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Introduction

Children and young people have many accidents and frights and this is a natural part of growing up. However, sometimes events can be more extreme and traumatic, when the child or young person's physical or emotional well being is threatened or even harmed.

Types of traumas may include:

• Severe accidents, natural disasters, war, car accidents, fires, etc.
• Witnessing another person being harmed
• Being physically or sexually abused

Reactions to a traumatic experience can differ greatly from person to person. It is important to understand that just because a child or young person has experienced a traumatic event, this does not mean that they will inevitably suffer severe emotional consequences as a result.

Factors that influence how much children and young people react to a traumatic event include the age of the child and their ability to understand the event, the nature of the event itself, the level of exposure, whether it happened to themselves or to others, the gender of the child, their personality and functioning prior to the event, how quickly they can return to a normal lifestyle after the event, their support network and people around them, and whether they have experienced a traumatic event in the past.

Experiencing or witnessing a traumatic event can make a child think that the world around them is no longer a safe and predictable place. This is very frightening, and they are worried that the even will happen again and that they or someone in their family will come to harm or even die. The event itself can be hard to understand for children, and this alone can sometimes lead to a lot of fear and anxiety as a result of the traumatic event.

Specific reactions to a traumatic event can differ greatly from person to person, and also with the age of the child. Quite often, reactions to a traumatic event consist of a seemingly contradictory cycle of trying to avoid any reminders of the event (such as denial, not wanting to talk about it, or even physically avoiding the place where it happened or things that remind the child or young person of the event, etc.) but at the same time re-experiencing the event in many ways over and over again (nightmares, re-enacting the event, distressing reactions towards any reminders of the event, etc).

At the same time, reactions to traumatic events are often accompanied by being in a general state of heightened arousal, such as agitation, nervousness, poor concentration, changes in appetite, irritability, crying, worry and anxiety as well as being easily startled.

Of course the ways in which children and young people respond to a traumatic event can be very different depending on the age of the child. Younger children may start behaviours again that they had grown out of, such as tantrums, thumb-sucking or bed-wetting. They may start to cry more often than they used to, become frightened easily and start being excessively clingy. Young children (under the age of 5) also sometimes re-enact the event repeatedly.

School-aged children may become moody, blame themselves for the event, become more aggressive and angry, withdraw from their friends and school, and worry about not being taken care of, as well as being frightened and tearful. They might deny that the event occurred but at the same time asking a lot of questions about it. At this age, children often feel angry and sad about the event, and feel guilty that it happened to them. Sometimes they show a deep desire to help others in need, and worry greatly about the safety of their loved ones.

Teenagers may also become more angry and upset, and withdraw from their friends and other important social activities. They may also become more moody and show signs of feeling depressed, and are anxious about the future. Their appetite and sleeping patterns can change as well. Sometimes teenagers start using alcohol and drugs after a traumatic event, or engage in other high-risk or illegal behaviours.

It is important to understand that coping with traumatic experiences is a complex challenge, and therefore the reactions to the event can be very different and unpredictable.

Things to think about                                                                      

Many children and young people will experience or witness a potentially traumatic event at some point in their lives. This does not automatically mean that they will suffer serious emotional consequences as a result. In fact, sometimes traumatic experiences can even function as 'eye-openers', leading individuals to appreciate their lives and time with their loved ones more than before.

However, it is also not unnatural to feel afraid and stressed after a traumatic event, and often these reactions do not last for very long. However, it can be the case that severe reactions to a traumatic event can last for a long time, even months and years, and in this case a specialist should of course be involved.

Remember that the specific reactions to a traumatic event or experience can differ greatly. And to some degree these reactions are completely normal. After all, traumatic events can be very severe, so an initial strong reaction should not be entirely unexpected. Reactions to a traumatic event only become problematic if they are very severe, last for a long time, or result in the child or young person not living their life the way they did before the event, e.g. withdrawing from their friends.

It is also possible for a child or young person to only show emotional reactions to a traumatic event after some time has passed.

It is often helpful to children and young people to talk about the traumatic event, or to just express their feelings about it. This can help with understand the event, and to feel less alone and scared about it. However, this is not always the case, and some people prefer not to talk about it at all. It is important not to be pushy and simply to respect this.

Think about yourself                        

Your own experiences of how you or others have coped with trauma will have a bearing on how you respond.  Being aware of these biases and responding to the individual child and their specific situation is the best way to be helpful.  For example, if you have had a similar traumatic experience, or their experience provokes strong emotions in yourself, you may not be the right person to talk to at this time.  Being aware of your own ability to cope with discussing issues of trauma is important, so that you do not deter a young person from talking about a traumatic event in their life.

What you can do                                                               

• First things first - ensure that the child/youth is safe and out of danger. Ensure that basic needs, such as food, shelter, clothing are met.
• Give reassurance to the best degree that you can. If you can guarantee that the child can be kept physically safe, then make that guarantee. Often times however, you cannot absolutely guarantee that bad things won't happen. In those cases, guarantee what you can, e.g. that you love them and no matter what happens, your love with always be with them. E.g. that there will always be someone to take care of them, etc.
• Give extra attention and consideration following a traumatic event. Recovering from a traumatic event is difficult and so child/youth may extra love and caring during this time.
• Try to stick to routines as much as possible. Routines help the child return to their normal lives, and make the child or young person feel safe and secure. Make sure you stick to the routines and the limits that you set.
• Encourage the child or young person to express their feelings. For young children you can encourage them to express how they are feeling through play, art, or storytelling, and for young people be available to talk to them. At the same time it is very important that you do not force them in any way to talk about their experiences, or make the child or young person feel like they should talk to you. This is very personal and entirely up to them, so respect their wishes. For more information, see section on counselling techniques.
• Acknowledge and validate how your child/youth feels. When listening to a child/youth talk about their feelings, accept that those are their feelings by remaining calm and validating how they feel. Don't invalidate or belittle their feelings by telling them that they shouldn't be worried, or that "that's such a silly thing to worry about."
• Validate negative feelings, but don't forget about positive feelings. Its important to validate how your child feelings, but excessive validation of negative or unpleasant feelings isn't healthy. Its important to validate other, more positive feelings (and behaviours) such as caring and empathy.
• When asked questions about the event, give simple but honest answers. Make sure that your answer will help the child understand the event better, and not confuse them more about it.
• If possible, try to avoid extra stress in the child or young person's life, such as big lifestyle changes, etc.
• Encourage getting back to a normal life (school and recreational activities) as soon as possible.
• Encourage the young person to take part in physical activities, such as sports or relaxation.
• Fight feelings of powerlessness by giving your child/youth something to do to take action. E.g. it might range from young children simply expressing themselves, or for older children, it might be actual involvement in an organization that works to prevent future traumatic events... E.g. if the trauma is the loss of a family member due to mental illness, then involvement in a mental health advocacy group may be helpful.

How to know when your child is doing better

Every person deals with trauma different, however some signs that your child is recovering/recovered from the trauma include:

• Ability to talk about the tragedy openly with friends and family
• Ability to resume day-to-day school and social activities
• Ability to resume day-to-day routines and activities at home

When to contact a health professional     

If a child/youth is having problems that are not going away, then speaking your family physician, paediatrician or local children's mental health agency.

About this document

Adapted from "Trauma", from Hands On Scotland (http://www.handsonscotland.co.uk/) an online resource for those working with children and young people, developed by the Playfield Institute (National Health Service Fife), in partnership with Barnardo's and the University of Dundee. Special acknowledgements in particular to Derek Harley, Information and Resource Nurse.

Disclaimer

Information in this pamphlet is offered ‘as is' and is meant only to provide general information that supplements, but does not replace the information from your health provider. Always contact a qualified health professional for further information in your specific situation or circumstance.