Trauma in Early Childhood

What do we know about pre-birth, new-born babies and relationships?

Babies are primed biologically for connection or attachment at birth. They have been listening to, and will have been spoken to, by their mother and other parent/key person whilst in the womb and so it isn’t surprising when you see a just born baby respond to their facial expressions.

What is going on in the brain?

During the nine months of pregnancy, the foetus develops many, many neurons. In the third trimester the cerebral cortex starts to take on the jobs that the brainstem has been doing up until then such as foetal breathing and responding to external stimuli.

In the first year of life, babies’ growing brains make more than 1 million new connections every second – it is amazing!

If babies receive the attention of attuned adults, they will understand that they can trust the world and new synapses - connections between brain cells - will be made and existing ones strengthened. A healthy system of different neural networks will be woven together as a result.

Part of normal brain development is that the ‘pruning’ takes place of connections that are or seldom used or not used at all.

What about self-regulation?

All our emotions are held in our body and the body sends information to the brain to register hunger, discomfort etc. Babies can’t manage their emotions on their own as they don’t have the biology to do so. They need their main adults to do this with them through co-regulation.

As the neural networks develop due to this co-regulation, a young child will learn how to self-regulate.

What happens if babies don’t have a stable, predictable, safe relationship with their main carer?

Many babies may not receive the attention they need due to the environment they are living in; their main carer may be unwell, have post-natal depression; they may live in a home where there is conflict between family members and domestic abuse.

If babies are not stimulated, synapses don’t develop, and the brain will make fewer connections.

If the baby is exposed to repeated, ongoing stress without the assistance of a caring adult, their brain cells can be severely damaged – the high levels of cortisol that is produced can cause brain cells to die and reduce the connections between the cells in certain areas of the brain.

The first year and particularly the first 2 months are crucial as research undertaken by Bruce Perry and his team shows:

“If, in the first two months of life, a child experienced high adversity with minimal relational               buffering but was then put into a healthier environment for the next twelve years, their                     outcomes were worse than the outcomes of children who had low adversity and healthy                 relational connection in the first two months but then spent the next twelve years with high             adversity.''

This is because the brain is developing rapidly, and the brain is at its most sensitive.

These stressful contexts can also affect a foetus. There is evidence that the foetus registers maternal long-term emotional distress and that the placenta may be the way that cortisol accesses the foetus.

This can have an impact upon both the physical and emotional wellbeing of the baby, affecting birthweight and possibly longer-term effects on brain development.

What does that mean for children in early years settings and schools who have had a traumatic start to life?

It is possible for children who have not had an enabling start and haven’t had those strong, positive bonds, to develop these connections and self-regulation skills through the trusting relationships they may form with early years practitioners.

This could be because as Bessel van der Kolk says, ‘attachment relationships trump the trauma.’

Children who have had a traumatic start will have developed sensitised stress responses where they become distressed, hit out, withdrawn. They react from the reptile part of the brain (brainstem) rather than the thinking brain (the cortex).

If the child’s regulatory system is supported (see below), through repetition and pattern, they will develop a normalised stress response and be able to cope with being exposed to moderate, predictable stress. This is most likely to happen when the conditions around them are more secure. Ideally this will happen before they start school.

If not, children will continue to have sensitised stress responses which means the brain is treating any new neurological info as threatening and the thinking part of the brain will stop processing. The child will either shut down or blow up.

According to Bruce Perry, trauma healing requires 6 R’s; it must be:

• Relational (safe)
• Relevant (developmentally matched to the individual)
• Repetitive (patterned)
• Rewarding (pleasurable)
• Rhythmic (resonant with neural patterns)
• Respectful (of the child, family, and culture)

How can education staff support young children who have experienced trauma?

Focus on helping the child to regulate first as shown on the left-hand side of the above diagram.

• Do lots of dance/art/physical activities which will help them to develop their regulatory system through repetition and pattern. This is also called ‘Somatosensory regulation.’
• Enable the child to help themselves to self-regulate at group times by providing something they can tap or rock.
• If a child gets angry and verbalises, restate what they are saying. Be present, do reflective listening (see right-hand side of diagram). ‘Absorb their emotional intensity’ (Bruce Perry).
• If possible, do the above whilst doing something rhythmical such as playing, colouring side by side, kicking a ball back and forth.

Once they can regulate, they will find it much easier to relate.

• Make sure there is a predictable pattern of the day and prepare the child for any changes to that structure.
• Create a connection with the child through a key person approach but understand that the child may need a break from that person and interact with different adults. It may be too intense for them.
• Give them lots of time and experience so they can build neural networks with a new set of associations to the ones they have had, which have said that the world is scary.

When they can relate to others, they will be able to access their thinking brain and will be able to reason with you.

• Give a child choice, so they feel they have some control. If they are struggling to comply, frame the ‘consequence’ as a choice: ‘You can choose to do what I have asked, or you can choose to…’

Other Key Points:

• If the child starts to talk about the traumatic event(s) do not avoid the conversation, listen, provide answers and comfort. It is ok to say to the child that you don’t know the answers.
• Children may repeat or re-enact the traumatic events. If this or other symptoms such as poor social functioning, sleep, nightmares, persist for more than 3 months or interfere with functioning, advice needs to be sought from a professional.
• Keep a record of any of the above behaviours to see if you can identify any patterns.
• If a child’s parent is traumatised, get them support as a priority as they will be more available for their young child if they are given support.
• Keep learning!

References:

‘What Happened to You? Conversations on Trauma, Resilience and Healing’, Bruce Perry and Oprah Winfrey (2021), Bluebird

‘Collaborative Problem Solving’, Perry, B.D. and Ablon, J.S. (2019) An Evidence-based Approach to Implementation and Practice. Boulder, Springer

Helping Traumatized Children - a Brief Overview for Caregivers Bruce Perry Child Trauma Academy : www.ChildTrauma.org

When Does the Fetus's Brain Begin to Work? ZERO TO THREE : www.zerotothree.org

Early childhood brain development reducing trauma – Bruce Perry : https://www.youtube.com/watch?v=BRuPhF9SsBA&t=6s

Stress, Trauma, and the Brain: Insights for Educators--The Neurosequential Model, Bruce Perry :  https://www.youtube.com/watch?v=_3is_3XHKKs

Why The First 2 Months are Crucial for a Baby's Development | Super Soul | Oprah Winfrey Network : https://www.youtube.com/watch?v=78NarH0i7RQ

Earliest Years of Life Podcast Episode 1: What is Attachment and Why Does it Matter? Featuring Dr Suzanne Zeedyk : https://www.betterstartbradford.org.uk/earliest-years-of-life-podcast/

2-Day: Trauma Conference: The Body Keeps Score-Trauma Healing with Bessel van der Kolk, MD (Digital Recordings)

Perry: Rhythm Regulates the Brain: https://attachmentdisorderhealing.com/developmental-trauma-3/