Treating Childhood Trauma

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By Nicole Gregory

Being in a car accident or a fire, or witnessing a violent adult fight, can so damage a toddler’s sense of safety and security that she may withdraw, become anxious and even regress in her development. Restoring that sense of safety is critical to a toddler’s recovery, but how a parent should do this may not always be obvious or easy, especially if the child hasn’t learned to talk. Here, experts explain how toddlers struggle to cope with a traumatic experience and the most effective ways parents can help.

Symptoms of trauma

Trauma is defined as witnessing or being confronted with actual or threatened death, but even less dramatic events can be traumatic for toddlers. A fall from the top of a play structure, undergoing a medical procedure or seeing police offi cers chasing a robber, for example, can disrupt a tot’s sense of security.

“For children, we look at it as any event that overwhelms the child’s ability to cope with it,” says Chandra Ghosh Ippen, Ph.D., associate research director of the Child Trauma Research Project at the University of California San Francisco. Symptoms of trauma in a toddler may include becoming withdrawn, clingy, overly excited, jumpy at loud sounds or aggressive toward parents or other children. He may wake up more frequently at night, sometimes with nightmares, or regress in behavior.

“A toddler may seem more anxious or have trouble concentrating,” says Barbara Ryan, LCSW, director of trauma counseling at the Chadwick Center for Children & Families at Children’s Hospital in San Diego. If your child starts hitting or biting, understand that he is expressing anger or frustration related to the trauma, says Ryan. “But consistency is important,” she adds. Even if your family has been through a trauma, you must be firm and direct that there can be no biting or hitting. Naming the emotion your toddler may be feeling can also help. Saying “I know you’re having a hard time and that you’re angry” may ease some of your child’s anger.

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How to help

How a toddler reacts depends a lot on how parents react. “They will refl ect their parents’ anxiety,” says Ryan. If, for example, you and your child were in a car accident, you may suffer from anxiety yourself. Get the support and professional help you need to be a stable infl uence for your child. But what matters most is for parents to be there for a toddler who’s been through a trauma. “Reinforce security and safety,” says Eric C. Li, M.D., clinical instructor at the pediatric anxiety disorder clinic, UCLA Semel Institute, Department of Psychiatry. “If one or both parents are working, then it’s advisable for at least one to take time off from work to reassure the child that their environment is safe, secure and stable.”

Should you talk to your toddler directly about the trauma? Yes, say experts, but at the child’s pace. “If you say ‘We had a bad accident and it was scary,’ and your child says yes, then maybe you can keep talking about it,” says Ghosh Ippen, whose group is part of Early Trauma Treatment Network, a national organization for children and their families. “But if she gets up and walks off,” then don’t talk; just cuddle and let her know she’s safe. When you do mention the trauma, or any scary event, emphasize the doctors and firefighters who help people when they’re hurt. Stay positive: Remind your tot that you are always there for her.

Keep things normal

Returning to a regular routine is key to helping a toddler feel safe again. “Maintain a sense of normalcy,” says Elisa Coburn, director of the Susan Sims Bodenstein Preschool in Venice, Calif. Toddlers thrive on routine, and being able to anticipate how their day will unfold builds their sense of security. If a child is in preschool, return her to it soon. “Ask caregivers not to focus on the trauma, but maybe give the child some extra hugs and attention,” says Coburn. Children work out feelings in their play and artwork.

Art gives children control (via choice of media) and a way of expressing what they can’t say, Coburn explains. Toddlers who are able to talk about the event have an advantage. “The more they discuss the narrative of what happened, the more they become at peace with it,” says Li. The downside: They may want to tell this story 50 times a day, for weeks or months, to anyone who will listen. If a child becomes fi xated, seek professional help.

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Get help

Professional help for a toddler who has experienced a trauma is wise. Recovery takes time and a trained therapist can help. Li describes himself as a “talking doctor” to his young clients. This is another step in reassuring your toddler and reestablishing his world as a safe place.

Do’s and Don’ts

Here are some tips from child trauma experts on what to do—and not to do—to help a toddler recover from a trauma.

Do:

» Provide hugs and cuddling. If your toddler is clingy, let him be that way. » Remind your tot that what happened was not his fault.

» Explain what happened in the simplest way possible. Try to name his feelings to help him understand them.

» Let your tot know that you love him, will care for him and will keep him safe.

Don’t:

» Encourage more affection than you would normally exchange.

» Push for your child to talk about the event if he seems reluctant to do so; rather, follow his lead as much as possible.

» Try to talk him out of being angry or anxious.

» Allow aggressive behavior.

ORIGINALLY PUBLISHED IN TODDLER MAGAZINE, SUMMER ‘08

How to restore a sense of safety in your toddler after a frightening event.

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