Guest blog post brought to you by Nancy Kassam-Adams, PhD,

Co-Director of the Center for Pediatric Traumatic Stress


What does it mean to be “trauma-informed” and why does it matter for pediatric care?


The idea behind “trauma-informed” services is pretty straightforward:  When the care we provide is informed by a basic knowledge of how traumatic experiences and traumatic stress may impact the people we are serving, many things are likely to turn out better. 



Across a range of systems and institutions that interact with children, adults, and families, the idea of trauma-informed services is catching on.  What does this look like in practice?  Here are a few examples:


• A trauma-informed classroom teacher recognizes that the student with his head on his desk most mornings has been up all night because he often hears gunfire in his neighborhood. She adjusts her approach to engaging this student in class, and he is better able to learn.   

• A trauma-informed police officer enters a home on a domestic violence call, and after ensuring that everyone is safe, gets down on one knee to speak softly to the small child who just watched her father being arrested.   

• A trauma-informed pediatric nurse on a busy inpatient unit notices that a young patient in her care is extremely quiet and withdrawn in the hours leading up to a planned surgical procedure. She takes a few moments to talk with the patient and his family to understand and address their specific worries and concerns. 


The idea of a trauma-informed SYSTEM takes these ideas one step further, moving beyond the actions of individual professionals to incorporate knowledge of trauma into the policies, practices and “culture” of entire institutions. Trauma-informed systems also recognize the possible impact on staff who have repeated exposure to challenging, potentially traumatic situations. 


A paper just published in JAMA: Pediatrics presents a comprehensive view of trauma-informed care in pediatric health care networks – defining trauma-informed pediatric care and its importance for patient outcomes and staff wellbeing, and offering a framework for training and implementation. Key take-home messages are that, 


“Trauma-informed care minimizes the potential for medical care to become traumatic or trigger trauma reactions, addresses distress and provides emotional support for the entire family, encourages positive coping, and provides anticipatory guidance regarding the recovery process. When used in conjunction with family-centered practices, trauma-informed approaches enhance quality of care for patients and their families and the wellbeing of medical care providers.” (Marsac et al, 2015)


The paper delineates a vision for pediatric health care networks as trauma-informed systems that can provide sensitive and effective care for the children and families they serve.


Of course trauma-informed pediatric care will look different across the many health care settings where children are seen – from primary to tertiary care, rural to urban environments, and community health to pediatric specialty settings. In a brief commentary in Contemporary Pediatrics, Dr. Megan Bair-Merritt provides five steps to a trauma-informed practice for busy primary care physicians. Steps 1 “Develop trauma-informed practice habits in day-to-day interactions with patients” and 2 “Keep traumatic experiences on the differential diagnosis” are surely applicable to providers in every setting that sees pediatric patients. The DEF protocol also provides a simple way to remember key elements of trauma-informed pediatric care: reduce Distress, promote Emotional support, and remember Family needs and strengths. 


How do you integrate trauma-informed care principles into your practice? What are the most challenging aspects of implementing trauma-informed care in your setting?  Join the conversation on Facebook to share your insights and ideas.