When children lack safe, stable, and nurturing relationships, their response to stress over time can result in lifelong physical, mental, and relational health challenges. An American Academy of Pediatrics (AAP) policy statement, "Trauma-Informed Care in Child Health Systems," and accompanying clinical report provides practical tools for pediatricians to embrace this approach when working with children, families and communities.
"Almost half of American children have faced at least one potentially traumatic early childhood experience, and many have been harmed by the confluence of poverty, losses related to the pandemic and racial unrest," said James Duffee, MD, MPH, FAAP, lead author of the policy statement. Both policy statement and clinical report were written by the AAP Council on Community Pediatrics; Council on Foster Care, Adoption, and Kinship Care; Council on Child Abuse and Neglect; and Committee on Psychosocial Aspects of Child and Family Health.
Long-term effects of trauma and how to help
"Because of differences in temperament and prior life experiences, some children are more vulnerable to long-term effects of trauma than others. We see symptoms that range from changes in eating and sleeping to severe physical and mental health effects that may require treatment," Dr. Duffee said. "Helping children and their parents and caregivers draw on their close relationships with others can help lessen the harms of trauma and build resilience."
In surveys, poverty or financial stress is the most reported childhood adversity, second only to loss of a parent, according to the policy statement. Exposure to divorce, child maltreatment, sexual abuse, intimate partner violence, bullying, parental mental illness, parental substance use problems, and community violence are also common and racism is a common cross-cutting factor.
"Trauma-informed care embeds screening or surveillance in the context of comprehensive care, starting with engaging families, building resilience, addressing attachment, and assuring safety at all visits," said Heather Forkey, MD, FAAP, an author of the statement and clinical report.
AAP clinical recommendations:
Knowledge about trauma and its potential lifelong effects
Support for the caregiver-child relationship to build resilience and prevent traumatic stress reactions
Screening for trauma history and symptoms
Recognition of cultural context of trauma experiences, response, and recovery
Anticipatory guidance for families and health care workers
Ways to avoid re-traumatization in healthcare settings
Processes for responding in the pediatric setting and referral to counseling with evidence-based therapies when indicated
Attention to the prevention and treatment of secondary traumatic stress
"These reports also call attention to the fact that caregivers and health care workers can experience stress and burnout as secondary effects of addressing the trauma experienced by others," Dr. Duffee said. "We are calling on healthcare systems to adopt trauma-informed care as a core mission and for federal and state policy makers to help make that happen."
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