Trauma Reactions in Children
The way that children respond to potentially traumatic medical events is influenced by their age and development.
Younger children's responses to traumatic events tend to be more behavioral; they will SHOW you that they are upset, rather than tell you.
Parent report and your own direct observation of child behavior are the best ways to assess the impact of traumatic events on young children. We often need to rely on OBSERVED behavior rather than verbal report to understand how a young child is feeling and coping Younger children:
- Can regress behaviorally (bed-wetting, thumb-sucking, etc.) in response to distress
- May have strong startle responses, nightmares, and outbursts since their brains do not have the ability to calm fears
- Think in images and are more likely to process trauma through play, drawing, and storytelling
- Depend on parent presence and support to soothe and calm them, more than any other age group.
Younger children can’t always comprehend what's happening to them, so they act out in different ways. Sometimes, they cry; sometimes, they can't go to sleep because they’re scared of something, but they can't tell you exactly what. And they cling to you because you’re their caregiver, and you have a whole different level of relationship with them.
School-age children will watch closely and take cues from adults' non-verbal behaviors regarding how serious the illness or injury is, and how to respond. They may discount verbal explanations if what they observe and notice does not match up with what adults are telling them. In addition, they:
- Will use their imagination to "fill in the blanks" when they do not have realistic information
- Sometimes imagine that an illness or injury is punishment for something they did wrong
- Can experience significant grief and loss reactions, even if the loss was expected and discussed.
Ask open-ended questions to school-age children to learn what they know and especially, what they are IMAGINING.
My son was getting overwhelmed with all of the verbal explanations about the surgery, so the doctor pulled out a model and showed him what was going to happen. Five years later, he still has that model heart.
Adolescents can be more concerned about "here and now" issues, than about the future. In addition, they
- Can be idealistic or unrealistic in their expectations
- Can be self-conscious and sensitive about looking different from peers
- Will sometimes act more grown up than they feel inside
- May cover up their worries to protect others from their thoughts and feelings.
- May not like feeling more dependent on parents and other adults due to their illness, just as they are moving toward independence.
Encourage adolescents to anticipate and plan for future consequences, but don't dismiss their "here and now" concerns.
I have a good support system; it's my daughter that doesn't. She talks to her friends, but she doesn't want to burden them. She doesn't want to call them up and say, 'Hey, can you drive me somewhere?' She just feels that they're just going to feel sorry for her. So, I think she's dealing with more aloneness than I am.
For more information, download CPTS' handout on developmental impact of medical traumatic stress.