PTSD: National Center for PTSD
Very Young Trauma Survivors: The Role of Attachment
Very Young Trauma Survivors: The Role of Attachment
Years ago, little was known about PTSD in infants and young children. Today, we know that trauma and abuse can have grave impact on the very young. We also know how much the attachment or bond between a child and parent matters as a young child grows. This can make a difference in how a child responds to trauma. Below we discuss rates of trauma-related problems in infants and young children, as well as treatment options.
Please see PTSD in Children and Teens to learn about trauma in older children and teens.
How many infants and young children are abused?
In the United States, Child Protective Services receives reports on the abuse or neglect of about 5.5 million children in a year. Infants and young children have more risk of abuse than older children. Over one-third of proven reports to child protection services are for children under the age of five years. Further, children are most often hurt or killed from abuse when they are in the first year of life. Over three-quarters of children killed due to abuse are under the age of three years.
How do trauma and neglect affect infants and young children?
As with adults, following trauma, most children will have some symptoms. Young children may show a fear of strangers or be scared to leave their parent. They might also have sleep problems or bad dreams. Young children may also repeat themes of the trauma in their play. For example, a child who was sexually abused in her bed might play out "dark" bedroom scenes with dolls. They might also be more fussy, irritable, aggressive, or reckless. Young children may lose skills they once had, such as toilet training. They might go back to earlier habits, like sucking their thumb. Very young children may not show the same PTSD symptoms we see in adults. This may be because many of the symptoms of PTSD require that the child be able to talk about what happened.
Early trauma affects the child's nervous system. The nervous system is shaped by the child's experiences. Stress over a period of time can lead to changes in the parts of the brain that control and manage feelings. That is to say, stress and trauma early in life can change the brain. This can have long-term effects on physical, mental, and emotional growth. What's more, the impact of early abuse often extends into later childhood, teen, and even adult years.
Diagnosing PTSD in infants and young children
Although most children have symptoms following trauma, only a few will go on to get PTSD. Diagnosing PTSD in children can be difficult. The definition of trauma that is used to diagnose PTSD is specific. It says that a person must feel fear, helplessness, or horror for an event to be a "trauma." It is hard to say if this happens for a very small child. Young children are often not able to describe in words the event or how they felt about it. For this reason, other ways of diagnosing PTSD have been created for use with children ages zero to three years.
What is attachment?
Attachment is the connection found in the main relationship in a child's life. Usually it is with his or her caregiver. Children and parents are meant to form attachments with each other. For example, your baby is born knowing how to cuddle and cry, and it causes you to respond. Also, infants like their caregiver's face and voice more than other sights and sounds. The type of attachment between a child and caregiver can affect how a child will relate to the people she or he comes across in life.
Why is attachment important when dealing with trauma?
A child's main attachment helps him learn to control his emotions and thoughts. When a caregiver's responses are in tune with a child's needs, the child feels secure. The child then uses this relationship pattern as practice to build coping skills. On the other hand, a child who gets confusing or inconsistent responses from the caregiver might be fussy, have a hard time calming down, withdraw from others, or have tantrums.
Children also use their caregivers to guide how they should respond to events. Have you noticed how a child sometimes looks at his or her parent to know how to respond? When you stop your child from doing something unsafe, he in time learns to stop himself. So a parent's reaction to trauma affects the child. Through a relationship with their caregiver, children learn how to be in charge of feelings and behaviors, and how to act with other people.
Here are some examples:
- If a caregiver often helps a child manage her feelings, the child can build coping skills. This could lead to better healing for children who go through trauma.
- A traumatic event might hurt the attachment between a caregiver and child due to strong feelings that get in the way of a good relationship. Sometimes a child can be angry toward her parent for not keeping her safe. Even very young children can have these feelings. Or, a parent might feel guilty about the event and this might affect the relationship.
- If the caregiver has her own trauma history, her symptoms (trying not to feel, always worried about danger) might get in the way of caring for her child.
What kind of help is out there?
- Child health care settings, doctors, and other health care providers can give support, education, safety planning, and information about treatment.
- Child and family social services can help caregivers with many issues.
- In-home nurses and other providers can help new parents provide good care for their young children. They might help with feeding, sleep, safety, or illness.
- Therapy is needed if relationship problems or PTSD symptoms do not get better. Treatment that involves the caregiver and child together is best for cases with poor attachment and trauma. One such treatment is called child-parent psychotherapy (CPP). CPP helps caregivers understand their children, keep them safe, and give emotional help.
- For some children, treatment does not take place for many years. No matter the age, when trauma and PTSD are involved, evidence-based, effective treatment exists.