A trauma is an event that feels like an intense threat. You may be involved in that event or witness it.

Even though adults generally try to keep their children safe, research suggests that more than half of Canadian children and youth will experience a potentially traumatic event before adulthood.

Trauma can be caused by a single event like a fire, car accident or the death of a loved one. Trauma can also be caused when you are exposed to traumatic events again and again. If a caregiver or family member experienced trauma in the past, the effect of this trauma may be passed on so that a child or youth may be affected by trauma that they have not directly witnessed or experienced. This is often called “intergenerational trauma”.

Examples of trauma:

• Physical abuse
• Sexual abuse
• Bullying
• Family / intimate partner violence (“domestic” violence)
• Community violence
• Traumatic grief
• Medical trauma
• Terrorism
• Refugee experience
• Natural disasters
• Serious accidental injury
• Neglect
• Emotional abuse
• Impaired caregiver
• Forced separation
• War
• Trafficking
• Seeing a suicide
• Racism or other discrimination

It is important to remember that trauma affects people in different ways. The trauma is not the event that happened, but the way that the child or youth experienced it. A small event to one person may be traumatic to another. Also, the more trauma someone experiences, the smaller their ‘window of tolerance’ may be. This means they may negatively react to events that they could once handle.

Children and youth are resilient; many can heal from a traumatic event without long-lasting symptoms. But, some develop disorders when their brains and bodies are overwhelmed and cannot cope. These disorders are called trauma related disorders, and can take many forms including post-traumatic stress disorder (PTSD). Healing depends on many factors, including the type of trauma, the person, the larger system and environmental factors. If the child or youth feels safe and supported, as many as 50% can heal from trauma related disorders without any formal treatment. However, importantly, if the disorder remains untreated, it can have a negative impact on a child or youth’s social, emotional and physical development.

You may have experienced the trauma with your child, or they may have experienced it alone. Either way, traumatic experiences tend to impact the whole family. It’s easiest to support children and youth through trauma if their caregivers are also well supported. Parents and family members can explore options that attend to their own mental wellness, including but not limited to: counselling, medical care, peer support, engaging with community and culture, and practicing self-care.

There can be a wide range of reactions to a trauma depending on the child or youth and the traumatic event. Trauma responses may also change over time. These reactions can start right after the trauma, or months or even years later.  If you are a caregiver who has only become involved after the traumatic event, it may not be easy to know to what extent these features are new or possibly trauma-related. That’s OK. If you notice these features following a potentially traumatic event, consider seeking supports.

The initial shock from the trauma may last quite long and your child may not start processing and reacting for some time.  After the trauma, watch your child or youth for possible signs of trauma, listed below.

Emotional Trauma Reactions:

• Emotional changes caused by a trauma can vary. They may seem more anxious, sad, irritable or even numb or detached.
• These changes can look very different depending on how old the child is. For example, a young child might become clingy or throw tantrums; a teenager might want to be alone or argue and defy you.
• Children and youth can have intense emotional reactions to sudden memories (“flashbacks”), nightmares or reminders related to the traumatic event.

Behavioural Trauma Reactions:

• Children and youth may begin to avoid people and activities they enjoyed before. They may also avoid specific activities or people that remind them of the traumatic event. They may engage in risky activities, use substances, self-injure or be more aggressive. 
• Some children have setbacks in learned skills, such as toilet training.
• After a trauma, some children and youth become “over-functioning”. They try to be “perfect” or behave like “mini parents”. Sadly, those children and youth are often missed and do not get the support they need.
• Younger children may act out the event, or something connected to the event, in their play or art. They may not seem upset, but this may be how they are reacting to the trauma.

Cognitive Trauma Reactions:

• Children and youth may attend school less, do less homework, or not be able to focus.
• Children and youth may start to believe things that are untrue or unhelpful after a traumatic event. These beliefs can have a negative impact on their development and future. Examples might include:
  • Self – may blame self or have a negative self view
  • Others – may have trouble trusting others; change what they expect of others
  • The world - may think the world is very dangerous

Relationships

• Children or youth may avoid social situations or relationships after a trauma. They may develop relationship patterns that are unhealthy which can vary based on the child’s age, trauma and reactions.
• It is important for the parent or caregiver to be aware of the relationships their child has and support them in building healthy relationships.

Biological Trauma Reactions

• The brain continues to grow and develop during childhood, adolescence and early adulthood. A traumatic experience can cause various biological responses, for example: changes in hormones, brain structure and function that are linked to symptoms such as increased fear.
• Children and youth may experience changes to their sleeping or eating habits. They may have stomach aches, headaches or other aches and pains in their body.
• They may have intense physical symptoms like heart racing, shortness of breath, sweatiness and other uncomfortable feelings in their body if certain trauma reminders cue a panic attack.
• Adverse Childhood Experiences (ACEs) can increase long term risk for physical illnesses

How do I know if it’s Post-Traumatic Stress Disorder (PTSD) or another trauma related disorder?

While many children and youth will experience a traumatic event, only about 5% will develop post-traumatic stress disorder (PTSD). Some children or youth may experience other trauma related symptoms or disorders that can cause similar distress and affect their daily lives.

Look for support if you are concerned about a child or youth who has experienced or witnessed a traumatic event. The challenges can start right after the trauma or be delayed. Sometimes trauma responses can look like, or happen at the same time as, other mental health concerns. A qualified health professional may be able to help identify and treat a child or youth’s needs.

An important way that a child or youth is affected by a traumatic event is the loss of their sense of safety and trust. It’s important to first make sure the child or youth is no longer in any danger, and also to ensure they feel safe and know that you are there to help. That will help them feel calm and more in control. You can start by letting your child know that you understand their feelings and support them unconditionally. This support can also help your child cope with past or current traumas or stressors. Children and youth benefit from opportunities to build trusting relationships and a sense of belonging (to their supportive family, cultural identity, spiritual or other supportive community).

If the traumatic stress is affecting your child’s school or social life, or causing distress, try to get support from a mental health professional.

Talking with your child about the traumatic event

Below you can find some tips for talking with your child if they have experienced a traumatic event. It is best to have these conversations when you are emotionally ready.

• Pick a good time and place to talk where the youth will have privacy and safety. Remember that children may not be ready to discuss their trauma when you are, and forcing them may be harmful. Be ready to answer some hard questions truthfully. Children and youth benefit from having honest conversations with people that they trust. You may need to ask for some details to make sure there’s no ongoing safety risk.
• Always keep messages healthy, truthful and appropriate for the child’s age. Honesty is key in supporting youth who have experienced trauma, as the trauma experience can harm their sense of trust and security.
• As children and youth process a trauma, more questions may come up and may sometimes seem to come out of nowhere. It’s important that they know you are there for them and ready to talk at any time.
  • An example of your response could be: “Thank you for coming to me with this, I’m so glad we can talk about these things” or “This is a really important question so I’m going to give it some thought and we’ll talk about this (tonight/tomorrow – be specific with time)”.
• Remember it is ok to not know the answer to something, and sometimes there is no answer that will make everything alright.
• It may help to tell your child they are not alone, and that many children will experience a traumatic event. Depending on your child’s age and stage of development, it may help them to know it’s not uncommon for Canadian children to experience abuse or witness violence at home.
• If your child has been a victim of sexual assault, it may be a shock and difficult to understand. Support from a parent or caregiver is key to the child’s healing. You can find more information about child sexual abuse here. Children aged 12 and over may benefit from reading this resource with you.
• You can let your child know that what happened is not their fault, and does not change who they are as a person.
• If the family is dealing with the death of a loved one, it can help to discuss it openly and share your own feelings. Children and youth may share more if they see others sharing. You can find more information about supporting your child through grief and loss here.
• You should consider the child’s age and abilities when choosing what words to use and how much detail to share.

Ways to support your child at home

• Have a calm, predictable home environment.
• Develop and keep the same routines (morning, school, homework, bedtime) and plan for times when there will be a change or transition (getting to school, visiting relatives).
• Help your child learn about and name feelings, pay attention to your child’s feelings and teach your child to name them.
• Try to maintain a calm and open way of being with your child, even when they are in distress.
• Ask your child what helps them feel calm. Try to practice these during calm moments so they can use them effectively in times of distress.
• Help your child focus on the here and now (ask the child or youth to describe what they hear, see, smell, etc.).
• Be realistic about what to expect from your child given their age and developmental stage.
• Talk about what you expect from their behaviour when they are calm and  be clear about the limits and consequences.
• With your child’s age in mind, show how you identify and accept your feelings.
• Be aware of and manage your own reactions - it may be helpful to seek help if you are struggling with this.
• Model healthy problem solving and coping mechanisms.
• Praise and reward your child’s efforts to cope with trauma and stress.
• Take care of your own needs – get support by talking to others, asking for help when you need it, and walk away or take breaks from emotionally charged situations if you need to.

Healthy living & healthy coping skills

• Some children benefit from changes to their sleep, activity levels, eating habits, stress management, social connections, and technology use.
• It can be very helpful to learn skills for dealing with emotions. This might include identifying soothing activities the child or youth enjoys, breathing exercises, muscle relaxation, or grounding techniques. For youth, some short guided exercises are available for free in the “Chill Zone” of the Anxiety Canada CBT MindShift app.
  • Please note: Mindfulness skills can be helpful for people with trauma related disorders. But, sometimes certain mindfulness exercises can increase symptoms for some people so it’s important to seek guidance from a mental health professional.
• A child or youth may use unhealthy ways to cope after a traumatic event. This may include disordered eating, exercising too much, substance use, self-harm, or overuse of videogames or social media. In these instances, it helps to learn what healthy coping skills they have, or are open to trying, and encourage those, for example: sports, music or art. Helping children and youth build healthy coping strategies is an important part of helping them let go of unhealthy coping skills. Often it's helpful to find extra support if your child develops unhealthy coping strategies.

School

If your child is struggling in school, they may need some extra support from staff and other school personnel. With consent, it might be helpful to share your child’s diagnosis or symptoms and how these may impact their school performance. It’s important to only share information that is needed and that your child is comfortable sharing.

Types of treatment for children and youth impacted by trauma

There are many therapies and treatments that can be helpful for children and youth impacted by trauma:

• Trauma focused cognitive-behavioural therapy (TF-CBT)
  This is often the most successful therapy for children aged 3-18 who are struggling with trauma. In 12-20 weekly sessions, children and their caregivers explore how trauma symptoms relate to past experiences and learn ways to cope with and manage these symptoms.  Children and youth gain skills to cope with symptoms and retell the story of the traumatic event in a supported and safe way to process and work through it. This softens the power of the memory and the thoughts and feelings connected to it. The therapist helps to identify and deal with unhealthy beliefs connected to the trauma so they don’t shape the child’s future. TF-CBT also focuses on promoting the child’s future safety and development. Research has shown that this type of therapy is most effective if a caregiver or other supportive adult is actively involved. 
• Eye movement desensitization and reprocessing (EMDR)
  EMDR is a treatment that tries to reduce the distress linked with traumatic memories. A trained clinician helps to target specific parts of a traumatic memory. Eye movements are used during one stage of the treatment. Research shows EMDR can be effective for both children and adults with PTSD. For more information on EMDR, click here.
• Play therapy
  Play therapy can be used to treat young children with trauma or stress related disorders. A mental health professional uses games, drawings and other ways to help children process the thoughts and emotions connected to traumatic memories. For more information on play therapy, click here.
• Child Parent Psychotherapy
  This type of therapy is for children aged 0-5, and takes about 50 weeks. It is based on supporting the relationship between a child and their caregiver to heal trauma related symptoms.
• Medications
  While therapy and social interventions are the most important treatment tools for trauma related disorders, medications can help some specific trauma related symptoms, such as nightmares or other sleep difficulties. Medications can also be helpful to treat other mental illnesses which can often also be present among children and youth with trauma related disorders.

Self-care for parents and caregivers

Parenting is really important work, and can be particularly challenging when a child or youth is struggling with trauma related difficulties that can often lead to increased strain in the parent-child relationship just when they most need caregiver support. It’s important to look after yourself. Research shows us that children heal faster and do better when their parents are well. You can best support child or youth if you first look after your own physical and mental health, and this also provides a healthy example of self care for your child to follow. Reach out for support from family, friends, community members, or health professionals.

A note on growth and learning after a trauma

It can be helpful to remember that while potentially traumatic experiences are common, and can sometimes lead to a lot of distress and challenges, effective treatments exist. Unfortunately, the traumatic experience cannot be deleted from a person’s past. Fortunately, it does not need to define their future.  There is sometimes opportunity for growth and learning after a trauma. This process can be empowering for children and youth who may become more resilient, self aware, and socially connected.

If traumatic stress is affecting your child’s school, family or social life, or causing distress, it’s time to get support from a mental health professional.

Talk to your doctor and get help from a mental health professional by:

• Getting a mental health assessment and support through your local Child and Youth Mental Health team (through a walk-in intake clinic in your community).
• Contacting your Employee Assistance Plan (EAP), if you have this option.
• First Nations peoples can access counselling through First Nations Health Authority’s registered mental health providers list.
• Contacting a private psychologist or counsellor.

Looking for more information on this topic? Connect with a family peer support worker at the Kelty Centre to discover additional resources, learn more about support and treatment options, or just to find a listening ear.