Signs of Trauma in Children

Childhood trauma is a disturbing event experienced by a child that is perceived as life-threatening, violent, and/or dangerous. Trauma causes fear and significant psychological, physical, or emotional harm. The traumatic event can be a one-time occurrence like a car accident, the death of a loved one, or a natural disaster such as an earthquake or hurricane. The traumatic experience can also be ongoing such as being a victim of physical or sexual abuse, neglect, racism, bullying, or living in an unsafe neighborhood.

Trauma in children can have detrimental impacts on their physical, mental, social, and emotional well-being. Untreated or unresolved trauma in children can carry into adulthood. It has been shown to be associated with an increased risk of depression, self-harm, and high-risk behaviors like unsafe sex and dangerous driving.

Therefore, it’s important to recognize the signs of trauma in children in the weeks and months following a traumatic event so that early intervention can help minimize and/or prevent long-term consequences. 

Emotional Signs of Trauma

A child with trauma usually has trouble identifying, expressing, and managing their emotions. Sometimes, they internalize their feelings and have limited language in their emotional state. When reacting to stress, they may respond strongly and unpredictably and have difficulty de-escalating their heightened emotions.

If the nature of their trauma involves interpersonal relationships, they may become extremely vigilant and defensive when interacting with others as a way to protect themselves. If the child does not have meaningful and trusting relationships, they may not learn how to manage their emotions appropriately. As a result, they may give up quickly on tasks as soon as they feel frustrated. 

Some of the emotional signs of trauma in children include the following:

• Feeling sadness or worthlessness
• Showing intense outbursts of anger and aggression
• Being easily frightened or scared
• Feeling guilt or shame
• Feeling depressed or alone
• Showing fear when being separated from a parent
• More crying or screaming
• Feeling timid or more pressured

Behavioral Signs of Trauma

Trauma in young children can have detrimental effects on the developing brain. When the brain prioritizes recognizing and responding to threats, it impacts skill acquisition and delays development. Parts of the brain that are affected include the limbic system, hippocampus, and prefrontal cortex. The prefrontal cortex is responsible for emotional regulation, attention, cognition, executive function, and impulse control.

Some of the behavioral signs of trauma in children include:

• Having a low tolerance for frustration
• Showing signs of dissociation, being withdrawn, closed-off, not present, or shut down 
• Having problems focusing or concentrating on school work, projects, tasks, and/or conversation
• Regressive behavior where they return to an earlier stage of development, such as wetting the bed and/or thumb sucking
• Refusing to go to school
• Crying frequently 
• Having difficulty sleeping
• Gaining or losing weight suddenly
• Changing their eating habits or showing signs of disordered eating or an eating disorder
• Exhibiting reckless and risky behaviors such as substance misuse and inappropriate sexual activity
• Showing signs of self-harm such as cutting or suicidality
• Expressing extreme concern about their safety
• Reenacting the traumatic event, especially in younger children

Physical Signs of Trauma

When children experience trauma, it can negatively affect how their immune system functions. Specifically, exposure to trauma causes the immune system to activate inflammatory responses for a prolonged period of time. This can cause children to be more susceptible to illnesses such as metabolic syndrome, asthma, and infections.

Another physical sign that a child has experienced complex trauma is body dysregulation. Body dysregulation is when the body over-responds or under-responds to sensory stimuli. For instance, the child may be hypersensitive to noise, touch, light, or smells. They may complain about pain in parts of their body where there is no physical cause.

Or they may be desensitized to their physical sensations, as in they aren’t aware when their body experiences pain or touch. Consequently, they may hurt themselves physically without knowing.

Screening

Pediatric healthcare providers use validated screening tools to assess a child’s development, mental health, and behavior. They can help identify whether a child’s symptoms, such as developmental delays, anxiety, and socio-emotional issues are due to trauma. 

Some common screeners used include:

• Ages and Stages Questionaire
• Pediatric Symptom Checklist
• Strengths and Difficulties Questionnaire
• Patient Health Questionnaire

The Intermountain Care Process Model recently developed the Pediatric Traumatic Stress Screening Tool to assess traumatic stress in children in the primary care setting and to help identify diagnostic criteria for PTSD.

Resources for Parents and Caregivers

If your child or someone you know has experienced trauma, here are some resources to support you. 

• The National Child Traumatic Stress Network
• Substance Abuse and Mental Health Services Administration (SAMHSA)
• American Association for Marriage and Family Therapy
• Child Mind Institute's Helping Children Cope After a Traumatic Event: A recovery guide for parents, teachers and community leaders

A Word From Verywell

Each child is different and how they respond to trauma depends on multiple factors, including the severity of the event, the chronological age of the child, the developmental stage of the child, the level of support in the child’s caregiver, and the type of environment the child is exposed to. 

After a traumatic event, it can be difficult to focus on how to move forward. However, children can recover from trauma when parents, caregivers, and teachers around them make them feel safe again, comforting and guiding them through their grief and fear. Supporting a child during their healing is crucial to prevent them from suffering the long-lasting effects of trauma.