Looking after your child following trauma

Trauma affects people in different ways, at different times; there is no right or wrong way to think or feel.

Some of the things people commonly experience following a trauma are;

• nightmares and struggling to sleep
• upsetting thoughts
• unwanted memories and pictures of the event
• feeling as though it is happening all over again
• feeling anxious, jumpy and on edge
• having panic attacks or physical sensations (dizziness, heart racing etc)
• becoming upset at reminders
• being more worried about bad things happening
• finding it difficult to cope with everyday stresses
• feeling scared to go out
• finding it hard to be separated from loved ones
• feeling sad and irritable
• having difficulty concentrating
• feeling guilty for what they did or didn’t do and how they are feeling now
• feeling like things will never get better

Trauma reactions are often invisible and are hard for children to articulate but they may demonstrate the distress they are feeling through their behaviour;

• regressive behaviour (e.g. bed wetting, thumb sucking, being more clingy)
• intolerance, irritability or anger
• physical complaints (e.g. stomach ache, headaches)
• changes to play
• risk taking behaviours
• increase in anxiety around separations (e.g. worry about parents or siblings leaving the home)

It can be difficult to see your child upset and anxious but it is important to bear in mind that these reactions make a lot of sense given the fear that they have experienced. Often, following a traumatic event, children’s views of the world may be temporarily changed; it will feel less safe and more unpredictable.

Many behaviours you see may be an attempt to reduce anxiety and make the world feel safer and more predictable: for example, checking doors and windows are locked, saying goodnight a set way, sleeping in a parent’s/carer’s bed or playing in a repetitive manner. Some of these behaviours can be beneficial in the short term and begin to help a child readjust to their world.

However, in the longer term these activities can maintain a child’s focus on their worries and concerns, and this will slow down their recovery. So it is important you encourage your child to notice and acknowledge their worries and fears, reminding them that the trauma is over and they are safe now. Gradually as you re-establish a more normal routine, this will help your child feel more secure and reduce the anxiety-driven behaviours.

During a trauma our brain switches on its survival mechanism (the limbic system).

The limbic system is the most primitive part of the brain and acts as the body’s alarm to danger. When it is triggered it ensures that people react in a way that helps them survive.

This is the flight-flight-freeze response and means someone can react quickly to danger; to stay and fight, run away or freeze to hide.

While the brain is prioritising survival, more complex processes such as planning for the future and processing information go off-line or shutdown.

This means information that is happening at the time of the trauma is not processed or stored in the same way as other memories. So memories that are made during a traumatic event can be incomplete or disjointed and they can be linked to the very strong emotions that were experienced at the time of the trauma.

The incomplete processing of trauma memories is partly why they are so volatile; popping up unexpectedly or being easily triggered by reminders of the trauma.

The nature of these memories can trick the brain into thinking the trauma is happening again and floods the person with the same fear that they experienced at the time. These memories are known as flashbacks and are a common experience following a trauma.

Understandably, people may do everything they can to stop these memories being triggered; such as trying not to think about the event or avoiding reminders and situations that make them anxious.

Unfortunately, avoidance keeps the memories disorganised and keeps the brain and body in a state of ‘high alert’, making people jumpy and reactive to even the smallest fears.

Avoiding memories and reminders does not allow the brain to process the memory, and it continues to feel that the event is happening again every time the memory is triggered. Avoidance also interferes with recovery as it prevents the person learning to tolerate their distress in the knowledge that they are actually safe and the event is over.

At times of increased stress children take their emotional cues from the important adults around them, so one of the best ways to help your child is to make sure you take care of your own needs.

Do not ignore or discount your own reactions to the trauma your child has experienced; it is important to notice and respond to these. The way you feel will impact on how you respond at home, so the better you feel the more effectively you can respond to your children, which will help them in their recovery.

You may notice that you experience some of the symptoms outlined above or that you are recognising a number of different thoughts or emotions.

Often parents can feel guilty and responsible that their child has been involved in a traumatic situation. This can lead to many normal questions but also at times lots of wishful thinking and wondering if somehow they could have prevented the trauma (e.g. “if only….” or “what if…”).

Some parents may also struggle with how they reacted or responded to their child’s trauma, either during or after the event and this may bring a wave of other feelings, like guilt, shame or anger.

It is so important that you pay attention to what you are feeling and have realistic expectations for yourself, just as you would for your child. These feelings are normal and they will come and go if you take care of them. Talk about them with someone you trust, writing them down or using other strategies found in the children's guide to managing trauma may help.

There are also many other self-help resources that will guide you in how best to deal with tricky and unpleasant feelings and thoughts.

Helping their recovery

Following a trauma, it is a normal parental response to try and make everything feel better for your children; reduce stress or worries, make everything feel safe and take suffering away.

This is of course unrealistic both for you as parents and for your children, as ‘feeling better’ will take time and support and cannot be rushed. Try not to put pressure on yourself to make everything ‘right’ for your child; it will happen slowly as you support them on their journey.

Remember that recovery from trauma can take weeks and months and the best thing you can do is get alongside your child, understand what they are going through and help them take steps to navigate their journey.

Some ways of doing this for both them (and for yourself) might include:

• Remind your child that they are safe.
• Reassure them it is understandable to have strong feelings and thoughts about what has happened.
• Ensure your child is meeting their basic self-care needs - eating well, getting enough sleep and doing a small amount of exercise every day.
• Maintain or re-establish some normal routine.
• Take pressure off them where you can – does their room have to be tidy, can you get them some time off homework?
• Encourage them to get back to doing things they used to do as soon as possible, even if they need support and adaptations to do this.
• Discuss with them what will make it easier to go back to school/college/ hobbies and problem-solve their worries.
• Remind them the trauma is in the past – help them choose a picture on their phone of something good they have done since or something you are looking forward to.
• Make their bedroom and living space comfortable, have things around them that make them feel safe and encourage them to spend time with people (or pets!).
• Stay away from social media and the news if this is upsetting and monitor what your child is seeing.
• Don’t worry if your child feels anxious and scared, this is to be expected after a frightening event. Remind them it does not mean there is danger now and it will improve with time.
• Help them make sense of what has happened. Talking about the event or writing it down can help, when they are ready, with a person they trust. Fill in missing information for them if possible with age appropriate information.
• Answer difficult questions as honestly as you can, allow yourself to demonstrate emotions and show them you can tolerate their distress. Children often avoid talking about traumas for fear of upsetting family members.
• Remember recovery is different for everyone and it often takes steps forwards and backwards.

There are lots of suggestions to help build resilience and manage trauma responses throughout the children’s guide to managing trauma.

These are most effective when your child choose the ones they like and then stick with them. Practicing strategies when they don’t need them will make them more effective when they do need them.

Matching the type of strategy to how they are feeling is also important, for example, do they need to do some exercise to burn off excessive anxious energy or do they need to try more soothing ones to help them feel more settled and less stressed.

Some children will find returning to school following a trauma a welcome relief and a great distraction. They will be keen to get back to the routine, see their friends and may actually find school a safe and reassuring environment to be in.

Equally, other children will find their post-trauma view of the world and their heightened anxiety will mean returning to school brings with it enormous challenges. Some will struggle with: separation from loved ones, the distance they are from the safety of their home and worries about others asking questions.

Many children may find their anxiety is triggered by the school environment. Triggers at school will vary depending on the trauma someone has experienced, but common ones include: unexpected loud noises, screaming, bangs, crowds, alarms, smells, subject topics or specific places within school.

This may not become apparent until your child returns to school, but one important way of supporting your child is to liaise with the school and help them understand what your child has been through and what the challenges at school might be.

There is a helpful resource for schools called The Journey of Recovery that has been developed with young people who have experienced trauma, specifically to help those within education understand why returning to school might be so difficult following a trauma. There is both an animation and a resource pack, which you are welcome to view and read. It has been distributed by the Department for Education and it might be a helpful starting point for your child’s school.

Clearly there maybe times that the difficulties your child is experiencing are more than can be managed within the school or the family home and professional help may be needed. To find out how to access more help please see the end of this guide.

After a trauma our brains can become oversensitive to danger and can keep people in a constant state of ‘high alert’, expecting the worst and keeping anxiety high.

Many things can become associated with the trauma and will trigger memories or flashbacks to the event. Triggers can be noises, songs, smells, stories in the media, places or other things that are less obvious.

It may be instinctive to help your child avoid triggers and reminders as you don’t want them to be distressed. However, as mentioned above, if ‘avoidance’ becomes a key strategy for dealing with distress then memories will remain disorganised and the brain and body will stay in a state of ‘high alert’ when triggers arise.

This can interfere with your child’s recovery. It is therefore key that you help them tolerate and ride out the emotions that come with their flashbacks and memories.

Understanding trauma triggers can go some way to making them less frightening and can help you make plans about how to manage them. There are lots of ideas about to help your child feel grounded and safe in the children’s guide to managing trauma, as well as strategies for helping them with distress and anxiety

Sleep is important as it is restorative and helps us make sense of the day’s experiences. Following a trauma it is common for sleep to be disturbed by worries, fear and nightmares; this could include difficulty drifting off to sleep or awakenings during the night.

Remind your child that anxiety during the night is their brain trying to keep them on high alert so they can avoid any potential dangers; reassure them it is safe to sleep. Ensuring their bedroom is as comfortable as possible and that they maintain a soothing bedtime routine will help. Using sensory strategies from the children’s guide to managing trauma may also be beneficial.

Whilst nightmares can be distressing they are actually a normal part of recovery from trauma. If your child does have nightmares don’t feel compelled to talk about them during the night, comfort them and try and encourage sleep. Your child may want to talk the following day or they may do a picture that represents their nightmare; but equally likely, they may not remember that they had one!

If they do want to talk or draw, it is important to be curious and empathic but also reassure them that while nightmares might be scary they are a normal part of recovery and their brain is trying to make sense of what happened to them.

Upsetting thoughts and increased worries are common after experiencing a trauma. These could be memories, guilt, or worries about bad things that have happened or might happen.

Difficult thoughts and worries can take up a lot of time and can lead to feeling more anxious and exhausted. Instead of battling with them, or spending ages thinking about them, it is more helpful to let thoughts just come and go. Pushing thoughts away leads to them coming back stronger, but they will go away if you let them fade in their own time.

It is important to try and help your children keep their worries in-check;

• Remind your child that thoughts are just thoughts, not facts.
• Help your child to notice when worrying might be starting for example when they start a sentence with “what if…”
• Create a worry box that your child can post their worries in, with the understanding that you will read them and get back to them at a given time in the day.
• Help your child write their worries down and come back to them later. Spend time looking at them together and help them notice which problems are within their control and which are worries. Makes plans to let the worries go and problem solve and action the problems.
• Worries come and go like any other thoughts; help your child notice a worry and see if they can ‘watch it’ come and go as other thoughts take over.
• Try to help your child focus on what they can control rather than things that are out of their control.

Letting your child know when you have noticed they are worrying can help them choose a more effective way to respond. You can support them to manage their worry, problem solve and action real dilemmas, and use the grounding or sensory ideas from the children’s guide to managing trauma to help refocus them.

Children often look to their parents for reassurance in times of uncertainty and distress. Clear, factual and age appropriate answers are helpful; however, there will be some questions that you can’t answer and it is important to help your child tolerate that uncertainty remains part of life.

After a trauma this can be much harder for a child to manage because their whole world can feel different and uncertain and it may feel like the trauma they experienced could happen again.

Repeated questions and requests for reassurance can often mean that a child is becoming dependent on your answers to reduce their anxiety. However, this can become an unhelpful cycle; they seek reassurance, feel briefly better but then anxiety returns so they ask another question.

It is important to help your children identify the content of their worries and if it is a problem to be solved now or if it is something out of their control. If it is not something to be solved then refocus them back onto what they could be doing or what it would be helpful for them to be doing. You may need to answer them once and then let them know you are not going to answer again.

It is also important to be mindful of false assurances. You can’t promise that bad things won’t happen but you can let them know it is not very likely and that you will deal with things if they happen.

After a trauma people often describe feeling low and upset. Life may have changed and feel different and some children may feel a sense of loss because of these perceived changes.

Others will be impacted by the distress of recurring memories and associated thoughts and feelings they are having. Distress is normal after a trauma but over time the wider impact of the trauma can develop into a more persistent change in mood.

You may see an increase in the frequency of some of these behaviours;

• crying and tearfulness
• shouting and irritability
• changes to appetite
• changes to sleep pattern
• not going out with friends or to previously enjoyed activities
• decreased motivation
• poor self-care
• withdrawing and isolating themselves
• excessive tiredness
• deterioration in concentration

Encourage your child to take care of themselves, to spend time with other people, do one small nice thing every day and exercise regularly.

Creating a plan together will encourage more helpful strategies and allow them to reduce less helpful patterns of behaviour. You may need to be creative and actively ensure they are sticking to it. Building in rewards can also be useful.

It may not be possible to get a great improvement in mood, but instead aim to build in times when they can have some respite from it. Also, planning ahead will ensure they do not cause further difficulties with relationships (by isolating themselves) and with their achievements (e.g. getting behind with work).

Sometimes people have thoughts of harming themselves after a trauma. There are a number of reasons for this; some may think harming themselves may help to reduce difficult emotions while others may actually feel that they want to end their lives.

Hearing that your child may have thoughts about harming themselves is clearly very distressing and needs to be taken seriously.

Having a thought about self-harm does not always mean that someone wants to carry out these thoughts; they may actually feel very scared that they are having these thoughts.

You can explore this with your child and help by supporting them to speak openly to you about it; reassure them you are on their side and revisit how much they are having these thoughts on a regular basis. If in doubt or if you remain concerned then seek help from professionals, like your GP or school nurse.

If you are concerned for your child’s immediate safety then ensure they are supervised, remove any potential hazards and seek help from your local mental health service or emergency department.

It is important to remember that each family member will react differently to any given trauma and people’s journey of recovery will also be very different. There may also be a lot of variation in how people will want to deal with their own reactions, for example; some will want to shut down and avoid while others will want to talk.

Families often report difficulties with relationships after a trauma: this may be an increase in arguments, differences of opinion about what will help or people becoming more distant.

There is no simple solution to this, although some things may be beneficial:

• Encourage people to talk about the impact of the trauma and to listen to the views of others.
• Try and understand and respect one another’s reactions.
• Identify the unwanted visitor in the house (e.g. the trauma) as the problem, not the family members as the problem.
• Identify things that you have done well as a family since the trauma, what positive steps have you taken, what are you proud of?
• Plan time together as a family doing things you are comfortable doing.
• Think about strengths you already have as individuals and a family - how can you build on these to manage the current challenges?
• Identify the current difficulties the trauma is causing - can you problem solve any of these as a family, do you need other people to help you (consider school staff, other family members), can you make a plan to tackle one of the problems?
• Plan rewards for trying and make sure you all get a reward!

Parents who are able to take care of their own reactions will be better able to tolerate the reaction of their children and they can demonstrate that a range of reactions are to be expected.

For example, your child might want to watch a TV show that you think will be distressing for you. That does not mean that the TV show is turned off, but it might mean you talk to your child about how you are feeling about watching it.

It is also okay to say that you don’t want to watch it now but you might try and watch it later, or that you are happy for them to watch it and can be there for them if it upsets them, but that you are going to do something nice for yourself instead.

Families need to be careful not to create an environment that encourages ‘avoidance’ in the household. As explained above, it can seem that avoiding reminders can reduce distress in the short-term but it is not helpful in the long term, and is part of what can prolong a normal trauma reaction and interfere with recovery.

Some ideas to encourage an environment of acceptance and safety:

• Notice what you are avoiding and why and see what happens when you don’t avoid.
• What does your child do when reminders come up; are they avoidant, do they leave the room, do they go quiet? Check in with them and offer reassurance that it is hard and it’s okay to feel this way.
• Model talking about how you are doing and how you are taking care of these emotions; you might be keeping a diary or talking to friends etc.
• Reassure your child that even if it feels scary, they are safe and it is good to talk.
• Remind your child that trauma can create all sorts of feelings - it is more helpful to acknowledge these feelings rather than push them away.
• Reassure them that things won’t always feel like this.

People will react in very different ways after a trauma and some will find they can get on with life with only mild trauma-related difficulties or that difficulties come and go. It is important that this is acknowledged. This will help remind others that things will get better. It can also help those feeling okay to feel less guilty about their response and ensure family life doesn’t just become focused on the trauma

Recovery can often take time and can involve setbacks. People can feel fine for a while and then feel worse later on, especially if there are other difficult things happening in their life.

It can be hard to remember how far you have all come. Being kind to yourself and allowing you and your child to have good and bad days will be helpful. Often people look back a long time afterwards and reflect on how far they have come even though they can’t see it at the time.

If things feel really difficult or don’t seem to be getting better there are services that can help. You might benefit from extra help if your child is:

• putting a lot of effort into not thinking about things
• having upsetting memories or nightmares
• easily reminded about what happened
• feeling very anxious or low
• feeling jumpy, irritable or on high alert a lot of the time
• not able to do the things they would like to be able to do

Even if you or they are not sure they want support, discussing this further can help you all make a more informed decision.

Often parents’ first concern is getting help for their child. However, children often recover quicker if they can see their parents getting back on track. Learning new ways to cope may also give you ideas how to better support your child.

If you are noticing that any of the difficulties described in this guide are getting in the way of your own wellbeing and functioning, it is worth considering if you would benefit from additional help.

Where to get help for your child

If your child needs more help with trauma memories and/or managing low mood and anxiety, trauma-focused cognitive behavioural therapy (CBT) and eye movement desensitisation and reprocessing (EMDR) are recommended.

Your child’s pastoral lead, school nurse or their GP can direct you to the right service.

If they are under 16 most services will be provided by Child and Adolescent Mental Health Services (CAMHS).

For anyone over 16 the local NHS talking therapies service will be able to help and your child will often be able to refer themselves to this.

Setbacks to recovery

Even if you feel that your child is recovering well there may be times when things are harder or memories and feelings about the trauma resurface, for example:

• anniversaries
• police and legal investigations
• media reports
• other traumas

The important thing to remember is that it is entirely normal for things to feel trickier when there are more triggers and memories of the trauma around. You may notice that old feelings and behaviours return for a while but this will gradually settle again.

Some things you can do to help your child:

• reduce time on social media and media outlets
• ensure planned time to connect with others
• plan nice things to do each day
• encourage them to use strategies they have found helpful in the past
• prepare for significant dates, such as birthdays or anniversaries
• remember these events will also be emotional for yourself, be kind to yourself and make sure you look after your own needs too

The important things to remember for your child:

• Trauma affects everyone in different ways at different times; there is no right way to think or feel.
• Trauma recovery is a journey, it will take time, there may be set backs.
• Remember that the trauma is over; your child and family members are safe.
• Different self-care strategies will work for different people; choose the ones that work best for you and your child.
• Unprocessed memories can lead to flashbacks and nightmares; remind your child that they are safe.
• If your child feels low create a plan with them and help them stick to it.
• Remind your child anxiety can’t hurt them; it is their body trying to keep them safe but it can get it wrong and there may not be any actual danger.
• Help your child choose which thoughts and worries they should be engaging with and try and let the rest go.
• Help your child face their fears step by step, keep a record of how far they have come and reward them for trying.
• Seek more specialist help if things aren’t getting any better.

Parents and carers:

• You don’t have to have been there to be affected by trauma.
• Your reactions are valid and important; look after yourself.
• Use the support around you, ask people for help.
• Be aware of the impact on other family members too.

Visit our helplines page for details of helpful phone numbers you can call, including NHS 111, Papyrus, Young Minds, Childline and Samaritans.