The bad news is that trauma is a fact of life. The good news is that so is resilience. Simply stated, resilience is the capacity we all possess to rebound from stress and feelings of fear, helplessness and overwhelm. The analogy sometimes given for resilience is that of a metal spring, such as a “Slinky.” If you pull it apart, the coil naturally rebounds to its original size and shape. Of course, if you stretch this spring too many times (or exert too much force), it will eventually lose its elasticity.
People (especially young people), however, need not lose their resilience through wear and tear. On the contrary, we have the capacity to actually build and increase our resilience as we encounter the stresses and strains of life. Resilient children tend to be courageous. This doesn’t mean that they are attracted to dangerous situations, but rather that they are open and curious as they explore their world with gusto and exuberance. And, in their explorations, they inevitably have their share of rumbles and tumbles, collisions and conflicts.
When resilient kids meet these forces of nature, they are open rather than shut down. Openness, indeed, is the characteristic that most typifies resilient kids. They are open to other children and enjoy sharing with them. At the same time, they are able to set boundaries of their own personal space and their possessions. They are in touch with their feelings, expressing and communicating them in age-appropriate ways. And, most of all, when bad things happen, they have a wondrous capacity (when supported) to breeze through them. They are the happy, lively children we wish we were. Their biggest challenges occur from events that could be potentially traumatic. Let’s delve into what types of life’s circumstances might cause such overwhelming reactions in our kids.
Trauma can result from events that are clearly extraordinary such as violence and molestation, but it can also result from everyday “ordinary” events. In fact, common occurrences such as accidents, falls, medical procedures and divorce can cause children to withdraw, lose confidence, or develop anxiety and phobias. Traumatized children may also display behavioral problems including aggression, hyperactivity and, as they grow older, addictions of various sorts. The good news is that with the guidance of attuned parents and other caregivers who are willing to learn the necessary skills, children at risk can be identified and spared from being scarred for life, regardless of how devastating the events might be or seem.
Parents are, at times, conflicted between protecting their children and permitting them to take the risks that build confidence and competence. It’s a tricky balancing act because as they master their world, children can also be traumatized when the unexpected inevitably happens. As much as you may try to “child-proof” your home, ultimately children—driven by their curiosity—will explore and get hurt. That is how they learn and they will have their share of falls, burns, electrical shocks, animal bites and other encounters with the non-forgiving forces of nature. No matter how hard we try, we cannot close our children off in an impenetrable (and inescapable) bubble of safety.
Our children are frequently exposed to potentially traumatic events. But parents need not despair. It is possible to minimize the effects of the “ordinary” situations mentioned above, as well as those from extraordinary events such as natural and man-made disasters, including violence, war, terrorism and molestation.
Are we being ridiculous by proposing that adults can “trauma-proof” kids? We don’t believe so. Remember, although pain can’t be avoided … trauma is a fact of life … but so is resilience, the capacity to spring back.
In this book you will learn practical tools to maximize your child’s resilience so that their equilibrium can be restored when they are stressed to their breaking point. Armed with this “recipe for resilience,” parents and other responsible adults can help to trauma-proof their kids while also generally increasing their tolerance to everyday stress. In this way they can truly become stronger, more caring, joyful and compassionate human beings.
The word “trauma” pops up in the headlines of magazines and newspapers regularly. Popular TV shows such as The Oprah Winfrey Show bring understanding to millions of viewers regarding trauma’s gripping effect on body and soul. Trauma’s devastating impact on children’s emotional and physical well-being, mental development and behavior is finally getting the recognition it deserves. Since September 11, 2001, there has been an information blitz on how to cope with catastrophe.
Despite this focus, however, precious little has been written regarding the common causes or the prevention and the non-drug treatment of trauma. Focus instead has been on the diagnosis and the medication of its various symptoms. “Trauma is perhaps the most avoided, ignored, belittled, denied, misunderstood, and untreated cause of human suffering.”1 Fortunately, you—the parents, aunts, uncles and grandparents who nurture and protect children—are in a position to prevent, or at least mitigate, the damaging effects of trauma.
In order to do the most good for the children in your care, first you need to recognize the roots of trauma. Next, we take a closer look at trauma—its myths and realities. In this way you will understand what may cause a child to remain overwhelmed even though the actual danger has passed.
This book will teach you how to help children notice and move through painful sensations and feelings without undue distress. Your new knowledge will help take the fear out of the experience of the involuntary reactions and emotions that allow children to rebound from trauma as well as other difficult feelings. Many real-life examples are included to illustrate how you can support children in recovering from overwhelming experiences. You will learn to recognize the signs of trauma while acquiring simple skills to alleviate or prevent trauma symptoms after a frightening mishap or stressful life event. While these basic principles are meant to be “emotional first aid” applied by conscientious caregivers, there are situations, of course, when professional counseling is highly recommended. We will help you to know when this might be necessary.
Real-Life Examples of Children We Have Known
By taking a peek into the worlds of five different children, you will have a better sense of the scope of trauma that can occur at any age. One or two of the situations described may even remind you of your own kids! After you read the dilemmas of the youngsters below, you will discover what caused their behavior.
Lisa cries hysterically every time the family prepares to get into the car.
Carlos, a painfully shy fifteen-year-old, is chronically truant. “I don’t want to feel scared all the time anymore,” he says. “All I want is to feel normal.”
Sarah reports dutifully to her second-grade class on time every morning; invariably, by 11 a.m., she is in the nurse’s office complaining of a stomachache, although no medical reason can be found for her chronic symptoms.
Curtis, a popular, good-natured middle school student, tells his mother that he feels like kicking someone—anyone! He has no idea where this urge is coming from. Two weeks later he starts behaving aggressively, bullying his little brother.
The parents of three-year-old Kevin are concerned about his “hyperactivity” and “autistic-like” play when he feels stressed. He repeatedly lies on the floor and stiffens his body, pretending he is dying and slowly coming back to life, saying, “Save me … save me!”
What do these youngsters have in common? How did their symptoms originate? Will their symptoms disappear or grow worse over time? To answer these questions, let’s take a look at where their troubles began.
We’ll start with Lisa, the hysterical crier. When she was three years old, she had been strapped into her car seat when the family’s van was rear-ended. There were no physical injuries to her or her mom, who was driving. In fact, the car was barely scratched and the accident was considered a minor “fender bender.” Little Lisa’s crying was not associated with the accident because it took several weeks before the numbing impact of the collision wore off. Her initial symptoms (shortly after the accident) were unusually quiet behavior coupled with a poor appetite. Her parents thought she was “over it” when her appetite returned. Instead her symptoms changed to fearful tears whenever she came near the family van.
While Lisa experienced a one-time episode, Carlos’ symptoms developed over time. He had been physically intimidated for more than five years by an emotionally disturbed teenaged stepbrother. No one intervened. His parents considered it “normal” sibling rivalry. They didn’t have a clue that Carlos was terrified of his brother because he locked his secret deep inside, fearful that his parents would be furious with him for not being empathetic to his brother’s disability. He had tried to express his dread to his mother but his feelings were dismissed; he was, instead, asked to be more tolerant.
No one except Carlos’ older sister, who was in distress herself due to the family dynamics, saw his pain or predicament. Meanwhile, Carlos fantasized night and day about being a professional wrestler, but he had barely enough strength or confidence to get out of bed to come to school, let alone become part of a high school sports team. It wasn’t until Carlos revealed a plan for suicide at school that his parents finally recognized the heavy emotional toll that the repeated harassment was having on their son.
The next youngster mentioned above was Sarah, who had been very excited about starting second grade. After a fun shopping spree with mom to pick out brand-new clothes for school, she was told, abruptly and unexpectedly, that her parents were getting divorced and her father would be moving out in two weeks! Her joy for school became paired with panic and sadness. The aliveness in her tummy changed into tight twisted knots. No wonder she was the nurse’s most frequent visitor!
While waiting for the school bus one morning, Curtis witnessed a drive-by shooting that left the victim dead on the sidewalk. He was with a small group of classmates at the bus stop, and all received some counseling when they arrived at school. Curtis, however, continued to look disturbed and agitated as the days passed.
The last youngster described was Kevin. He had been delivered by emergency cesarean and had a lifesaving surgery within twenty-four hours of his birth. He was born with anomalies requiring immediate intestinal and rectal repair. Often, medical and surgical procedures are required and do make life possible. Amidst the relief and celebration of a saved life, it is easy to overlook the reality that these same procedures can inflict trauma that may leave emotional and behavioral effects long after the surgical wounds have healed.
Except for the shooting witnessed by Curtis and the major surgery performed on Kevin at birth, the situations above are not extraordinary; in fact, they happen to many children. Although each “event” was very different, what these youngsters have in common is that each experienced feelings of overwhelm and helplessness. Each youngster was traumatized by what happened and how they experienced what happened. How do we know? The answer is quite simple. Each child carried on in life, some way, as if the event were still happening. They were “stuck” in time, as their bodies responded to an alarm that was set at the traumatic moment. Although these children may not remember the event (or their parents may not connect their symptoms to it), their play, behavior and physical complaints reveal their struggle to cope with the new and frightening feelings they have inside.
The above examples demonstrate the breadth and depth of common situations that can be overwhelming to children. Throughout this book, examples and first-aid suggestions will be given on how to deal with a variety of situations, both ordinary and extraordinary, at various ages and stages of a child’s life.
Trauma Is Not Only in the Event
Trauma happens when an intense experience stuns a child like a bolt out of the blue; it overwhelms the child, leaving him altered and disconnected from his body, mind and spirit. Any coping mechanisms the child may have had are undermined, and he feels utterly helpless. It is as if his legs are knocked out from under him. Trauma can also be the result of ongoing fear and nervous tension. Long-term stress responses wear down a child, causing an erosion of health, vitality and confidence. This was clearly the case with Carlos and his bully brother.
Trauma is the antithesis of empowerment. Vulnerability to trauma differs from child to child depending on a variety of factors, especially age, quality of early bonding, trauma history and genetic predisposition. The younger the child, the more likely she is to be overwhelmed by common occurrences that might not affect an older child or adult. It has been commonly believed that the severity of traumatic symptoms is equivalent to the severity of the event. While the magnitude of the stressor is clearly an important factor, it does not define trauma. Here the child’s capacity for resilience is paramount. In addition, “trauma resides not in the event itself; but rather [its effect] in the nervous system.”2 The basis of “single-event” trauma (as contrasted to ongoing neglect and abuse) is primarily physiological rather than psychological.
What we mean by “physiological” is that there is no time to think when facing threat; therefore our primary responses are instinctual. Our brain’s main function is survival! We are wired for it. At the root of a traumatic reaction is our 280-million-year heritage—a heritage that resides in the oldest and deepest structures of the brain. When these primitive parts of the brain perceive danger, they automatically activate an extraordinary amount of energy—like the adrenaline rush that allows a mother to lift an auto to pull her trapped child to safety. We personally know a woman whose arm was trapped under the tire of a truck as an eight-year-old girl. Rescue workers were unsuccessful in helping her until they were able to get her father to the scene. With his powerful, protective, bear-like surge of energy, he was able to pull her out.
This fathomless survival energy that we all share elicits a pounding heart along with more than twenty other physiological responses designed to prepare us to defend and protect ourselves and our loved ones. These rapid involuntary shifts include the redirection of blood flow away from the digestive and skin organs and into the large motor muscles of flight, along with fast and shallow respiration and a decrease in the normal output of saliva. Pupils dilate to increase the ability of the eyes to take in more information. Blood-clotting ability increases, while verbal ability decreases. Muscles become highly excited, often causing our child to tremble. Alternatively, when faced with mortal threat or prolonged stress, certain muscles may collapse in fear as the body shuts down in an overwhelmed state.
Fear of Our Own Reactions
When a child or adult is uncomfortable with what is happening inside them (their inner sensations and feelings), the very responses that are meant to give a physical advantage can become downright frightening. This is especially true when, due to size, age or other vulnerabilities, one is either unable to move or it would be disadvantageous to do so. For example, an infant or young child doesn’t have the option to run and escape from a source of danger or threat. However, an older child or an adult, who ordinarily could run, may also need to keep very still, such as in the case of surgery, rape or molestation. There is no conscious choice. We are biologically programmed to freeze (or go limp) when flight or fight is either impossible or perceived to be impossible. Freeze and collapse are the last-ditch, “default” responses to an inescapable threat, even if that threat is a microbe in our blood. Infants and children, because of their limited capacity to defend themselves, are particularly susceptible to freezing and therefore are vulnerable to being traumatized. This is why the adult’s skill is so crucial in providing emotional first aid to a frightened youngster. Parental support can slowly move a child out of acute stress to empowerment and even joy.
What must be understood about the freeze response is that although the body looks inert, those physiological mechanisms that prepare the body to escape may still be on “full charge.” Muscles that were poised for action at the time of threat are thrown into a state of immobility or “shock.” When in shock the skin is pale and the eyes vacant. Breathing is shallow and rapid, or just shallow. The sense of time is distorted. Underlying this situation of helplessness, however, there is an enormous vital energy. This energy lies in wait to finish whatever action had been initiated. In addition, very young children tend to bypass active responses, becoming motionless instead. Later, even though the danger is over, a simple reminder can send the exact same alarm signals racing once again through the body until it shuts down. When this happens we may see the child becoming sullen, depressed, whiney, clingy and withdrawn.
Whether your child is still fully charged or has shut down, your guidance is imperative to alleviate their traumatic stress response and to build up their resilience. Furthermore, young children generally protect themselves not by running away, but by running toward the protective adult. Hence, to help the child resolve a trauma, there must be a safe adult to support them. The parent who has the skills of emotional first aid can help them literally “shake things off” and breathe freely again.
How does the outpouring of survival energy and multiple changes in physiology affect our kids over time? The answer to this question is an important one in understanding the consequences of trauma. This depends on what happens during and after the threat. The catch is that to avoid being traumatized, the excess energy mobilized to defend us must be “used up.” When the energy is not fully discharged, it does not simply go away; instead it remains as a kind of “body memory” creating the potential for repeated traumatic symptoms.
The younger the child, the fewer resources she has to protect herself. For example, a preschool or primary-school child is unable to escape from or fight a vicious dog, while infants are unable even to keep themselves warm. For these reasons the protection of respectful adults who perceive and meet children’s needs for security, warmth and tranquility (and respect for their boundaries) is of paramount importance in preventing trauma. Additionally, adults often can provide comfort and safety by introducing a stuffed toy animal, doll, angel or even a fantasy character that can act as a surrogate friend. These objects can be especially consoling when children must be temporarily separated from their parents, and as sleeping aids when they are alone in their room at night. Resources such as these may seem silly for an adult but may prove vital to the young child in preventing overwhelm.
Adults who received this type of secure connection when frightened as children may call the above information “common sense.” This implies that children’s needs are commonly noticed and attended to. Historically, however, the needs of children have been disgracefully minimized, if not overlooked entirely. Developmental psychiatrist Daniel Siegel, author of the acclaimed book The Developing Mind, provides a synthesis of the neurobiological research underscoring exactly how crucial the safety and containment provided by adults is to infants and children. The early brain develops its intelligence, emotional resilience and ability to self-regulate (restore equilibrium) by the anatomical-neuronal “shaping” and “pruning” that takes place within the face-to-face relationship between child and caregiver. When traumatic events occur, the imprinting of neurological patterns is dramatically heightened. Thus when adults learn and practice the simple emotional first aid tools we offer, they are also making a pivotal contribution to healthy brain development and behavior in their children.
The Recipe for Trauma
The likelihood of developing traumatic symptoms is related to the level of shutdown as well as to the residual survival energy that was originally mobilized to fight or flee. This self-protective process has now gone haywire. Children need consistent, patient support to release this highly charged state and return to healthy, flexible functioning. The myth can be laid to rest that babies and toddlers “are too young to be affected” by adverse events or that “it won’t matter because they won’t remember.” What was not so obvious becomes apparent as we learn that prenatal infants, newborns and very young children are the most at risk to stress and trauma due to their undeveloped nervous, muscular and perceptual systems. This vulnerability also applies to older children who have limited mobility because of permanent or temporary disabilities, such as having a splint, brace or cast due to an orthopedic injury or correction. Included in this category are children less able-bodied due to cerebral palsy, congenital deformities or developmental delays.
The Reason Our Bodies Don’t Forget: What Brain Research Has Taught Us
Why is it that once the threat is over we are not free of it? Why are we left with anxiety and vivid memories that alter us forever if we don’t get the help that we need?
The highly regarded neurologist Antonio Damasio, author of Descartes’ Error and The Feeling of What Happens, discovered that emotions literally have an anatomical mapping in the brain necessary for survival.3 That is to say, the emotion of fear has a very specific neural circuitry etched in the brain corresponding to specific physical sensations from various parts of the body. When something we see, hear, smell or taste evokes similar body sensations to a previous threat, the emotions of fear and helplessness are again evoked, mimicking what happened when the initial danger was present. Originally, the experience of fear served an important purpose. It helped the body to organize a “flee or freeze” plan to remove us from peril quickly. However, the trigger now produces a similar fear even though there is no conscious memory of its origin (just the identical physical response). The heart rate escalates rapidly or drops precipitously, sweat is produced, and the anguish occurs because the body is totally re-engaged, mistaking the body’s responses for the original threat as if it were actually happening in present time. But what parents are more likely to observe are seemingly inexplicable behaviors and emotions.
The Recipe for Resilience
As we explained earlier in this chapter, whether a child remains distressed or bounces back with resilience depends on what happens during and/or after the threat. You have learned that to avoid being traumatized, the excess energy that your child mobilized in a failed attempt to protect or defend himself must be accessed and then “used up.” When this “emergency” energy is not fully engaged and discharged, it does not simply go away. Instead, it is capable of causing all sorts of troublesome symptoms, as you shall see shortly with “Henry.” You will also see how Henry’s aversion for and his avoidance of certain foods and noises soon disappeared as he “used up” his anxious energy to joyfully rebound with the support of his parents. And, the skills that Henry’s parents utilized are the same skills that you will be learning throughout this book to help your child when she is apprehensive, stressed or outright terrified after a frightening challenge.
Four-year-old Henry’s mother became concerned when he refused to eat his (previously) favorite foods: peanut butter and jelly with a glass of milk. When his mother placed them in front of Henry, he would get agitated, stiffen and push them away. Even more disturbing was the fact that he would start shaking and crying whenever the family dog barked. It never occurred to her that this “pickiness” and fearfulness of the barking were directly related to an “ordinary” incident that had occurred almost a year before, when Henry was still using a high chair.
Sitting in his high chair, devouring his favorite foods—peanut butter, jelly and milk—he had proudly held out his half-empty glass for his mother to fill. As things like this happen, Henry lost his grip and the glass fell to the ground with a crash. This startled the dog, causing it to jump backward, knocking over the high chair. Henry hit his head on the floor and lay there, gasping, unable to catch his breath. Mother screamed and the dog started barking loudly. From his mother’s perspective Henry’s food aversion and apparent fear of the dog made no sense. However, from the vantage of trauma, the simple association of having milk and peanut butter right before the fall and the wild barking of his dog, in a Pavlovian response, conditioned his fear and aversion to his previously favorite foods.
Once Henry had “practiced” controlled falling onto pillows (with the suggestions detailed later in this book), he learned to relax his previously stiffened muscles as he gradually surrendered to gravity. Before this, he “simply” would not eat those foods and had trouble sleeping when dogs barked in the neighborhood. Fortunately, after a couple of play sessions this little boy was once again devouring his favorite foods and barking back at the dog in playful glee. In other words, Henry got to use up the energy that was bound up in his defenses against falling during these safe “tumbling sessions.” As he gained mastery of his balance—with the help and safety of his parents—Henry’s fear was transformed into delight.