Trauma Informed Care: Pediatric Mental Health Minute Series

Trauma-informed care (TIC) is defined by the National Child Traumatic Stress Network as medical care in which all parties involved assess, recognize, and respond to the effects of traumatic experiences on children, caregivers, and healthcare providers.

Scope in Pediatrics

• In the clinical setting TIC includes the prevention, identification and assessment of trauma, response to trauma and recovery from trauma as a focus of all services. Pediatricians are able to support the caregiver-child relationship, the context in which there can be recovery from trauma and the restoration of resilience.

• TIC is characterized by an understanding that traumatic experiences can impact the brain and body, and can present as problematic behaviors and health issues.  These conditions need to be treated as medical concerns, not willful or punishable actions.

Teaching Points

• Toxic stress is the result of activation of the stress response in the absence of protective relationships.  
• It is in the protective context of safe stable and nurturing relationships that the child develops the varied resilience skills that will prevent/ameliorate the impact of trauma. These skills can be remembered with mnemonic: THREADS 
  
  T – Thinking & learning brain 
  H - Hope 
  R - Regulation or self-control 
  E - Efficacy 
  A - Attachment 
  D – Developmental skill mastery 
  S – Social connectedness 

• Trauma can be experienced in a spectrum and trauma symptoms can present in a spectrum ranging functional symptoms, to post traumatic stress symptoms, to complex trauma. Most common symptoms can be remembered with a mnemonic: FRAYED 
  
  F - Fits, frets, fear 
  R - Regulation difficulty 
  A - Attachment problems 
  Y - Yelling or Yawning 
  E - Educational delays 
  D - Dissociation/depression 

• ACE screening alone is not part of a trauma informed response which includes putting the screening into a larger context of the family, ensuring physical and psychological safety, providing tangible supports, responding in ways that prevent re-traumatization, and promote recovery and resilience.