Unfortunately, there are many difficult traumatic events that children go through in their lives. Etymologically, the word “trauma” comes from the Greek word “τραϋμα” and means “wound.” By analogy with a physical wound, an “emotional wound” involves the presence of shocks, stressors, or blows that harm the psyche by exceeding, at a given moment, a child’s attempts or efforts to adapt.

A child’s response to a situation that threatens their physical and psychological well-being is closely linked to the internal resources they can draw upon (e.g., cognitive and emotional abilities, temperament) or to protective factors in the environment (e.g., the presence of emotionally warm and supportive parents, a favorable socioeconomic context, access to medical services, etc.).

The most common traumatic experiences a child may go through at any given time are: Being involved in or witnessing a car accident. Undergoing major surgery (bone marrow transplant, prolonged hospitalization, severe burns). Being involved in or witnessing a natural disaster (earthquakes, hurricanes, floods, fires). Violent crimes (kidnappings, robberies, the attack or murder of a parent or loved one). Community violence (school attacks, the suicide of a friend, family member, or peer). Prolonged (chronic) physical or sexual abuse.

Post-traumatic stress as a reaction to trauma

Post-traumatic stress disorder (PTSD) is an anxiety disorder that can develop after experiencing a major trauma (either as a victim or a witness). Children and adolescents with PTSD may experience a wide range of symptoms that fall into the following three categories:

– Re-experiencing the trauma—nightmares, repetitive play, and intrusive thoughts may occur;

– Attempts to avoid anything that reminds them of the traumatic event;

– Extreme anxiety (also called “hyperarousal”) and being easily startled by anything. Typically, children and adolescents with PTSD experience symptoms from all three categories.

Although 15–43% of children will experience a traumatic event at some point in their lives, many of them will not develop PTSD. The risk of developing PTSD increases with the severity of the traumatic event. For example, many children who have witnessed an attack or the death of a parent will later suffer from PTSD. Children with PTSD may exhibit depressive symptoms, other anxiety problems, or behaviors such as withdrawal or aggressive outbursts. Substance use problems (alcohol, drugs) are common among adolescents with PTSD.

Recommendations for Parents to Support a Child Who Has Been Through a Traumatic Experience

Parents often feel overwhelmed and unsure of how to respond when their children are going through a difficult event. These suggestions may be helpful:

This may be the first time the child’s sense of security has been shaken.  The child’s sense of safety has been threatened, leading to a change in their perception of the world. Experiencing emotions such as sadness, fear, and despair is quite common among children. It’s important to let children know that it’s natural to feel sad and scared, and to work together to find ways to help them feel more comfortable.

Use concrete words that accurately reflect what has happened, without trying to sugarcoat or downplay things. Trying to substitute or replace certain words to make them seem less frightening—while it may be comforting for adults—can actually cause even more confusion for children.

The child may remain afraid to talk about the event out of fear of consequences or to avoid the negative emotions associated with it. Provide them with a safe space where they can express themselves and offer them various materials—colors, dolls, drawings—so they can describe and talk about what happened. Nightmares are quite common among children. The more naturally the child is able to process these experiences, the more the nightmares will subside.

Different types of trauma can lead to different consequences. A child who has been in a car accident may have difficulty riding in a car for a while. After your child has experienced a traumatic event, you will naturally tend to protect them from any danger. However, this can sometimes turn into overprotection. In trying to protect your child, you may unintentionally reinforce or encourage avoidance behaviors. For example, your child may not want to get into a car (or may not even want to see a car) after being in a car accident, and as a parent, you support this decision and won’t let them near any car. Although the child’s avoidance reaction is understandable, it will not help them overcome their fear. Today, the child is afraid to get into a car, and this fear may worsen over time, eventually leading to a fear of leaving the house. How can you help? The best way to help your child is to help them face their fear rather than avoid it. If your child is afraid to go to school, hang out with friends, go to crowded places, go shopping, or ride in a car, then you can help them reduce their fear. This will happen gradually, with plenty of praise and rewards for each achievement.

Feelings of guilt and taking responsibility for what happened are common among children who have gone through traumatic experiences. It is important to help children understand that what happened was not their fault.

Children who have experienced or witnessed physical violence may internalize fear, shame, anger, confusion, and a desire for revenge. This can sometimes cause them to exhibit tantrums and aggressive outbursts that are difficult to control. Children may also exhibit a range of physical symptoms: headaches, stomachaches, loss of appetite, weight gain or loss, etc.

The self-esteem of a child who has gone through a traumatic experience may be affected, as the child may feel different from others. In this regard, it is important not to make any changes to their schedule or treat the child differently from other children.

Get back into a routine. As a parent, it is very important to ensure that your child returns to their daily activities as soon as possible. Although it’s normal to want to give your child some space, this isn’t helpful at this time. Following a traumatic event, your child should return to school within the next few days (if possible) and continue their daily routine, including going to bed at the same time and participating in school activities (team sports, hobbies, visits with friends).

As a caregiver (support person) for a child who has experienced trauma, this can be very difficult for you as well. For example, you may have feelings of guilt and blame, thinking you didn’t protect them enough. Your first impulse might be to leave the child alone for a while so they can process what happened. This must be done with the utmost care, as the child may misinterpret your actions and believe that you hold them responsible for what happened. Much of your success in helping your child move past the traumatic event depends on how well you yourself are able to move past it.

Important to remember: Consider scheduling a few appointments immediately after the incident with a mental health professional—a psychologist or psychiatrist—to assess the need for specialized intervention. If you notice behavioral changes that persist for several months after the traumatic event, seek support from a mental health professional. It is generally believed that symptoms should resolve completely within 3 months. During this time, it is important to be attentive to any changes that might indicate the presence of prolonged distress or aggravating factors—such as persistent sadness, outbursts of anger, increased anxiety related to various situations associated with the event or generalized to other contexts, etc.

Bibliography
Holmes, M.M. (2000) A Terrible Thing Happened, Magination Press, Washington, DC
Petrovai, D. (2009) Anxiety Disorders in Children and Adolescents: A Psychoeducational Guide for Health and Education Professionals, Save the Children Organization, Bucharest