Kids and Trauma: Why It’s Not Just a Phase (But It Might Feel Like One!)

In this episode of MomDoc Talk, host Kristen Cook delves into the complexities of helping children navigate trauma and difficult situations. The discussion highlights the importance of acknowledging and addressing trauma in children, recognizing that different age groups process traumatic events uniquely. Emphasis is placed on the critical role of parents in providing emotional support, maintaining open communication, and understanding their children's perspectives. The episode underscores the necessity of creating a nurturing environment to help children cope with grief, loss, and other life challenges, ultimately fostering resilience and emotional well-being.

• Importance of acknowledging and addressing trauma in children
• Different ways children of various ages process traumatic events
• Role of parents in supporting children through trauma
• Need for open communication and emotional support
• Unique perspectives of children coping with grief and loss
• Impact of trauma on infants and the importance of secure attachment
• Behavioral changes in toddlers and preschoolers after trauma
• Understanding the permanence of death for school-aged children
• Coping mechanisms and challenges faced by teenagers
• Importance of parental self-care and emotional well-being in supporting children

The information in this podcast is for educational and informational purposes only. It is not a substitution for professional medical advice, diagnosis, or treatment. Always seek the advice of your healthcare provider for medical issues. All the opinions are of Dr. Kristen Cook and do not reflect the opinions of her employer nor the hospitals she is affiliated with. The authors and publishers of this podcast do not assume any responsibility for errors, omissions, or consequences of using the information provided.

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Transcript

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As a parent, the last thing we want is to watch our child try to navigate a challenging situation. We instinctively want to shield our children from grief, loss, sadness and anything difficult that life throws their way. Yet, attempting to shield our children from life's challenges can actually harm our children more than it helps them. As a mom, my heart breaks every time that one of my children cries. I hate watching them try to cope with disappointment or sadness. I imagine you feel the same way. Yet the truth is that pain and suffering are a part of life. As parents, we cannot ignore this. In fact, we have a responsibility to help our children navigate the tough stuff. I firmly believe that everyone experiences trauma. According to the American Psychological Association Dictionary of Psychology. Trauma is defined as any disturbing experience that results in significant fear, helplessness, dissociation, confusion, or. Other disruptive feelings intense enough to have a long lasting negative effect on a person's attitudes, behavior, and other aspects of functioning. Traumatic events include those caused by human behavior, such as violence, as well as events caused by nature, such as hurricanes. These events often challenge an individual's view of the world as a just, safe, and predictable place. Well, that's clear as mud. Let's simplify. Trauma is a person's emotional response to a significantly stressful event. Certain events may be more traumatic than others. Trauma exists on a continuum. Understanding how our children experience difficult situations is an essential skill for successful parenting. When parents seek to understand how their child experiences trauma and seeks to help that child process the trauma in a positive manner. It fosters healing and growth. On the other hand, ignoring the situation or minimizing its physical and emotional impact will create deep emotional wounds. In my experience, ignoring traumatic events can set the stage for mental health problems, addiction, or worse, attempts at suicide. Trauma is a complicated subject. Before we dive in, please understand that I am not a trauma expert. My intention is to help you view trauma through the lens of child development. My hope is that you are able to understand the experience of trauma from your child's unique cognitive, emotional, and social experience. As always, the following is for informational purposes only. It is not intended to be a substitute for professional medical advice, nor is it meant to diagnose or treat any medical conditions. We have been conditioned to believe that trauma involves a dramatic event such as rape or war. I challenge you to adopt a different perspective. Death. Divorce or separation. Moving long term illnesses and loss of a job are at the top of the list of traumatic experiences. Yet there are many others. As I discussed in a previous episode, my son having to witness the aftermath of my daughter's seizure was an incredibly traumatic experience for him, as well as for me and my husband. After my daughter had her complex febrile seizure, Mason would have behavioural meltdowns whenever Savannah became ill. No matter how minor the illness was. That's my polite way of saying that Mason had massive, excessive, prolonged temper tantrums when Savannah was sick. We ignore these behaviors and they seem to improve. When Savannah turned five and was no longer at risk of febrile seizures. But when Mason was in fifth grade, his school had an unannounced fire drill. He panicked because he was incredibly worried about his sister's safety. His behavioral response was so uncharacteristic that the principal actually called me to express her concerns. Whenever a person experiences trauma, it creates a wound in the bride, a wound that is unable to heal on its own. There are several trauma based treatments that can help heal such wounds. Yet those specific modalities are beyond the scope of this podcast. Let's switch gears and focus on how children understand and process traumatic events. Infants are not immune to experiencing trauma. Neglect and abuse are far more common than most people realize and can lead to profound long term negative consequences. Traumatic events for infants often involve an event that threatens their physical safety or the safety of a of a caregiver. Loud noises and frightening visual stimuli can very much affect infants in a negative manner. In addition, infants are very much aware of the behaviors and emotions of their caregivers. They will recognize if a parent is sad or fearful. They can tell if a caregiver is angry and may in turn become incredibly frightened. If a caregiver expresses that anger in a negative manner. Unfortunately, infants cannot utilize language to verbalize their distress. An infant who is dealing with trauma may demonstrate increased irritability. They may cry more often, or they may cling to a caregiver. They may have a decreased appetite, poor weight gain, or scream for seemingly no reason. Children thrive in an environment that is structured and predictable. Keeping consistent routines is essential for a family who is going through a challenging situation. Infancy is a critical time for the development of secure attachment. Infants should not be away from their primary caregivers for prolonged periods of time. In turn, caregivers need to respond to their infant's needs in a timely manner. There is no such thing as spoiling a baby, so extra snuggles may be helpful. Caregivers who are attempting to help an infant navigate a traumatic event need to be caring, positive, and protective. It's also important for the caregiver to pay attention to their own emotions and actions. Staying calm and keeping expressions of strong negative emotions away from infants is important. That's not to say that caregivers should suppress their emotions. Quite the opposite. Those emotions need to be felt, experienced and processed, just not in front of an infant. Children 12 months of age to about five years of age who experienced traumatic events may act out, they may have excessive temper tantrums, and they may imitate or recreate the traumatic event. During play activities similar to infants, they may become more tearful, clingy, or fearful. Their temper tantrums may increase in frequency, severity, and duration. They may have changes in appetite or sleeping habits. Their behavior may regress in response to the stress, meaning that they act in a manner that is younger than their current age. For example, older toddlers and preschoolers may refuse to use the toilet, or they may want to sleep with a pacifier. It's not uncommon for young children to develop aches and pains. In my experience, stomach aches and headaches are the most common. It's important to take such complaints seriously and take your child to see their primary health care provider if needed. Children are not immune to illnesses that are linked to stress at the same time. Be on the lookout for significantly decreased appetite, change in sleep patterns, social isolation, excessive clinginess and excessive worry. These may be signs of a mental health disorder. It's important to understand that egocentrism is a key feature of this age group. Egocentrism means that children assume everyone sees the world the exact same way that they see the world. They are unable to adopt the perspective of others. In addition, preschool and younger school age children tend to engage in magical thinking. People who engage in magical thinking assume that their thoughts or actions create an outcome that has nothing to do with them. For example, a child who engages in magical thinking may believe that their parents are getting a divorce because they called their mom a meanie in front of their dad. Or they may think that their grandfather died because they refused to give him a hug at a recent family dinner. It's important to understand that magical thinking thoughts are very, very real to the people who experience them. They should not be minimized, but rather addressed in a thoughtful manner. Furthermore, children may not express their magical thinking thoughts to the adults in their life. They may feel guilt or shame and choose to keep those thoughts to themselves. How do we approach traumatic events to children within this age group? We understand that preschoolers and young children may ask questions. Please do not criticize them for their curiosity. It's important to answer those questions. Yet it's best to be brief and concrete. Honestly, answer their questions in a brief and age appropriate manner. Make sure to verbalize that they are not to blame for the situation, and that they had nothing to do with the outcome that occurred. Allow for open communication and make sure to actively listen when your child speaks. Support your child's emotions and encourage the positive expression of emotions. Finally, please do not take any misbehavior personally. As with infants, it's important to stay consistent with routines. Maintain an environment that is predictable and secure. However, it's important to avoid being overprotective. Don't hover and don't try to control your child's behavior. Children should be encouraged to be independent, and please do not make any promises that you cannot keep. It's actually counterproductive to tell your child. Don't worry, mommy is healthy and won't die like grandpa. The insincerity of such promises will eventually be exposed. Children at this age do not understand idioms, meaning that telling a child that a loved one has passed away will fail. You need to be specific and tell a child that a loved one has died and is no longer on earth. Or that Mommy and daddy are divorced, which means that they will now have two separate homes. In turn, it's important to anticipate any potential magical thinking thoughts and challenge them. You may need to say grandpa died because of cancer. You had nothing to do with his death. Or mommy and daddy both love you very much. We just don't love each other anymore and that is not your fault. That is why Mom and Dad are not living together anymore. Our beloved dog, gizmo died very unexpectedly when Mason was 11 and Savannah was eight. Gizmo was sleeping next to me at the time of his death when I realized that he had died. I screamed louder than I have ever screamed in my life. Fortunately, my kids were not home when this happened, which meant that I had time to wrap my little buddy in a towel, get myself together, and prepare for the next steps. I called my husband, who was coaching Mason's baseball game. We were fortunate to have wonderful friends help us during such a difficult time. Even though my children can think abstractly. We still kept the explanation very simple. We took each child aside, individually, held their hands and said, gizmo has died. He loved you very much and he had a very good life. Would you like to see him one last time? Mason did, and Savannah didn't. We respected their wishes. Chad and I reminded the kids that it was okay to talk about their thoughts and feelings. There were a lot of tears, but also a lot of hugs. Gizmo will always have a special place in our hearts, and fortunately, we were all able to fully grieve his death. I have a special consideration if the traumatic experience involves the death of a loved one, and that includes pets. Children don't understand the finality of death until they are about 6 or 7 years old, meaning that young children do not view death as permanent. They may question when a deceased loved one is coming home. Or they may ask when they can be with the deceased again. Please don't take this as a sign of defiance. Be consistent with your responses to any repetitive questions. Most school aged children, meaning children 6 to 11 years old, understand that when someone dies, they are not coming home yet. Younger school aged children are unable to think abstractly, which is why it is important not to tell children that a deceased loved one is sleeping, or that they have gone home or went to a better place. Just as with toddlers and preschoolers, younger school aged children do not understand idioms. These children take these words and phrases very literally. In addition, school aged children may be very curious about the events that caused their loved one to die. They may ask about the events that occur after death. This curiosity also translates into events such as divorce or illness. School aged children may have a lot of questions. It's important to answer those questions in a brief and honest manner. In addition, please make sure that those answers are age appropriate. Be truthful, but tread cautiously. If Mom and Dad are getting divorced because of infidelity, children do not need to be made aware of the cheating. While school aged children are more likely than toddlers or preschoolers to ask questions about a traumatic situation. They are not immune to behavioral regression. Thumb sucking, refusal to sleep alone, and wetting the bed may occur. Again, it's important to understand that behavioral regression is not due to defiance. It's triggered by a stressful event. While these behaviors can be frustrating, please do not express that frustration to your child. Rather, understand that these behaviors are temporary and a sign that your child needs help. Somatic complaints are not uncommon in this age group. Children may complain of headaches or stomach aches. In addition, children are not immune to mental health disorders. Remember the red flags I discussed earlier? And do not hesitate to reach out to your child's health care provider. The best way to support a child who experiences a traumatic event is to be loving and nurturing. Allow for open communication. Actively listen. Be honest, yet make sure your responses are age appropriate. Be understanding of behavioral regression. Finally, allow for emotional expression and encourage positive expression of emotions. Teenagers are able to mentally process difficult life experience in a similar manner that adults process such information. They understand the finality of death. They are less likely to assign blame to themselves for something that was not their fault, and they can anticipate the consequence of a parent losing a job. However, they do not possess the same coping skills as adults. Teenagers who experience a traumatic event may act out. They may become defiant and they may engage in more risk taking behavior. Love them through this difficult time. Yet, please be on the lookout for behaviors that can cause injury to them. Teenagers may turn to alcohol, drugs, or promiscuous sexual behavior and attempts to cope. If this is the case, it is important for you to address this behavior. Express your concerns and provide support for your child. Also, watch for significant changes in sleep or appetite, decreased academic achievement or severe isolation. These may be signs of a mental health disorder. Please remember that teenagers are not adults. While it is important to answer their questions honestly, don't allow them to become your friends. Don't provide them with intimate details about a failed relationship. Don't expect them to support you as you heal from the traumatic experience and in the case of divorce. Don't ask them to choose sides. It's important to understand that teenagers crave independence. They may not want to speak to their parents about their emotion. That's fine, as long as they have friends or other trusted adults that they can speak freely with. As with all other age groups, continuing on with normal routines is helpful. Again, allowing open communication, actively listening and providing emotional support are all important aspects of helping your teenager to cope. Parents are not immune from traumatic or stressful events. When trauma occurs, you are likely going to feel a wide range of emotions and your behaviors may change when directly caring for an infant. Put on a brave, happy face. Consistently provide for their needs, yet at the same time, make sure to take care of yourself physically, mentally, emotionally, and spiritually. Take the time to process your emotions and grieve for as long as you need to. Just please try not to demonstrate strong emotions or behavioral reactions in front of an infant. When it comes to children aged 2 to 3 years and older, it's okay to express your emotions in front of your kids. In fact, it greatly benefits their emotional and social development. It's perfectly fine to cry in front of your kids. Talk about your emotions with your kids. Just try to do so in a developmentally appropriate manner. In addition, do your best to express your emotions in a positive, productive manner. As a pediatrician, it is uncommon for one of my patients to die. But when a death occurs, it is devastating. Once I had a very young patient that died in a situation that could have easily been prevented, I went home and simply told my husband, my patient is dead. I changed my clothes. Went into our basement gym and did a mixed martial arts workout. At the end of the workout, I screamed, fell to my knees and started sobbing. When I came upstairs, my concerned children were waiting for me. I gave them a hug and said, I am sad and I am mad because one of my patients died. I just need a few minutes and then you can ask me any questions that you have. If you have experienced a traumatic situation. Please make sure to take care of yourself. Get enough sleep. Ask for help when you need it. Scream into a pillow. Take a bubble bath. In fact, it benefits your child to observe you engaging in self-care behaviors. Likewise, pay attention to what you say in front of your kids again. Be honest, brief, and specific. Do not badmouth other people involved in the situation in front of your child. For example, if a beloved uncle died from cirrhosis due to alcohol abuse, please don't talk about how the death was his fault when the kids are around. If the situation involves divorce, do not trash your acts in front of the kids, and certainly don't expect your child to take sides or to choose a favorite parent. If the If the situation involves the death of a loved one. Please allow your child to have a voice in how they would like to be involved with the arrangement. If your child is older than seven years old, ask them if they would like to attend the funeral, memorial service or any celebratory events involved at these events. Please don't force them to hug anyone. Respect their choices and advocate for them at the events if needed. We all know that life is full of challenges, and as painful as these challenges are, they also help us to grow. Significant life stressors and traumatic events are inevitable. But if we can take the time to view the situation from our child's perspective, understand how that child is processing the situation and help them navigate the aftermath. Our children will be able to heal. And as parents, if we accept our own emotional response and do our best to express those emotions in a positive manner, we will be able to heal as well.