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The Impact of Trauma on Infants W CHILDREN, YOUTH & FA MILY CONSORTIUM CHIL DREN’S MENTAL HEALTH eREVIEW The Impact of Trauma on Infants CHILD WELFARE SERIES JANUARY 2012 young children are at disproportionate risk of experiencing traumatic events; they represent the wThe Children’s Mental Health eReview summarizes majority of children who die from child abuse and children’s mental health research and implications for neglect 1, are more likely to live in a home with practice and policy. domestic violence 2, and for the first year of life This is the fourth experience the single most dangerous period of their issue in a series childhood 3. In addition to the increased risk of focusing on trauma exposure, infants and young children are also at and child welfare. increased risk of negative outcomes related to trauma This issue captures because of their limited ability to cope with the presentation of challenging experiences4. We long believed that Dr. Alicia Lieberman children too young to talk about traumatic events on May 12, 2010 were not affected by them, but research and titled “Child-Parent observation has shown that this is far from the truth. Psychotherapy in a It has been described by some that children can have Cultural Context: a “visual memory” about a traumatic event that Repairing the Effects precedes their ability to speak 5. Infants as young as of Trauma on Early three months old have demonstrated traumatic stress Attachment". This responses following direct exposure to trauma 6. presentation was Infants and young children show many of the same sponsored by the Irving B. Harris Foundation and symptoms of posttraumatic stress as adults 7, and presented as the 2010 Harris Forum research has shown that children exposed to (http://www.cehd.umn.edu/CEED/conferences/harrisf traumatic events have higher rates of depression, orum/default.html) and part of the 2009-2010 Lessons anxiety disorder and other impairments 8. These from the Field seminar series findings demonstrate the critical need to understand (http://www.cmh.umn.edu/culture/culture_2009- and respond to the needs of infants and very young 2010.html) children experiencing trauma, not only to reduce possible negative effects but also to prevent later mental health challenges. RESEARCH SUMMARY Infant Mental Health and an Ecological Lens Cari Michaels, MPH Children, Youth and Family Consortium, Children’s According to the national organization Zero to Three, Mental Health Program the term “infant mental health” refers to (1) how an infant experiences, expresses and regulates emotions, Introduction as well as recovers from dysregulation of these Infants and young children in the United States are emotions, (2) how an infant learns to establish exposed to a wide range of traumatic stressors, trusting relationships and repair conflict within them, including child abuse and neglect, natural disasters and (3) how an infant explores and learns from her such as hurricanes and floods, community and school environment, managing and mastering fear and © 2010, Regents of the University of Minnesota. All rights reserved. University oftrepidation Minnesota Extension when is anthey equal arise opportunity 9. educator and violence,employer . domestic This material violence,is available in and alternative terroristic formats upon acts. request. Very Direct requests for consultation on formats to 800-876-8636. Printed on recycled and recyclable paper with at least 10 percent postconsumer waste material. 12/10 2 Infant mental health cannot be separated from Traumatic Stress in Young Children physical health or healthy development, and parents, Children experience many different types of stressors family members and community members all throughout their lives. Some stress may be 10 contribute to the infant’s state of mental health . normative and developmentally appropriate. For Because infants’ activities happen within the context example, a two-year-old who experiences the birth of of family and community, it is important to view the a new baby in the family may feel normative stress infant’s state of mental health within an ecological (see Figure I). context. This perspective considers the infant’s well- being within multiple ecological environments that Figure I. Risk as a continuum 11 influence one another and the child’s development . For ideal infant mental health, supports must be in Normative, Emotionally Traumatic place at each level of the model. For example, the developmentally costly (toxic) stress infant receives support from family and community appropriate stress stress to achieve optimal growth and development (security, self confidence, character strength and social relationships). The family receives support, resources and guidance to prepare for the birth and provide a Used with permission, Dr. Alicia Lieberman, May 12, 2010 presentation ‘Child-Parent Psychotherapy in a Cultural Context: Repairing the Effects responsive environment after birth. The community of Trauma on Early Attachment’ embraces and supports all families, celebrates the birth of the child and creates a comprehensive and The child finds it difficult to learn to share the integrated array of accessible services that promote mother’s attention, but will also likely learn coping well-being 12. Donald Winnicott 13, a psychologist and strategies that benefit him later in life. Further down pediatrician, states “there is no such thing as a baby", the continuum of risk to the child, toxic stress is a meaning that an infant cannot exist independent of “strong, frequent, and/or prolonged activation of the someone else who cares for him. The “holding body’s stress-response systems in the absence of the environment” of each level of the ecological model is buffering protection of stable adult support” 14. The necessary not only for the infant’s mental well-being, baby or toddler who constantly worries that his but for his very survival. parents will fight with one another bears an Children’s environments vary. Children in emotionally costly burden with potential long-term Minnesota experience a range of characteristics of consequences. Children exposed to family violence, families, neighborhoods and communities. Because physical or emotional abuse, extreme poverty, or this historically homogeneous state has experienced parental substance use may experience toxic stress. an influx of immigrants from disparate places in the Toxic stress can lead to physiological changes (such world, Minnesota children now experience a greater as brain architecture) that in turn can lead to poorer variety of child-rearing practices, a range of images management of stress over time, so the presence of about what constitutes a productive adult, and toxic stress in childhood can have long-term effects. differing perspectives about the best ways to get At the end of the spectrum of risk, traumatic stress there. Generally, there are now more types of can result when the young child is exposed to an ecological contexts and, therefore, greater variability unpredictable event or series of events that in children’s experiences, responses to those overwhelm the ability to cope. It can result in experiences, and appropriate types of interventions. feelings of horror and helplessness. A traumatic This diversity points to the usefulness of the event can be a one-time shock such as a serious ecological perspective as a tool to help identify and automobile crash, or a long-term situation such as understand an infant’s web of influences from family, domestic violence or sexual abuse, but by definition community, policy, and culture, as well as possible it is one for which the young child cannot prepare. ways to strengthen parts of that web to benefit the The event or circumstance is perceived as horrifying child. because it involves “actual or threatened death or serious injury to the child or others, or a threat to the 3 psychological or physical integrity of the child or within the culture, community, and family as others” 15. Finally, the event immobilizes the child’s well as the child’s history come together to influence coping mechanisms and renders him helpless. These subsequent development. Traumatic events at one feelings in young children often result in level can be exacerbated or overcome by potentiating disorganized or agitated behavior. The five criteria or compensatory factors at another level 24,26. For for posttraumatic stress disorder in very young example, a situation of domestic violence (family children are: level) can lead to family disruption (family level), which could result in a decline in financial safety if 1. Exposure to a traumatic event (actual or threatened death or serious injury or the wage earner leaves the family (family level), a threat to physical or psychological move to a new neighborhood (community level), and integrity of child or another person); a new preschool for the child (community level). In 2. Reexperiencing the traumatic event contrast, a child who adjusts well to the ongoing through posttraumatic play, recurrent or challenges of poverty or community violence intrusive recollections of the traumatic (community level) may develop internal coping event outside play, repeated nightmares, characteristics (individual level) that later help her physiological distress, recurrent overcome a situation of domestic violence (family flashbacks or dissociation; level). 3. Numbing or interference with The presence of traumatic events, and therefore developmental momentum revealed by potential traumatic responses, can vary among
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