By Leisa Pritchard – Psychologist
Ruby* was 6 when her parents bought her for counselling. Although Ruby was a bright child, they had concerns that she was falling behind her peers socially and emotionally and had some troubling behaviours. After an initial assessment it became clear that Ruby had experienced multiple traumatic events. Ruby had a heart condition that had led to many hospitalisations and medical procedures in her young life.
What is trauma?
Trauma is an event that overwhelms the central nervous system impacting a person’s ability to make sense of what has occurred. For children this may be an event that they have found frightening, difficult, or sad. Experiencing trauma may change the way a child remembers and reacts to reminders of the event. These reminders are often referred to as “triggers”, as they fire up the “body’s memory” of the overwhelming stress response that occurred because of the traumatic event/s. It can be helpful to think of it like our body getting stuck at the time the event occurred.
When does trauma occur?
One way to understand the nature of trauma and its impacts on children is with the terms ‘Big T’ and ‘Little t’ trauma. ‘Big T’ trauma refers to life threatening events such as an accident, natural disasters, a single instance of significant sexual or physical abuse, the unexpected death of a parent, or even witnessing any of these things.
‘Little t’ trauma is recurring adverse experiences such as bullying, repeated medical procedures, exposure to substance abuse or domestic violence, or witnessing a significant world event. Repeated exposure to little “t” traumas can have a similar impact on a child to Big “T” traumas.
It is important to understand that not every adverse event will traumatize a child. If the child perceives that they were able to escape the “danger” they may be able to process the event in a healthy way. The first 1000 days of life and various points during adolescence have been identified as crucial developmental periods where a child is more prone to be adversely impacted by stressful life events.
Due to her developmental stage, Ruby was not able to understand why she had to go through the pain of the medical procedures. Therefore, she couldn’t make sense of her experiences. What is even more difficult is that her loving parents often had to restrain Ruby during the procedures. Although the actions of her parents and health professionals were necessary to keep her safe and healthy, Ruby’s nervous system knew no difference.
What are the signs that my child is struggling with trauma?
- Some signs that a child may be experiencing a traumatic stress response can be:
- Becoming withdrawn or shutdown
- Distressing emotions that feel unsolvable for the child
- Anxiety and worry
- Odd or out of character behaviour
- Violence
- Periods of zoning out, acting unlike themselves or forgetting things that they have done
- Changes in play; repetitive depressive or violent play
- Somatic symptoms such as tummy or headaches
- Changes to engagement with peers, attending school, and participating in activities previously enjoyed
- Regression of skills
- Nightmares and/ or bed wetting
- Separation anxiety.
Ruby has strong emotional reactions to the mere mention of doctors. She struggles to maintain friendships, avoids school, and her teacher reports that she often appears “zoned out” during class. Ruby’s early experiences have led her to distrust her caregivers. Her parents are concerned because although Ruby has severe separation anxiety, she often lashes out at them physically. Her parents struggle to provide appropriate discipline as Ruby often has no recollection of these episodes.
Putting the pieces back together
A child can heal and move forward from their trauma when a sense of safety is restored in their life and relationships. A child can be helped to make sense of their experiences, understand that they are events of the past, develop a felt sense of safety, and identify people who love and protect them. Due to the nature of trauma, simply telling your child these things may not be enough. However, there are things a caregiver can do to support their progress toward healing:
- Let them know that their emotions make sense given what they have been through
- Let them know that you think they are brave and courageous
- Provide lots of time to connect with you
- Routine and consistency will help provide familiarity and predictability, helping to restore a sense of safety
- Exercise, good nutrition, and sleep routine to help regulate stress within the body
- Play, play, play! Never underestimate the power of playing with your child every day. Play is a child’s occupation, and they are often processing their thoughts, feelings, and experiences within play.
Having protective factors such as a supportive family, nurturing caregivers, stable relationships, stability, and structure at home, caring social connections, and adequate housing, finances and healthcare can act as a “buffer” to trauma.
Seeking the right help
If you suspect that your child is showing signs of traumatic stress after adverse life events, it is important to seek the advice of a trauma–informed health professional. Ask questions such as what experience they have working with traumatized children, what approaches they use, and what the therapy process will look like.
Therapy with Ruby involved restoring a sense of safety within her body and environment, supporting the repair of relationship ruptures with her parents, and helping her to process the troubling memories of the medical procedures by using age–appropriate therapeutic play, EMDR, somatic (body) regulation, and attachment–based approaches.
Having a child that has experienced trauma can be devastating for parents. However, change, healing and growth are possible with the right support.
*denotes fictional example
Leisa Pritchard is a Psychologist and the Co–founder of The Heart and Mind Collective, a private practice on the Central Coast providing psychological assessment and treatment to children, teenagers, & adults. Leisa has special interests in the areas of trauma, gender diversity, Autism Spectrum Disorder, ADHD, and EMDR. Contact Leisa on 02 4327 9435, or visit https://www.heartandmindcollective.com.au for more information.