat.

b)            https://www.childwelfare.gov/pubs/reslist/tollfree/ has several useful numbers based on the child’s case.

c)            If you need to report instances of child abuse, this website provides contact information of child protective services state wise.

https://capsli.org/reporting-abuse/individual-state-hotlines/

d)            NAMI provides valuable help and mental support to individuals with different mental health needs. To contact the NAMI HelpLine, please call 800-950-NAMI (6264), Monday through Friday from 10 a.m. to 6 p.m., ET, or send an email to info@nami.org