Trauma in Childhood

Six weeks after an accident in which no one in the family was seriously hurt, a four-year-old has started waking at three in the morning and walking, fully awake, into her parents’ room without speaking. She doesn’t cry; she climbs in and lies down between them, and by morning she doesn’t remember doing it. The school has rung twice to say she has been crying in assembly and doesn’t know why. The paediatrician at the follow-up has said her physical recovery is on track.

One of her parents has begun to understand that the accident hasn’t left the family. It’s still there, in their daughter’s body, in her school day and in the small hours of the night, and this parent’s own sleep has gone strange. Neither adult in the house has said the word out loud yet.

In our work, families often come to us in some version of this situation. It might be after an accident, an illness in the family, witnessed violence or a death, or after years of living with an adult whose unpredictable moods have dominated the household. This chapter is about what trauma is in a child’s development, what you can do as a parent, and what you can’t do alone.

What is actually happening

The event is what happened. The trauma is what’s left in the child’s nervous system, and in the family’s, once the event is over and she is too young to make sense of it on her own. Two children can witness the same accident and come out of it differently, and it has nothing to do with bravery or character. In nearly every case, the difference is what each child had around her in the days and weeks afterwards.

Clinicians sometimes distinguish between big-T trauma and little-t trauma, and the distinction is useful as a starting point. Big-T trauma is the discrete event: the accident, the death, the assault, the disclosure, the witnessed violence. Little-t trauma is the pattern: chronic unpredictability in the home, persistent insecurity, repeated emotional unavailability of an attachment figure, sustained low-grade fear. People tend to take big-T trauma seriously and little-t less so, when in fact, over years, little-t trauma often has the larger effect on a child’s development. A child can be more affected by ten years in an unpredictable household than by a single dramatic event that warm, responsive adults helped her through.

The Anna Freud Centre’s work on developmental trauma is the single best UK resource we know of. Their family-wellbeing pages are calm, clinically authoritative and easy for parents to read. Dr Karen Treisman is a UK clinical psychologist whose consultancy, Safe Hands Thinking Minds, has shaped how a generation of NHS-aligned practitioners think about relational trauma. She’s the clinician we most often point parents to when they want a writer who explains how trauma affects a child’s development without oversimplifying it. Her wider writing on felt safety is the clearest practical material for parents that we’ve found.

The work in this chapter is the parent’s, with the school as partner, the GP as the route to specialist help, and trauma-trained counsellors as the longer-arc support when one is needed. None of those can do this alone.

What trauma does to a child’s body and behaviour

Trauma shows up in a child’s body and behaviour before it shows up in anything she says. It’s often assumed that a traumatised child will talk about what happened, or have nightmares or flashbacks about it. What clinicians see is wider than that. Most traumatised children don’t talk about the event directly in the days and weeks afterwards; it comes out in other ways.

In younger children, the most common picture is regression: a five-year-old who returns to thumb-sucking, who wets the bed again, who refuses to sleep alone, who clings, who replays the event in unstructured play. None of this is weakness. Her nervous system is going back to an earlier state, one in which it knew how to be safe.

In school-age children, the picture is often somatic and social: stomach aches and headaches that do not respond to medical assessment, sleep disruption, new irritability or new flatness, concentration falling apart, friendships becoming difficult, refusal of an activity she had done happily. Teachers may notice before you do, because a child will often keep up appearances at home and let them drop at school.

In teenagers, trauma can present as withdrawal, irritability, risk-taking, self-harm, entrenched school refusal, the friendship cluster that has dissolved, the mood that has flattened or sharpened beyond the normal teenage range. It can present as substance use, as the new bad-tempered relationship with food, as the device kept face down on the bedside table at night. The teenage manifestation is often the one most easily misread as ordinary adolescent storm, and the misreading delays help.

The thread across all ages: the trauma has changed the texture of the child’s days, and the change has stayed changed for longer than the family expected. Distress that does not lift over weeks and months, or distress that lifts and then returns at six months, twelve months, two years, is the picture that warrants specialist attention.

The they do not remember assumption, and why it is wrong

The belief we hear most often from parents about this is some version of they were too small to remember: a two-year-old at the time of the accident, or a three-year-old when a grandparent died. The assumption is that small children, who don’t yet have autobiographical memory, are protected by their age from the impact of what they went through.

According to the clinical literature, that isn’t how it works. Children too young to put an event into words still retain it: in their bodies, in their attachment patterns, and in what their nervous system has learned to expect from the world. Pre-verbal trauma is real, and in some ways it’s harder to repair, because the child has no way of telling it as a story. The felt sense of being unsafe isn’t attached to anything she could tell you. By the time she’s seven, she may not remember the accident. Her nervous system, which learned to brace for it, is still bracing.

None of this is a reason to despair. The same nervous system can change, particularly in childhood, and it goes on being shaped by what happens next. When a child who experienced early trauma has been looked after in the years since by warm, predictable, attuned adults, that care has substantially rewritten her nervous system. Repair comes from the repeated experience of being safe in a family that knows what happened and responds calmly now.

What the parent can do

What you do in the aftermath is more important than you probably give yourself credit for. It’s also harder than you may realise, because the family is caught up in what happened too. If you witnessed the accident, your own body is still reacting to what you saw. If you lost the same person your child lost, you’re grieving alongside her. You’ll be doing all of this without having recovered first.

The clinical idea that parents respond to is what Treisman and others call felt safety: a child needs to feel safe in her body with the adults around her, even after the world has shown her that it isn’t always safe. You can’t build that in one conversation. It comes from the repeated, predictable, calm presence of an adult who is the same person today as yesterday and tomorrow, in all the everyday details of life. In practice, that means bedtime going the same way every night, a hand on her back at the front door, getting home when you said you would, and a voice that doesn’t rise when she doesn’t eat her supper. At this stage, those details are the whole of the repair.

The practical steps follow from that.

Keep to a routine. Trauma disrupts a child’s sense that the world is predictable, so your job is to be the most predictable thing in her week: she gets up at the same time, eats the same breakfast and goes to school by the same route. It’s exhausting, and if you’re finding it exhausting, you’re doing it exactly right.

Give her words for what she’s feeling. Younger children rarely have the language for what’s going on inside them, and you can offer some: “Sometimes after something big happens, our bodies remember it before our heads do. You might notice your tummy feels strange even when you’re not thinking about anything. That’s normal.” Say it when you’re side by side, and say it again in different ways over the following weeks.

Let the regression happen without making it the topic. A four-year-old climbing into your bed at three in the morning is doing repair, and the most useful response is a slow, calm welcome that doesn’t turn it into a household project. Lift the duvet and make room for her, and don’t sit her down to discuss it the next morning.

Be sad in front of her without asking her to manage it. If she sees you briefly sad and still keeping the house running, she learns that hard feelings can be part of family life without breaking the family.

Talk to the school, early, calmly, and in detail. The school cannot help with what it does not know. The Designated Safeguarding Lead is the right adult to bring in when the event has a safeguarding dimension; the head of year or class teacher is the right adult for the daily watch. Both need a clear account of what has happened and what to expect. Schools take this seriously, and they adjust the day for a child who is going through something hard. Place2Be, where the school has an in-house counsellor or partners with them, is often the right route for school-anchored support; ask the pastoral lead.

When to bring in professional help, and which kind

Not every traumatised child needs specialist therapy. Many children, with attuned family response, the right school environment, and time, recover well from significant events. The question parents ask, often after weeks of keeping everything steady at home, is when the family work needs to be joined by a clinician.

The honest answer is that the question is the wrong way round. The right question is not “is my child sick enough to need help”, it is would specialist input now reduce the risk of a longer-arc impact. In trauma work, early specialist help, even when the picture is not yet at crisis, often shortens the recovery. Waiting until the picture is bad enough to be obviously clinical is, in many cases, waiting too long.

The route, in the UK, is the GP, the gateway to CAMHS and to local specialist trauma services where they exist. The waiting lists are honest about being long. Where the family can pay for private support, the BACP and NCPS therapist directories list counsellors working specifically with children and with trauma; filter by age range and by trauma. The school, particularly in schools with in-house counselling, may also be a route; ask the pastoral lead.

Parents often ask which approaches have evidence behind them, so here is a brief note, without prescribing any one of them. Trauma-focused cognitive behavioural therapy, EMDR for older children and adolescents, and play therapy for younger children are the approaches most commonly named by NHS-aligned services. Each is a different fit for a different child; the GP or the local CAMHS team are the right people to advise on which, not the parent reading at half past ten on a Wednesday. The parent’s job is to engage the gateway and to be present alongside whatever the clinical work then is.

Your own work in parallel

In many cases, the parent reading this chapter is part of what happened. The accident happened to all of you. If someone died, you’re grieving them too. If an unpredictable adult at home is part of your child’s little-t trauma, you may be living with that adult as well. You’re being asked to be the calm, attuned adult your child needs while you’re depleted yourself.

That’s useful to know, and it isn’t a failure on your part. Helping a child recover from trauma while your own experience is still unresolved is the hardest work we see in our practice. The right move, where the resources exist, is parallel support: your own counsellor, your own GP, your own friend, your own twenty-minute walk without the phone. Family Lives’ confidential helpline at 0808 800 2222 is the right line if you need to be listened to by someone who hears about this all the time. The Mental Health Foundation’s family-wellbeing pages cover the parental side of this clearly.

If you went through your own childhood version of what your child is living through now, then in some sense you’re twelve again as well as forty. Your reactions have a history, and recognising that is part of the repair. If you can notice that some of what you’re feeling belongs to your own past, you’re in the best position to keep your response in proportion to what’s happening now.

At different ages

Trauma shows up differently at different ages, and children recover from it differently too. Use the bands below as a rough guide.

If your child is between four and seven. At this age it shows in her body and her play: regression, sleep disruption, magical thinking that has tipped into worry, repetitive play that replays the event. She needs you to be there, to be predictable and to welcome the regression calmly. Stay with her through it, and don’t try to talk her out of the feeling. The school nurse and class teacher are the right early partners; the school’s DSL where there is a safeguarding dimension. Play therapy, through CAMHS or a registered counsellor, is the modality that most often helps children this young; the GP is the gateway.

If your child is between seven and nine. It shows in her body and, more and more, in what she says: stomach aches, headaches, sleep, friendship difficulty, new fearfulness, new irritability. She has more words now, so talking in the car, side by side, starts to be useful. Briefly name what her body might be doing, then leave a silence and don’t rush to fill it. Talk to her class teacher and pastoral lead in detail. Place2Be, in schools that have it, is very good with children of this age.

If your child is between nine and eleven. Before secondary school, children become more self-conscious, and that now comes on top of the trauma response. She’s more aware of being different, and may start hiding the difficulty so she doesn’t stand out. Tell her in so many words that at home, she can let it show: “You don’t have to be fine. Our house is the house where you don’t have to perform.” The school’s pastoral lead becomes more important as the social environment becomes harder to manage alone.

If your child is in early secondary, eleven to thirteen. The picture often broadens to school refusal, sustained low mood, irritability, somatic symptoms. The early secondary years are a vulnerable window where trauma can compound the ordinary disruptions of transition. The school’s DSL and head of year are the right early partners. The GP-to-CAMHS pathway is the clinical route. Trauma-focused CBT and, for some older children in this band, EMDR are the modalities most often named; the family does not need to choose, only to engage the gateway.

If your child is in mid to late secondary, thirteen to sixteen. Trauma in this band is often where the impact becomes visible in self-harm, risk-taking, withdrawal, or entrenched school refusal. The crisis dimension can become live, and the standing crisis block at the foot of every chapter applies. The GP is the gateway. Where the picture is acute, NHS 111 is the route into the mental health crisis line in England, Scotland and Wales, and Lifeline on 0808 808 8000 in Northern Ireland. The school’s DSL needs to know. A trauma-trained counsellor through BACP or NCPS is the right private route if the family can use it; many areas have Kooth available for the child who will not, at sixteen, talk to anyone she has met.

If your child is sixteen and beyond. Your conversations with her are increasingly adult to adult. She may want to find her own support; make that possible without turning it into a project. The GP for clinical routes. The BACP and NCPS directories for trauma-trained counsellors taking young adults. Often your job is to be the household she can still come back into, on her own terms.

The longer arc

In most cases, recovering from trauma in childhood isn’t a project you finish. It happens over a long time, as the event becomes one piece of a child’s life and stops being the piece that organises everything else. A child who has been looked after by her family and school, and where necessary by clinicians, through the months and years after something hard, grows into a young person who knows what happened and lives with it, and who isn’t, in any final sense, defined by it. The recovery is slow, but in nearly every family we have seen, it’s real.

Six months from now, the four-year-old who has been climbing into her parents’ bed at three in the morning will be doing it less, and a year from now, less again. The school has settled her into a routine with her year group, and it’s lasting. The family has talked about the accident often enough that it can come up without taking over. The parent has, in the meantime, talked to her own counsellor about her own night. It’s a slower, less dramatic recovery than most people expect: the recovery of a family that has had something hard happen and has decided to live, deliberately, in the aftermath.

This is yours to do. It is also not yours alone: the school, the GP, and, where one is needed, the specialist are in it with you. By being calm and predictable, and willing to be sad when that’s what the situation calls for, you’ve done the largest single piece of the repair.

She will, in time, be alright. The repair comes from keeping things predictable, and that is something you can give her. For the parts you can’t do alone, the help is there when you reach for it.

NOTES

1. Treisman, Karen. A Therapeutic Treasure Box for Working with Children and Adolescents with Developmental Trauma. Jessica Kingsley, 2018. Treisman’s felt-safety frame and the practical work with developmentally-traumatised children.
2. van der Kolk, Bessel. The Body Keeps the Score. Penguin, 2014. The somatic register of trauma and the limits of cognitive interventions alone.

Where to go further

Betsy de Thierry, The Simple Guide to Child Trauma: What It Is and How to Help A short, clear first book on what trauma is, how it shows up in a child’s behaviour and body, and what calm, consistent adults can do about it. Read it before anything longer.

Bruce D. Perry and Maia Szalavitz, The Boy Who Was Raised as a Dog A child psychiatrist’s case stories of how early trauma shapes a developing brain, and, more hopefully, of how relationships help children recover. It is written for anyone, and it is the book we suggest to a parent who wants to understand why the relationship is the treatment.