CARING FOR THE TRAUMATIZED CHILD
Patricia Koch, Ph.D.
What is trauma | How trauma affects the brain | How trauma affects behavior | What can parents do to help
What is trauma?
When a person feels threatened, the body responds with alarm to avoid danger. When the body senses danger, chemicals are released into the bloodstream that make the heart beat faster, blood pressure increase, and breathing quicken. The person also may be very aware of the things that are happening around him. These bodily responses prepare the person to escape from danger or fight if necessary.
Trauma occurs when an individual feels that his/her life is threatened. The extent to which a child feels traumatized depends on many different factors. However, we know that domestic violence, fights and murders in neighborhoods, physical abuse, sexual abuse, and serious car accidents are traumatic events that can affect the child's future. Being abused or exposed to violence may influence the way the child thinks about the world, acts, and gets along with other people. Also, we know from brain scans of traumatized children that changes occur in the brain when children experience trauma.
How does trauma affect the child's brain?
The brain's job is to take in information, organize information, and act on information to help the child survive. We know that the brain grows very quickly before the child is born and during the first two years of life. The brain forms connections after the child is born. These connections are like telephone wires and connect cells in the brain with each other. Information goes back and forth on these connections. Research tells us that the number of connections, as well as how well information is able to travel back and forth on these connections, is influenced by how a child is cared for and the child's experiences. These connections are very important in determining how well your child learns, your child's attention span, and how your child gets along with other people.
Even more important, we know that there are prime times when certain parts of the brain are growing and developing. When the child is traumatized and not cared for during these special times, parts of the brain may not develop as they should. For example, if a child is rarely spoken to or read to, she may have problems learning language later in life.
As a child grows and learns, special parts of the brain develop that tell the child to use words instead of hitting, kicking, screaming, and biting. However, when a child is repeatedly in danger, it is hard for the brain to develop connections that help the child do other things besides hit, kick, and yell. If the child has to always watch out to stay safe, this keeps the child from exploring and learning about the world. We also know that it is important for a child to be held gently and lovingly touched so the brain can develop connections that allow the child to feel safe and connected to other people.
How does trauma affect a child's behavior?
Children that are traumatized repeatedly or severely, see their world as being unsafe. Instead of looking around and learning from the world, a child will look for cues that suggest he needs to watch out for danger. When a child is traumatized she stores information in the brain about unsafe situations that she may need to protect herself from in the future. Thus the child will pay attention to certain cues (sights, sounds, smells, kinds of touch, people, facial expressions) that she believes will predict danger. The child will come to think that certain sounds, objects, or people are unsafe and will either begin running, fighting or freezing as a way to be safe. For example, if the child was sexually abused in the bathroom, the child may refuse to go into the bathroom or want a safe adult to stay with her. Or if a child was beaten severely, the child may start to run away anytime he sees an angry face. Because it is hard to know what cues were present when a child was traumatized, caregivers may notice that a child's behavior is very unpredictable at times.
Trauma affects the way the brain organizes itself, especially when a child is traumatized in early life. Sometimes the child may have very intense feelings which are shown through hitting, kicking, screaming, biting, or running. Sometimes you might be very surprised by the quick change in feelings the child shows. Many traumatized children feel guilty because they think they caused the trauma or abuse, and they think that every problem is their fault. Because they could not control the abuse, children may try to control every situation or constantly say "no" to any request.
In addition, the traumatized child may be aggressive to others or animals, have problems with sleeping and nightmares, wet or soil his pants, have difficulty trusting others or seek attention from anyone, have difficulty calming down, refuse to eat or eat constantly, destroy toys or hurt oneself, frequently masturbate or try to have sex with peers, stare blankly when spoken to, and/or be extremely active.
What can parents/caregivers do to help the traumatized child?
First it is important to understand that trauma affects the way the child views the world and the way the brain interprets information. In addition, traumatized children often lack skills and need nurturing, limits and education to be successful. Just loving a child will not make the trauma go away.
1. Be understanding when the child talks about the traumatic event. Trauma-related thoughts do not disappear with time. If the child constantly talks about the trauma, set aside a special time to talk about the trauma. This way the child learns not to let thoughts of the trauma constantly interfere with life. If the child repeatedly plays out the trauma with toys, help the child identify ways to be safe. Playing out trauma, where the child is always unsafe or hurt, is not beneficial to the child.
2. Provide a predictable environment. Make sure the child knows the daily routine. Talk to the child about what you will be doing next. Always discuss any changes in the daily routine with the child before they happen.
3. Give the child choices when appropriate. Traumatized children feel very powerless over their lives. A child can choose clothes for school, which toys to sleep with, how to wear her hair, and so forth. Also avoid power struggles. Traumatized children are experts at engaging adults in power struggles. Find ways to offer choices, distract, or help the child see other perspectives. If the child is having difficulty following directions, offer the consequence as a choice. For example, "you have to stop stepping on your toys or your toys will go to time-out."
4. Teach empathy and help the child identify and label feelings. Talk to your child about your feelings and how your face looks when you have certain feelings. Help the child recognize feelings other children have when his behavior is aggressive or hurtful. Teach gentleness through touch and labeling.
5. Identify key behaviors to change. Reward any effort toward new behaviors. If not dangerous, ignore unacceptable behaviors. Be consistent and give frequent verbal rewards. Positive reinforcement works much better than negative consequences.
6. Let the child know exactly what is acceptable. Make sure the child understands what you want and what the consequence is for noncompliance. Verbally tell the child each time he is doing what is expected.
7. Help the child learn ways to calm down. Frequently traumatized children are agitated and anxious. Teach the child deep breathing and/or visualization of himself being calm. Provide experiences that are calming such as brushing hair, bathing, singing, swinging, rocking, or drawing.
8. Be nurturing and comforting. Be aware that the child may have had experiences with his body that felt unsafe. Let the child initiate physical contact. Abused children have body memories of trauma and may become upset when touched or approached in certain ways. Avoid telling the child to kiss or hug any person. This should be the child's choice.
9. When children sexually act out, set clear limits. Avoid placing the child in any situation that tempts the child to sexually act out. Avoid bathing the child with other children or having the child share a bed with others. You may need alarms on doors so you know when the child is out of bed. Closely supervise the child. Be clear with the child that sex is for grown-ups.
10. Protect the child from being retraumatized. If the child becomes upset by certain people, movies, or interactions, help the child do something else. Talk to the child about his feelings and what upsets him. Help the child talk about what scares him about a certain situation.
11. Be aware that traumatized children may dissociate or space out. If the child is not doing what you ask and you become more and more demanding, the child will retreat further and further inside and become frozen. A child in this state is unable to follow adult requests. Help the child be present by letting the child know she is safe. Recognize experiences that trigger memories of the trauma and be supportive of the child.
12. Be prepared for intense emotions with little or no warning. Help the child learn ways to manage these emotions. Give yourself and the child time to calm down. Talk with your child about ways to make her anger small. Do interesting things with anger - vacuum it up, throw it in the trash or out the window, stomp on it, shoot it out to space. Be creative and use humor whenever possible.
13. Help the child see the world as a safe place where adults can protect children from hurt and harm. Help the child play and enjoy himself. Do fun activities together. Help the child see another side of life that is not painful and frightening.
Top of page |What is trauma | How trauma affects the brain | How trauma affects behavior | What can parents do to help
Updated January 12, 2005