Trauma-informed paediatric care — formative SAQs

SAQ 1 (10 marks)

A four-year-old presents to the ED after a fall. During the assessment, the child becomes mute and physically still when the nurse reaches for the blood pressure cuff. The mother mentions they have recently fled domestic violence. ^{[10] [11]}

1. Name and define the SAMHSA four Rs of trauma-informed care. (4) ^{[9] [10]}
2. Describe how you would modify your immediate assessment approach for this child. (3) ^{[10] [11]}
3. Identify the single most powerful protective factor for this child and describe how you would strengthen it. (3) ^{[13] [2]}

Model answer

The four Rs are: Realise that trauma is widespread and affects health; Recognise the signs and symptoms in patients, families and staff; Respond by integrating trauma knowledge into policy, practice and settings; Resist active re-traumatisation of the children and families served. ^{[9] [10]}

Modify the assessment by pausing when the child freezes — recognising this as a stress response, not defiance. Lower the sensory load, bring the parent close, explain each step before acting, offer choice (for example, which arm to measure), and avoid forcing non-urgent procedures. Apply universal trauma precautions from the outset. ^{[10] [11]}

The most powerful protective factor is the presence of a safe, stable, nurturing adult relationship — here, the mother. Strengthen it by supporting her, keeping her present, acknowledging her protective action in leaving the violence, and connecting the family to social work and community supports. ^{[13] [2]}