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Trauma in children and adolescents

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Introduction

In our society it has become a sad fact that a huge percentage of our children are subjected to some kind of traumatic life event. Trauma can change a child’s view of the world – assumptions about safety and security become challenged. Children’s reaction will depend upon the severity of the trauma, their personality make-up and the availability of support. It is crucial that children undergo trauma debriefing as soon as possible after a traumatic event (preferably within the first 72 hours). If it is left to late we get the brain’s reworked versions of the events and many triggers get suppressed into the sub-conscious only to resurface at a later time. This could lead to the development of Post Traumatic Syndrome.

What are the effect of trauma in children?

It is natural for children to first experience some sort of denial, they feel a sense that what has happened feels unreal to them. Fears, nightmares and sleep disturbances are also common. Younger children may begin to regress emotionally or act younger than their chronological age. Thumb-sucking and bedwetting are common examples. They also may become more clinging and develop separation anxiety. Feelings of irritability, anger, sadness or guilt might emerge. Somatic complaints such as headaches or stomach aches are not unusual. Some loss of interest in school and poor concentration are other common reactions.

It needs to be emphasized that these symptoms are a normal reaction to an abnormal event. Children should be reassured that these symptoms will soon disappear. However, if these symptoms persist for a period of more than 2 weeks, it becomes necessary to seek professional intervention.

Children of different ages react in different ways to trauma

Birth to 2 years. Without the ability to speak children cannot describe their feelings. They retain memories of particular sounds, sights and smells which can act as triggers which force them to relive the trauma. Babies may be more irritable, cry more often and need to be held and cuddled frequently , while traumatic memories may emerge in the play of older children.

Preschool children. In the face of an overwhelming event, very young children can feel helpless and unable to protect themselves. When the safety of their world is threatened, they feel insecure and fearful. Children this age find it very difficult to comprehend the concept or permanent loss and often believe that the consequences are reversible. They will repeatedly recreate parts of the trauma in play. This is a normal and healthy reaction.

School age (7-11 years). Children at this age have the ability to understand the permanence of loss from a trauma. They can become preoccupied with the details and want to talk about it continually. This should be encouraged – the healing is in the retelling and the consequent desensitizing effect. They may not be able to concentrate in school and a drop in their grades is to be expected. Since their thinking is more mature this can result in a wide range of emotional reactions including; sadness, fear and anger. Children can be helped to deal with these emotions through activities such as play acting, drawing, sharing their experiences in groups and creative writing.

Adolescence. In this age group children may feel the need to share their anxieties and fears with their peers. Because they survived the trauma, they may feel immortal and this can lead to reckless behaviour and taking dangerous risks. Psychotherapy is effective with this group and often cognitive behavioural therapy is used to help them to positively reframe the events. In some cases medication may be used to control severe anxiety, depression or insomnia. However this should not be used as a substitute for psychotherapy for traumatized children.

What can I do as a parent to minimize the destructive effects of trauma?

  • Establish a sense of safety and security. Ensure that all basic needs are met, including love, care and physical closeness. Spend extra nurturing time with your child and provide a lot of comfort and reassurance. The family should make every effort to stick to their usual routines – meals, activities and bedtimes – as this provides the child with a much needed sense of predictability and security.

  • Listen actively to your child. It is easier for children to describe what happened on a sensory level (eg. What they saw, heard, smelled and physically felt) before they can discuss their feelings about the trauma. Often, children will want to tell their story over and over. Although this can be quite difficult for parents to hear, retelling is part of the healing process.

  • Validate your child’s feelings. Help your child to understand that what they are experiencing is normal and to be expected. Emphasize that it is temporary and that they will not always feel this way.

  • Allow your child the opportunity to regress as necessary. For example, your child may request to sleep in your bed or with the lights on. Aggression may emerge in a non-aggressive child. Be patient and tolerant and never ridicule. Remember that most regression following a trauma is temporary.

  • Communicate with the school about what has occurred. Most teachers will be understanding and helpful if they know that a child has been through a traumatic experience.

  • Get professional help. Seeing a psychologist does not mean that your child is mentally ill or that you have failed to support them. Following a trauma many children and adults have found that it is helpful to talk with someone who has specialized training in post-traumatic reactions.

Conclusion

Remember that children are resilient and with the proper support can make a full recovery from trauma. Affirm that your child is capable of coping in the aftermath of a trauma. Plant emotional suggestions that express confidence in your child’s ability to heal. Children should gain a sense of mastery – they need to feel that they did their best in a difficult situation and have come out stronger and in control of their lives.

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