Children grow into trauma, not out of it, according to Dr Nicole Milburn, Clinical Psychologist and Infant Mental Health Consultant. She reveals the way children experience trauma in the early years, and the longer-term implications if trauma goes untreated.
What kinds of things could be traumatic for a very young child?
Firstly, it is important to remember that trauma is not the event but the reaction to the event. A traumatic reaction is one where the body’s primitive defense mechanisms are activated - stress hormones flood the system as the person prepares for fight, flight or freeze. We are beginning to understand that repeated trauma responses, without the chance for recovery in between, are what most likely leads to Post-Traumatic Stress Disorder.
If we consider that the reaction to the event rather than the event itself is traumatic, this means that what is traumatic for one person might not be for another. A good definition of trauma is anything that overwhelms the ego’s capacity to cope. This definition firmly places trauma into a developmental context. Consider whether it is traumatic to be left alone in a room for three hours. This might be wonderful for a busy adult and life-threatening for a four-week old baby.
Although it is always important to consider the age and developmental stage of the infant or young child when considering trauma, some experiences are inherently traumatic for small children. Some examples are:
physical or sexual abuse
seeing their primary carers hurt or hurting each other (eg family violence)
being left or forgotten (eg not being picked up from pre-school or care)
being lost (eg at a shopping centre).
What kinds of effects might there be if an infant has experienced a traumatic event or longer-term trauma?
We can see trauma responses in babies and young children in things such as an exaggerated startle reaction, repetitive play that doesn’t change (this can look like an Autism Spectrum Disorder at times), and blank facial expressions. Sometimes, toddlers and preschool-age children will act out traumatic events in their play. This can often be distinguished from the normal aggressive play of children and the enjoyment on their face. Children enjoy the ‘goodies’ shooting the ‘baddies’ in normal play but, in traumatic play, someone being shot or beaten up is not fun for the child. This can be seen in their facial expressions and language. We can also see disrupted physical and emotional regulation, such as feeding and sleeping problems as well as difficulty soothing.
One of the great problems with developmental trauma is that responses to trauma can be embedded into the way the growing child organises him or herself in the world. If a trauma reaction has been prolonged, then the child can generalise the response. For example, children who have to be hypervigilant to prepare themselves for the next episode of family violence can find it very difficult to focus in an early learning setting.
How do infants experience trauma compared to older children?
Infants have fewer coping mechanisms than older children - they have little independent movement and few words, for example. When infants are traumatised, we see signs such as avoiding eye contact, irritability out of the normal range or different to previous, and wakefulness or extended sleep patterns. In rare occasions we see infants shut down or ‘switch off’ from the world. Older children can communicate their experiences more clearly, although it is still sometimes hard to understand. Older children might simply tell you something terrible is happening, sometimes at quite inappropriate moments, or they might show it in drawings or play.
What are the long-term effects of trauma experienced in infancy?
Trauma in infancy often occurs within their primary attachment relationship. This means the people who are there to keep them safe are unable to do so or, worse, actually harm them. Infants who suffer trauma often have relationship problems as they develop as well as trauma symptoms. For example, infants who suffer trauma by a primary attachment figure can then become avoidant of relationships and predominantly self-sufficient for their needs. Or, they can become anxious around their attachment figure, checking on them, showing that they need them because they’re not quite sure that their attachment figure will hurt them or help them. A much more problematic pattern is found when infants are unable to work out a way to have their needs met from anyone, and they can be seen to come to an adult and then move away or be otherwise quite confused. Within this framework, there would also probably be some regulation difficulties, perhaps some hypervigilance or fear responses from the trauma.
What is the best way for parents and carers to support an infant who has experienced trauma?
First and foremost, it is vital that the infant is made safe. This means stopping any frightening experiences and providing regular, responsive, and attuned care so that the infant can recover from the hyperarousal and feel that they can be kept safe. It is also important to talk with the infant or young child about what happened and reassure them that the experience is over.
What kind of treatment is available for these issues?
There are child and adolescent mental health services in most regions that provide mental health treatment to infants and children. Paediatric or perinatal psychologists are also available through Medicare. The most important thing is to speak to someone about it as soon as possible - infants do not grow out of trauma; rather, they are more likely to grow into it and have the trauma symptoms embedded in their personality.
See our KidsMatter family information sheets on trauma in early childhood.