How Caregivers Can Help Children Heal from Trauma
Four interventions to optimize family support.
Posted Nov 01, 2019
What can I say?
What should I not say?
Is there anything I can do to make things better?
Am I as powerless as I feel?
These are common questions parents and caregivers ask when a child has been hurt, abused or survived a terrifying event. They are great questions and—fortunately—there are comforting and helpful answers generated by research and practice in the trauma field.
Research (Birmes et al., 2005; McDonald et al., 2013; Bovin & Marx, 2011) has established that a person’s immediate experience during a traumatic event and their initial reactions afterward—the peritraumatic experience—can be accurate indicators of later symptomatic responses, as well as being predictive factors of a trauma victim developing Post-Traumatic-Stress-Disorder (PTSD). Practice has demonstrated that early interventions during the peritraumatic phase, particularly with children, can be effective in improving the odds that the child who is initially symptomatic will not progress to PTSD.
Two people may survive the same traumatic event—a car accident, sexual assault, combat experience—and one person may suffer traumatic symptoms while the other does not. There are many factors that may impact how an individual responds to an extreme stress. Therefore, it is preferable to consider the event to be a “potentially traumatic event.”(PTE) This distinction also places an appropriate focus on the person who is impacted rather than on what happened to them, shifting attention from how someone was hurt to how they will recover.
Berkowitz, Stover and Marans (2011) identify “the role of family support as a primary protective factor for children exposed to a PTE.” They point out that caregiver-to-child communication is an essential element of this helpful family support. Child and Family Traumatic Stress Intervention, the clinical approach they discuss, focuses this communication, not on the PTE itself but rather on the impacts of that event on the child and the implementation of strategies to address and reduce those impacts.
Caregivers can make the difference! The right kinds of early intervention can be extremely helpful, especially when administered by parents and other adult caregivers.
Here are four interventions that can be derived from this body of research and from our understanding of PTSD:
- Acknowledge and respond to the PTE’s impact on the child.
- Maintain, restore, or increase structure in the child’s life (particularly those that increase the expression of affection or comfort and those that focus on the child’s competencies).
- Recognize misbehavior and withdrawal as attempts to regain control and respond to them with opportunities to cooperatively increase their control.
- Take care of yourself.
Acknowledge and Respond to the PTE’s Impact on the Child
When children are impacted by a PTE, there are generally four symptom clusters. Three of these—depressive withdrawal, hypervigilance, and sleep disturbance—often become apparent once caregivers know to look for them. Each cluster manifests in behavioral changes following the PTE and do not quickly resolve themselves. A child may begin having nightmares, become resistant to sleeping alone, develop new fears, seek to avoid situations and people that remind them of the event, or lose interest in activities or friends. The fourth symptom cluster, intrusive thoughts or feelings, is often less obvious. A child may be having recurring images and/or sensations related to the PTE; these will usually appear as problematic behaviors which the child may or may not recognize as connected to these intrusive internal reactions.
When a parent recognizes what they believe to be a change in the behavior patterns of their child in the aftermath of a PTE, they should express their own authentic curiosity about the child’s behaviors and emotions. A caregiver might share: “I noticed that since (PTE) you’ve been having a hard time getting to sleep. Have you been thinking or having feelings about (PTE)?” Or “You seem to be having a lot of big feelings today. I wonder if some of your big feelings are from (PTE).”
Try not to judge the effectiveness of these interventions by how verbally responsive your child is in the moment. A big part of what the caregiver is doing here is communicating to the child that after the PTE, it would make sense that they might be feeling, thinking, and behaving differently than they had prior. Opening the door to this potential connection is itself a great help!
Remember that children tend to be unable to identify how they feel and they tend to express feelings in behaviors rather than in dialogue. This means that it is the parent or caregiver’s responsibility to identify the feeling, not the child’s. When the adult is attuned to a child’s emotional states, the child does not only feel understood but also will tend to feel held and protected simply by the fact that an adult is focused on both their external behaviors and their internal experience.
Parents should demonstrate that they are at peace talking about the past, upsetting event by using age-appropriate language that does not minimize what happened. Use of phrases such as “when your cousin abused you” “the time when Daddy hit Mommy” and “ when (name) touched you” can serve to communicate to the child that adults are okay talking about what happened to them and how it is making them feel. The child is not expected to never mention it or to forget it happened.
Specific word choices should always be guided by what the child understands. For instance, “touched you” can be used when the child understands it as a specific reference to an inappropriate touch. This understanding is usually established by the child’s use of the phrase to reference the scary event.
Recovery from the impact of trauma can be described as a process of overcoming fear that is dominating our bodies, minds, and lives. When a caregiver demonstrates fearlessness in facing the fact that a scary event happened, without avoidance or minimization, they help the child to believe that they, too—with the support of their caregivers—can face and manage what otherwise feels overwhelming.
Berkowitz, S.J, Stover, C.S, & Marans, S.R. (2011). The Child and Family Traumatic Stress Intervention: secondary prevention for youth at risk of developing PTSD. Journal of Child Psychology and Psychiatry, 52:6; pp 676-685
Birmes, P.J., Brunet, A., Coppin-Calmes, D., Arbus, C., Coppin, D., Charlet, P., Vinnemann, N., Juchet, H., Lauque, D., BovSchmitt, L. (2005). Symptoms of peritraumatic and acute traumatic stress among victims of an industrial disaster. Psychiatric Services, 56, 93-95
Bovin, M.J., & Marx, B.P., (2011). The Importance of the Peritraumatic Experience in Defining Traumatic Stress. Psychological Bulletin, vol. 137, No 1, 47-67.
McDonald, P., Bryant, R.A., Silove, D., Creamer, M., O'Donnell, M., and McFarlane, A.C., (2013). The expectancy of threat and peritraumatic dissociation. European journal of Psychotraumatology, 4: 10.3402/ejpt.v4i0.21426.