Best practice: Supporting children affected by trauma - In hiding

Trauma in early life can have a lasting impact on a child’s development, their personality and their ability to form healthy relationships. Recent research from Anna Freud Centre revealed that 69 per cent of nursery staff said they had experienced working with babies or children affected by trauma or abuse – and 71 per cent had worked with children affected by domestic violence.

Being aware of the signs of trauma in a baby or young child could make a difference to the way that child experiences the world in the future.

Dr Sheila Redfern, consultant clinical psychologist and head of the family trauma department at the Anna Freud Centre, says, ‘We know that the long-term consequences of a disruption to that early attachment relationship has a profound impact on the relationships the child will have for the rest of their life, which is why it’s so important to recognise the early signs of relational trauma and to try and do whatever you can in your work setting to address it.’

WHAT IS CHILDHOOD TRAUMA?

Trauma in childhood is triggered by neglect, abuse or violence or a single event such as an accident, bereavement or natural disaster. Babies and young children mainly experience relational trauma, which emerges when there is a consistent disruption to a child’s sense of being safe or loved within a family.

Dr Redfern says the most common trigger is abandonment or enmeshment, which is when a caregiver becomes so involved in their world that there is no separation between self and other.

She explains, ‘This can be just as traumatising as when a carer abandons their child and gives them no sense of safety.’

POSSIBLE SIGNS OF RELATIONAL TRAUMA

It is not easy to spot signs of traumatic distress in young children, particularly in babies, but there are some tell-tale signs to look out for, explains Dr Theresa Schwaiger, a clinical psychologist who works for the Anna Freud Centre’s family trauma service.

First and foremost, she advises practitioners to ‘observe and pay close attention’ to the separation and reunion with children’s caregivers.

‘Be curious about your own reaction to the child and the parents and how it makes you feel. Is there a lack of joy on reunion? Or perhaps the child freezes when they see their parents enter the room?’ she says.

Some of the behaviours listed below can be seen in all babies and children. Therefore, it is important to consider how persistent they are and what else is going on in the child’s life before automatically associating them with trauma.

Babies

• Show feelings of distress in a physical way, for example, persistent crying, which cannot be soothed by their caregiver.
• Struggle to sleep or sleep too much in an attempt to disengage from an environment that feels difficult and overwhelming.
• Little response to playfulness.
• Become rigid, arch their back, squirm, look unfocused or struggle to sink into your arms when you offer a hug.
• Avoid eye contact and interactions with caregivers; stare at lights or other objects for long periods or show a limited range of emotions in order to cope.
• Lack of interaction with parents or no expression of need as their needs have not been met or were responded to with fear or dismissiveness.

Toddlers and young children

Although they are able to express their feelings more directly than babies, it can still be difficult and confusing to read how toddlers and young children show their distress.

Dr Schwaiger says, ‘A lot of children who have experienced significant relational trauma display emotional regulation difficulties. They might alternate between approaching, freezing and turning away from you, or avoiding you. Or they may be over-familiar with you, even if they’ve never met you, which can sometimes be due to unmet need or the need to be seen, heard and cared for.’

Here are some other behaviours that can manifest:

• An increase in crying, fearfulness or clinginess with, or when separating, from caregivers.
• Difficulty settling into playing as they are on high alert trying to work out if their environment is safe. This impacts development of playfulness and imagination.
• Being more aggressive towards caregivers, peers or other adults.
• Violence experienced in the home might surface in their play with dolls, figures or animals.
• Going ‘backwards’ in their development, for example in toilet training and speech, or self-soothing behaviours such as thumb-sucking.
• Some show an age-inappropriate independence, where they do not express their needs and internalise their difficulties.
• Complain of physical symptoms such as head- and stomach-aches.
  
  

HOW TO HELP A YOUNG CHILD WITH TRAUMA

The impact of supporting a child affected by trauma or abuse can be profound, and Dr Redfern recommends sharing the load and talking it through with other team members.

She says, ‘It can often take a lot of time and reassurance for a distressed child affected by trauma to feel calm. Practitioners can offer comfort by letting them know that they are there to help them and that the feelings they are experiencing are so big – too big for a small person to carry alone.’

Children who are experiencing relational trauma often do not have a name for their feelings, so it can be helpful to label them in simple language, such as being ‘cross’ or being ‘worried’.

Abused and neglected children are also more likely to feel worthless and not valued. Praising them for their achievements, no matter how big or small, can go a long way to help increase their sense of worth.

‘Relationships are key,’ Dr Redfern affirms. ‘Be consistent, warm and reliable. Having a trusting relationship and avoiding any kind of sudden changes will be extremely helpful to a traumatised child.

‘Also, try to make the environment as predictable as possible, so that they know what’s coming up. Things can seem quite frightening and sudden and unexpected to a child who has experienced trauma. You might say, “Dad’s coming to pick you up at 3 o’clock”, or “It’s fruit break in ten minutes”.’

MORE INFORMATION

• Settings can watch the Anna Freud Centre’s ‘Supporting children in early years settings who may have experienced trauma or abuse’ on YouTube: www.youtube.com/watch?v=XKJuBemELjI. It includes presentations from Dr Sheila Redfern, Dr Theresa Schwaiger and Louise Jackson.
• This is one of a series of webinars to support practitioners with the key issues affecting children in their care. See also ‘Best Practice: Supporting Bereaved Children – Making sense of loss’: www.nurseryworld.co.uk
  
  

CASE STUDY: St Lawrence’s Primary School and Nursery, Shropshire

Louise Jackson, deputy head at St Lawrence’s Primary School and Nursery, has been involved in an action research project with the Centre for Research in Early Childhood to try to discover what indicators and actions are used in early years settings to help children thrive after trauma.

She has put together some practical ideas and resources, backed up by her research, that have worked well in early years settings across the country.

She says, ‘We’ve noticed an increasing number of children who have experienced different kinds of trauma over the past few years. Looked-after children, those coping with bereavement, separation, and many children who have been displaced – moved from a place of safety to a place where they no longer feel secure. Dealing with the behaviours these children display can be exhausting. All of our nursery staff are trained in attachment-informed practice because we find that this is often the cause of many of the issues that we see.’

Here are some examples of the methods they use:

Role play games

• Encourage children to imagine a virtual space where they feel safe.
• Golden Wellies: when the children put them on, they go to imaginary places (see book offer, right).

Communication

• Create a visual timetable for the day.
• Emotion cards can be used to talk about feelings and play bingo games with
• Help children understand non-verbal.
• communication. Use pictures of a dog or baby with various facial expressions or gestures.
• Different children relate to different modes of communication and at different times.
  
  

Ms Jackson is also an early years consultant, trainer and author of Cultivating Resilience in Early Childhood (Routledge). In September, one of her ‘Golden Wellies’ books, A Place of My Own, will be available to pre-order. Nursery World readers can receive a 20 per cent discount by using the code APR20 until 30 September.