Infants, Toddlers and Trauma

Article by Caila Holm, LMSW

Often caregivers of young children incorrectly assume that a child under the ages of 4 or 5 does not have the ability remember any traumatic or stressful events experienced in infancy. Implicit memory, consisting of perception, emotion, bodily sensations (senses), and behaviors such as walking or crawling, is encoded even before birth, and infants encode implicit memory exclusively until 18 months of age. (Siegel & Payne Bryson, 2012). Infants and toddlers can react strongly to emotional and sensory reminders of traumatic events (unconscious responses) just as adults can, but adults also have explicit memory (conscious recall) and other further-developed physiological systems that enable adults to more clearly communicate when an event has traumatized them. Infants and toddlers communicate their distress using cues such as facial expressions, behaviors, body responses, and expression of emotion, many of which can go misinterpreted, overlooked, or ignored by caregivers.

“Trauma is defined by two elements: an event that severely threatens oneself or people one is close to and our subjective response to the event” (Davies, 2017, page 102).

A traumatized infant or toddler may present differently than a traumatized child, adolescent, or even adult. Events that may be mildly stressful to an adolescent or adult can be experienced as very traumatic for an infant or toddler. Put yourself in the shoes of a 4 month old baby with a chronic medical condition. The infant makes frequent trips to the hospital, is repeatedly given injections and IVs, constantly surrounded by strangers (nurses, doctors, etc.), and sometimes stays overnight in a cold room while in pain from medical procedures. Some infants may be completely fine as they are able to be comforted by their caregivers throughout their ordeals. Others may have caregivers who are equally traumatized, have their own trauma history or severe mental illness, or are otherwise absent or unable to attune to the infant. Without having an attuned caregiver, the helpless infant can be left terrified and traumatized in the wake of such an event or series of events. Other common circumstances that may lead to traumatization of an infant or toddler include witnessing domestic violence and sudden, unexplained, or prolonged separation from a primary caregiver.

“Children who don’t feel safe in infancy have trouble regulating their moods and emotional responses as they grow older” (Van Der Kolk, 2014, page 120).

Recent research securely links the long-lasting impacts of traumatic events and accumulation of stressful experiences in childhood to lifelong challenges not just with mental health but physical health as well (Felitti et al., 1998). If we isolate children the ages of 3 and under, the impacts are even more profound. During these years, infants and toddlers experience nearly constant critical periods of development. When traumatic events occur in these critical windows, the child may encounter difficulties achieving normative developmental milestones as their focus at that time is ensuring their own safety rather than growth.

Signs of traumatization in an infant or toddler may differ very much from typical adult presentations of trauma responses. The traumatized infant or toddler may struggle with trusting caregivers, being overly trustful of strangers, being developmentally delayed in one or more areas, emotionally reactive, reduced expression of positive emotions, loss of interest in play, reenacting traumatic event in play, asking about traumatic event, difficulty sleeping, nightmares, fear/anxiety, physiological reactions (hives, sweating, shaking, stillness, etc.) when reminded of traumatic event, avoidance of reminders of traumatic event, sadness, irritability (fussiness or temper tantrums), difficulty concentrating, hypervigilance (always looking over shoulder), jumpiness, and potentially more (Zero to Three, 2016). Many of these symptoms can also be developmentally normal in infants and toddlers. If you have concerns about your child, infant and early childhood mental health specialists can help you determine if your child’s behaviors are developmentally appropriate or potentially problematic.

“Infant mental health specialists pay attention to the emotional experience of each toddler or infant and each parent. They ask ‘what is it like to be this baby? What is it like to be this parent?’… Carefully attuned to the infant’s expression of emotion, the Infant mental health specialist works at understanding the meaning of the infants communications and guides the parent in understanding this, too” (Weatherston, 2002, page 6).

Just as with adults, trauma responses can be modulated and treated by integrating implicit and explicit memory (Siegel & Payne Bryson, 2012). In order to be most effective, mental health treatment for children 6 and under necessarily involves caregivers in session. The point of infant and early childhood mental health treatment is not to sit a baby on the couch and have them talk about their feelings with a trusted therapist. Rather, the therapist works to establish or reestablish trust and security within the child’s relationship with caregivers, hold and support caregivers during the challenging period of raising a traumatized child, and ultimately give the family system the tools requisite to navigate and respond to ongoing or future stressors. Put simply, treatment for infants and toddlers centers around increasing attunement of and attachment to safe and regulated caregivers so that they may assist the child as they integrate traumatic memory. Therapists at the Steven A. Cohen Military Family Clinic at Centerstone can use a variety of highly-researched evidence-based therapies to treat traumatized infants, toddlers, and pre-school children both in person and via telehealth. Such treatments include Child Parent Psychotherapy (CPP), Parent-Child Interaction Therapy (PCIT), and Trauma-Focused Cognitive Behavior Therapy (TF-CBT).

“It is by now an inescapable conclusion that babies and young children remember what happens to them and show us what they learned from their experiences through their psychological profiles, the emotional quality of their relationships, and their approach to the challenges of exploring the world and learning” (Lieberman, Ghosh Ippen, & Van Horn, 2015, page 2).

Takeaways:

• Infants encode implicit memory even prior to birth, thus can have an imprint of traumatic event even if not a “memory” in the traditional sense
• Different experiences can be considered traumatic to an infant or toddler, compared to traumatic experiences for older children, adolescents, and adults
• Untreated trauma responses in infancy and toddlerhood can lead to developmental delay and long term health outcomes
• Infants and toddlers have trauma responses that differ from older children, adolescents, and adults; thus these can be easily overlooked
• There are many treatment options available for the traumatized infant, toddler, and preschool child such as CPP, PCIT, and TF-CBT; all of which are available at the Steven A. Cohen Military Family Clinic at Centerstone

Learn more about attachment, attunement, and telehealth services for children below:

Trauma and The Power of Attunement

Attachment: The Science of Love

Treating Children Via Telehealth

Learn more about treatment options for infants and toddlers available at the Steven A. Cohen Military Family Clinic at Centerstone:

TF-CBT: https://centerstone.org/healing-in-trauma-for-children/

TF-CBT: A More Comprehensive Trauma Assessment and Treatment Process for Children and Teens

CPP: https://www.nctsn.org/interventions/child-parent-psychotherapy

PCIT: https://centerstone.org/parent-child-interaction-therapy/

Resources:

Davies, D. (2017). Understanding trauma and its impact on young children. In Reflections from the field: Celebrating 40 years, volume 1. Michigan Association for Infant Mental Health.

Felitti, V.J., Anda, R.F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M.P., Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventative Medicine, 14(4), 245-258. https://doi.org/10.1016/S0749-3797(98)00017-8

Lieberman, A.F., Ghosh Ippen, C., & Van Horn, P. (2015) Don’t hit my mommy! A manual for child-parent psychotherapy with young children exposed to violence and other trauma (second edition). Zero to Three.

Siegel, D. J. & Payne Bryson, T. (2012). The whole-brain child: 12 revolutionary strategies to nurture your child’s developing mind. Bantam Books.

Van Der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.

Weatherston, D.J. (2002). Introduction to the infant mental health program. In Case studies in infant mental health. Zero to Three.

Zero to Three. (2016). DC:0-5™ Diagnostic classification of mental health and developmental disorders of infancy and early childhood.