Parents & Caregivers

What is Trauma-informed Parenting?

A traumatic event can be any event that is perceived by a child to be a scary and threatening experience. After experiencing a traumatic event, children may feel intense emotions (e.g., fear, sadness, anger, guilt, shame, helplessness) and have unsettling thoughts (e.g., worries about their safety, thoughts of self-blame). They may struggle to communicate these thoughts and feelings about their scary experience to others.

When children have difficulties expressing their thoughts and feelings verbally, they may express it through their actions or behaviours. For example, they may have trouble falling or staying asleep, have difficulty concentrating, struggle more in school, withdraw from others, appear "down" or have more emotional outbursts and temper tantrums.

When these behaviours occur, it can seem bewildering and frustrating to parents and caregivers. However, it is in these times that children need calm adults to connect with them and support them as they navigate their distress and difficulties following a scary experience. Any supportive adult in a child's life (e.g., parents, guardians, step or foster parents, grandparents, aunts, uncles, etc.) can play an important role in helping a child cope after a traumatic experience by adopting a trauma-informed understanding of their child's needs.

In fact, having a supportive and safe adult around is one of the top contributing factors to promoting resilience in children. Research shows that having even one consistent, supportive adult in a child's life can have an immediate and long-lasting positive impact on their health and resilience, especially in the face of adversity (National Scientific Council on the Developing Child, 2015).

Please watch the animation below for a brief introduction to trauma-informed parenting.

Adults who respond to a child's distress with warmth and connection can rebuild their sense of safety, nurture their ability to cope and lead the way to their recovery.

Being a trauma-informed caregiver means:

• Recognising the potential effects of scary or traumatic experiences on a child's health, development, behaviour, social and emotional well-being (How do Children React to Trauma?)
• Connecting with our children to help them communicate their needs and regain their sense of safety (How do I connect with my Child?)
• Soothing our children in distress through co-regulation (Co-Regulation)
• Encouraging our children to adopt healthy coping strategies (Encourage Healthy Coping)
• Caring for ourselves as parents and caregivers (Look After Yourself Too)

References

National Scientific Council on the Developing Child. (2015). Supportive Relationships and Active Skill-Building Strengthen the Foundations of Resilience: Working Paper No. 13. Retrieved from www.developingchild.harvard.edu

The Science of Resilience. (2015). Harvard Graduate School of Education. https://www.gse.harvard.edu/news/uk/15/03/science-resilience

Understanding How Children React to Trauma

What are some examples of traumatic events?

Traumatic events can happen within the child's family, school or community.

Some examples of traumatic events that can occur in a child's life include:

• Accidents (e.g., car accidents, near-drowning incidents, house fires, sports injuries, animal bites)
• Interpersonal Issues (e.g., abuse, divorce, separation, loss, incarceration, bullying, sudden moves or changes among one's friends and family)
• Natural or man-made disasters (e.g. fires, natural disasters)
• Community violence (e.g. physical assaults or fights)

How do children react to trauma?
Every child is unique, with their own social, emotional, cognitive, behavioural, physical, spiritual and developmental needs and strengths. As a result, children who experience stressful events will respond to it in different ways.

As an example, we would like to introduce two siblings - Sam and Alex. Sam and Alex just lost their father to a tragic road accident. After the accident,

• 10-year-old Sam became withdrawn and was often seen holding on to their favourite red fire engine toy while sobbing quietly. The toy was a birthday gift from their father just a few days before the accident took place.
• On the other hand, 8-year-old Alex had been acting out more at home and in school. Alex's teacher gave feedback that Alex could not pay attention in class and started getting into fights with peers. The teacher also shared that Alex seemed to be more agitated lately.

Sam's and Alex's reactions may look different, but they are both grieving over the loss of their father in their own ways.

Some other factors that are associated with increased distress reactions after exposure to trauma include:

• Perceiving that the event was threatening to one's self or loved ones
• Low social support
• Past or ongoing exposure to other traumatic events
• Prior learning, emotional or behavioural difficulties

A caregiver's awareness of the changes that can occur in our children's mood and behaviour after a distressing event is essential, as these changes signal when our children need our support to recover. For a list of possible reactions that caregivers can look out for, please see Possible Reactions After a Traumatic Event.

Being informed about how trauma can affect a child empowers us to identify the underlying needs that the child might be struggling to comprehend and communicate. This would help us respond and attend to the root causes (i.e. their emotional needs), rather than the symptoms, of our child's concerns, which is important in helping the child cope and recover from a traumatic event.

For example, Alex's acting out started after their father passed away in a tragic road accident. Alex's aggression at school could easily have been labelled as a "problematic behaviour" and punishment (e.g., detention) might have been considered a viable option. However, punishment alone fails to recognise, acknowledge and deal with the underlying emotional pain and sense of loss Alex might have felt from the demise of their father.

Learning How to Connect with our Children

When we connect with our children, it would be helpful to remember the following three guiding principles of trauma-informed parenting. All of these are important sentiments for our children to feel towards their caregivers after a traumatic experience.

Physical and Emotional Safety
Physical and emotional safety are often intertwined:

• Physical safety refers to when children are actually safe in their environment.
• Emotional safety refers to when children perceive that they are protected and safe from harm.

The child's sense of their own safety might be disrupted after experiencing a distressing or traumatic event. Parents and caregivers play a crucial role in helping the child learn how to calm down, cope and connect with others to get the support they need to feel safe again after these experiences.

Some ways that caregivers can ensure the physical safety and emotional safety of our children after a traumatic event include:

• Check-in with our children about how they feel in various places (e.g. home, school, tuition centre)
• Teach children how to contact safe adults in the event they feel scared or threatened.
• Ensure predictability in the environment (e.g., establish bedtime and mealtime routines, have bedtimes and mealtimes occur at consistent, predictable times every day).
• Pay attention to changes in our children's mood and behaviour. Talk to a doctor or another relevant professional if you notice that anything is causing our children distress or concern.
• Create a plan to manage any intense feelings or unsettling thoughts that could come up when the child comes across reminders of the traumatic event. Involving our children in the design and steps of this plan is recommended, where possible.

Trust and Transparency
Open and honest communication between caregivers and their children is the cornerstone of a safe and supportive relationship. This increases the likelihood of children communicating their needs to safe adults and seeking their help in times of need, instead of struggling on their own.

It is natural that adults may feel unsure about how, what and when to talk about traumatic events and their potential impact with our children. We may find ourselves tiptoeing around these topics because it can be uncomfortable for all to talk about these things. Although having these conversations may feel uncomfortable, avoiding the topic altogether may give the child the false impression that it is wrong, shameful or useless to talk about how we think and feel.

To connect with our children, validate their emotions and be non-judgemental by being curious about what they have to say and listening when they speak.

• If the child approaches us to share their perspective and experiences, give them our attention and listen.
• Respond supportively by acknowledging the child's feelings and explain that it is normal to have many different thoughts or feelings after a traumatic event, as there is no "right" or "wrong" way to react to a traumatic event.
• Provide comfort and encouragement as they speak, as this can help them feel safe to share what they truly think and feel.
• Ask clarifying questions to figure out where they are coming from and what is on their mind, instead of correcting them immediately. This helps us identify the underlying cause of their current mood and behaviours.

If our child does not feel ready to talk about the distressing experience, assure them  that we are there for them whenever they are ready to talk about it.

If we get stuck and are not sure what to say, we can simply thank the child for sharing their experiences with us, acknowledge what they experienced and reassure them about how much we love, respect and support them. For example, we could say: "Thank you for telling me how things have been going for you. It has been such a stressful and overwhelming experience, so it makes sense that you have been feeling this way. I just want to let you know that I am here for you if you need anything."

For more specific tips about how to talk to children after they have a distressing or traumatic experience, please refer to this Quick Bytes article on Trauma-Responsive Parenting.

Empowerment and Choice
Our children are worth much more than the trauma they have experienced. Their lives and identities are not defined by their traumatic experiences. However, traumatic experiences often leave people feeling disempowered and helpless.

Support them in re-establishing a sense of control by empowering them to tap on their natural strengths and resources (e.g., use of healthy coping strategies, positive affirmations, social support network, confidence, self-esteem, talents, skills, knowledge, ambitions, personality).

Some ways caregivers can empower children include:

• Keep children informed (e.g., updating them on what upcoming tests or processes they would be undergoing in advance, letting them know how the investigations are proceeding).
• Give children opportunities to exercise autonomy and make choices where possible (e.g., whether they want to use a pen or colour pencil to write with, which toy to bring or person they would like to accompany them for appointments, ask for their thoughts and perspectives).
• Guide children in problem-solving (e.g., talking through a problem as these surface, discussing and exploring possible options to address these problems with our children).
• Highlight our children's strengths (e.g., "You are so patient with your siblings", "You worked really hard on that project", "I enjoyed doing this task with you, thanks for helping me put your toys back").
• Guide children in establishing and enforcing personal boundaries (e.g., safe and unsafe touch from others). This empowers children to protect themselves too when they feel unsafe.
• Remind children that it is okay to say "no" to someone they feel unsafe or uncomfortable with, and to reach out for help from safe adults.

Please refer to the Myths about Trauma page for more information.

Summary
Connecting with our children as consistent, safe and supportive adults in their lives help boost their resilience, self-regulation skills and self-confidence. This sets our children up for success in coping with life's stressors and re-building their sense of safety, especially after a distressing or traumatic experience.

References

Fitzgerald, M. M., & Shipman, K. (2022). Quick Bytes 60 - Trauma Responsive Parenting. Trauma Network for Children. https://www.healthxchange.sg/childtraumanetwork/Documents/Quick%20Bytes/Quick%20Bytes%20Issue%2060%20-%20Trauma%20Responsive%20Parenting%20(Part%201).pdf

UPMC Children's Hospital of Pittsburgh. (2021, December 28). 9 Ways to Keep Your Child Physically Safe. UPMC

HealthBeat. https://share.upmc.com/2021/12/ways-to-keep-your-child-safe/?fireglass_rsn=true#:~:text=Parenting%20Tips%20to%20Keep%20Children%20Safe&text=Know%20where%20your%20children%20are,baby%2C%20even%20for%20an%20instant.&fireglass_params&tabid=a001fd322f708f4e&application_server_address=ihispteltd20-asia-southeast1.prod.fire.glass&popup=true&is_right_side_popup=false&start_with_session_counter=1

How do I Support my Child when they are Distressed?

One of the key ways of helping to soothe a child through a moment of distress is through co-regulation.

Co-regulation is a process where caregivers demonstrate or model how someone can soothe themselves in distress and guide the child in practicing these skills. Practicing co-regulation helps the child gradually develop the ability to manage their own emotions independently (i.e., acquire self-regulation skills).

Children, no matter the age, benefit from a calming and soothing presence from their caregivers when they feel distressed. Co-regulation begins right after birth. The younger the child, the more co-regulation they require from their caregivers.

When co-regulation with caregivers occurs consistently as children grow up, they learn that they can trust their caregivers to be present and to meet their emotional needs. This helps them feel emotionally safe and secure with their caregivers and, eventually, on their own.

Co-regulation is important in helping children learn:

• To understand and express their emotional experiences
• That strong emotions can be soothed
• That they have emotional support from their caregivers

Here are some steps to co-regulation:

Step 1: Be Mindful about How We Are Feeling
Just as children can have thoughts and emotional reactions after traumatic events, so can their caregivers, even if we were not directly involved in the event. We might feel scared, worried, overwhelmed, angry, helpless or sad. We might feel distracted, scattered, confused or numb. These feelings, in both adults and children, are completely normal following a distressing or traumatic event. On top of our own reactions to the traumatic event by itself, we may feel a variety of emotions when our children react to the traumatic event in ways we find hard to accept and manage (e.g., when the child demonstrates "challenging behaviours", like suddenly becoming quiet and withdrawn, temper tantrums, throwing things, shouting).

When we are co-regulating a child who is distressed, it is first important for us to be mindful of the emotions we are feeling and notice our tone of voice, facial expressions, gestures, and body posture when responding to the child.

Pause, take some time and effort to notice and acknowledge the feelings we are having. This is often more helpful than rushing to "solve the problem" or doing whatever we can to stop feeling these feelings.

The act of identifying and labelling exactly how we feel promotes a sense of calm, even in the most emotionally-charged situations, because it shifts activity from the alarm centers of the brain to the parts of our brain that support coping.

Step 2: Identify Where Our Feelings Are Coming From
Next, we identify where our feelings are coming from. Draw awareness to the possible reasons why an interaction or incident with our child caused a specific feeling to come up. The recent interaction or incident with our child may have magnified our own insecurities and fears as a parent or reminded us about a past situation that made us feel stressed. For example, an incident where our child stayed out past their curfew and was uncontactable may have reminded us of a time when we felt helpless and unheard as a child, leading us to feel extra hurt and angry in the present.

If such memories or thoughts come up, it would be helpful to take deep breaths. When we slow down and focus on our breathing, we initiate a physiological change that slows down our initial reflexive reactions and shifts our attention to our physical body, grounding us in the present instead of the past. This leads us to experience emotions as little more than physical sensations in our body and distances ourselves from being triggered (i.e., having any immediate strong, uncomfortable emotional reaction and letting that hijack our thoughts and behaviour).

By achieving a calmer state of mind, we can choose how to respond, rather than simply react. This makes us more prepared to talk with our children and, overall, manage the situation in a way that shows that they are safe now and that talking openly and honestly about their concerns is okay.

Focus on responding to the child's need or root cause of the child's behaving in a certain way, rather than the child's behaviour or emotional response itself.

Step 3: Nurture Our Child's Emotional Regulation Skills
Co-regulation with Young Children
Co-regulation with preschoolers (3 to 6 years old) and school-aged children (7 to 12 years old) is essential. At these ages, our children start to socialise with individuals beyond their household members and are learning how to express and regulate their emotions for the first time. Co-regulating a child of this age range can look like:

• Physical touch (e.g., holding, hugging or rocking)
• Recognising and labelling how the child is feeling
• Helping the child understand the reasons for their current mood (if any)
• Letting the child know that expressing their feelings is okay
• Practicing relaxation exercises like deep breathing
• Guiding our children to engage in regular activities and routines as they become calmer

Examples of what we can say to acknowledge and validate a child's feelings while co-regulating them:

• I see that this is hard for you.
• I hear you, you can tell me what is going on.
• It is okay to feel ___. Do you want a hug?
• I am here for you.
• How does your body feel right now? Where are you feeling ___ (e.g., anger) in your body?
• Sometimes things do feel unfair and we do not always get what we want right away, even as adults.

Co-Regulation with Teenagers
Effective co-regulation is important as teenagers (13 to 18 years old) navigate a life stage full of changes and challenges and begin to develop their sense of identity and autonomy.

Although a teenager's capacity to self-regulate their emotions tends to be more developed than a young child's, the brain region that enables a teenager to self-regulate (i.e., the prefrontal cortex) only fully develops in adulthood, around their 25^th birthday. As a result, teenagers still benefit from co-regulation by their caregivers during these growing up years, especially as they face increasing responsibilities and social pressures that are more and more complex to comprehend and respond to. Our child's self-regulation skills at this stage can have implications on their behavioural, cognitive and social functioning (e.g., how well they get along with their peers and create healthy relationships with others).

The principles behind co-regulation with a teenager are not that different from that of a younger child. The two key differences for us to note are i) the language we use, and ii) the acknowledgment of their age-appropriate desire for increased autonomy and personal boundaries.

Co-regulating a teenager's emotions can involve:

• Being warm, genuine, and consistent across our interactions with the child, even when we do not feel calm
• Staying curious by listening to understand, rather than listening to react (e.g., jumping to judging or trying to "correct" them)
• Helping them to identify their emotions and thoughts accurately
• Acknowledging their emotions as this helps them feel "seen", heard and valued by others
• Modelling healthy and adaptive ways to manage stress and negative feelings (e.g., exercising regularly, practicing deep breathing and grounding techniques)
• Identifying and encouraging them to use existing coping strategies (e.g., spending time with family and friends, listening to music, participating in sports)
• Asking them if they would like to talk about a specific topic now or have some space for themselves first (e.g., walking away to calm down before continuing a conversation that became emotionally-charged). If they prefer the latter, we can offer to check in with them later, as this can help them feel respected and supported.
• Recognising their efforts and intentions (e.g., saying "Thank you for letting me know how you are feeling now, that you needed some time to cool down on your own before we continued this conversation. Now that you have calmed down, I appreciate you reaching out to inform me that you are ready to continue our earlier discussion calmly and I will do the same.")
• Sharing your own perspective after they have calmed down (e.g., "I can appreciate that you enjoy spending time with your friends, especially during the school holidays. Nonetheless, I was worried about your safety when stayed out late without prior notice, as we agreed that you would be contactable and inform me of your whereabouts beforehand. This practice of accountability is important for me to trust you to go out on your own without supervision and I felt hurt when this was violated.")

Consistent co-regulation helps build our teenagers' capacity to self-regulate, helping them become more proficient in:

• Setting goals and committing to making them a reality (e.g., becoming more self-confident and independent, picking up healthy coping strategies and making them a habit, etc)
• Planning and organising their activities (e.g., managing various responsibilities both at school and at home)
• Being aware of changes in their mood, thoughts, and behaviours
• Solving problems
• Tolerating emotional distress
• Managing impulses (e.g., delaying gratification)
• Making prosocial and healthy decisions (e.g., exercising regularly, doing homework diligently, participating in team sports, not drinking alcohol, smoking or vaping)

In summary, when we model how distressing feelings can be approached, unpacked, understood and managed in a healthy manner, this develops the child's ability to be mindful of their own emotional responses, learn to recognise the situations at the root cause of their emotions and self-regulate more effectively, and more independently, with time and practice.

What else can I do to Help my Child cope after a Traumatic Event?

In addition to soothing our children through co-regulation, we can encourage them to engage in other healthy coping strategies and calming activities that help them cope with stress and any other overwhelming thoughts, feelings or experiences.

No matter the age of the child, key ingredients that promote their recovery are having adequate relaxation, rest and routines.

Relaxation
Encouraging a child or teenager to practice relaxation strategies is a helpful way of coping with traumatic stress reactions. Spending time with friends, playing games (e.g., video games, board games) and connecting with others through social media are common relaxation strategies that both children and teenagers use.

Other types of relaxation strategies we can encourage them to engage in include:

• Listening to or producing music
• Drawing, painting, or craft work (e.g., pottery, crocheting, knitting, jewelry-making, model building)
• Cooking or baking
• Deep breathing
• Reading or writing (e.g., journaling, blogging)
• Exercising (e.g., going for walks, participating in team sports, jogging/running, roller-blading, yoga, stretching)
• Meditating
• Taking a shower
• Drinking water
• Using aromatic oils or candles

Rest
Encouraging our children to get enough sleep is a must! Getting sufficient rest will help our children to better manage stress and uncomfortable thoughts or feelings. Rest also helps our children focus on tasks and learn better (e.g., in school).

Good sleep hygiene practices to follow include:

• Not having any screen time 1-2 hours before bedtime
• Avoiding heavy meals or caffeinated drinks (e.g., tea, coffee, soft drinks) 1-2 hours before bedtime
• Doing something relaxing for 30 minutes before bedtime (e.g., listening to a podcast for sleep meditation, reading, lying in bed and zoning out)

Routines
Children who have been through a traumatic events need safety, predictability and consistency in the caregiver-child relationship, and in the home environment. For advice on starting this, caregivers can refer to this Quick Bytes article for information about Creating Supportive Environments for Children, Youth and Families.

Look after Yourself Too

The aftermath of a child's experience of a traumatic event can be stressful for both the child and their caregivers. Having to manage our child's traumatic stress reactions, or our traumatic stress reactions after seeing our child experience a traumatic event, can give rise to thoughts of self-blame and guilt (e.g., "I should have done more/better to protect my child", "My child is suffering because of me", "It is my fault").

As a result, caregivers may end up being overprotective (e.g., disallowing our children from participating in activities and routines they usually enjoy to keep a closer eye on our children) or overly permissive (e.g., allowing our children to do anything or have anything they want). While these may be well-meaning responses, we may unintentionally prolong some of our child's difficulties in coping with their traumatic experience.

It is common for many caregivers to feel guilt or regret about not being able to prevent the traumatic event from happening. Nevertheless, it is helpful to be kind to ourselves, and remember that we do not have the ability to predict whether an assault, accident or any other type of traumatic incident might happen in the future.

These are some tips that may help us manage these thoughts and worries:

• Be aware of the thoughts and feelings that we have
• Take a few moments to pause and focus our attention on breathing deeply and slowly when we feel overwhelmed
• Focus on the present moment by noticing things around us using our five senses (e.g., practice grounding)
• Return to the thoughts and feelings we have and validate ourselves by highlighting that our reactions make sense in the context of what happened
• Remind ourselves that what happened or our child's current suffering is not necessarily our fault
• Show compassion to ourselves (e.g., saying statements like "I can be kind to myself" and "I can give myself the compassion that I need" out loud)

If we would like to learn more about how we can manage these thoughts better, it would also be helpful to check with our child's or our own therapist. A trained professional would be better able to provide more specific strategies so we can ensure our own emotional needs are met and put us in a better state of mind to soothe and co-regulate with our children during their recovery.

Remember to set aside time to engage in activities we enjoy or find relaxing as a form of self-care. This can include:

• Exercising (e.g., going for walks, engaging in sports)
• Resting (e.g., getting enough sleep)
• Listening to music that we find relaxing
• Engaging in meditation, prayer, gratitude, journaling, etc
• Making time for hobbies (e.g., pottery)
• Spending time with our friends and loved ones

Seek Support
It is common for children to experience traumatic stress reactions after experiencing a traumatic event. However, if these reactions persist for more than a month, or are severe enough to affect our child's functioning, it would be beneficial to consider seeking professional help for our child.

It is also common for some caregivers to experience traumatic stress reactions (after seeing our child go through the traumatic experience, or even as a result of our own past traumatic experiences) and we may feel overwhelmed by trying to support our child while also managing our own traumatic stress reactions. If we notice ourselves experiencing some traumatic stress reactions, and if these reactions persist for more than a month after the event occurred, it would  be beneficial for us to seek professional support as well.