Paeds · professional-practice-and-evidence
Trauma-informed paediatric care
Also known as Trauma-informed care in paediatrics · TIC for children · Adverse childhood experiences and toxic stress · SAMHSA trauma-informed approach · Preventing medical traumatic stress
Fellowship guide to trauma-informed paediatric care: the SAMHSA four Rs and six principles; the ACE study and toxic-stress mechanism; recognising trauma across age groups; the trauma-informed encounter and procedural adaptations; screening safely; building resilience; preventing medical traumatic stress; and ANZ/UK/US/Canada system and cultural considerations.
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Target exams
Red flags
- A child who freezes, dissociates or becomes aggressive during a routine examination
- Developmental regression following an injury, hospital admission or frightening procedure
- Restraining a distressed child for a non-urgent procedure without offering choice or comfort
- Asking about adverse childhood experiences without any follow-up or support pathway in place
- Ignoring historical and intergenerational trauma in Indigenous, refugee or asylum-seeking families
- A clinician showing signs of vicarious trauma after repeated work with traumatised children
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Developmental and behavioural paediatrics
- Safeguarding and child protection themes
- Renewed curriculum — Learning goal: social determinants of health and trauma-informed practice
- Mental health and psychosocial aspects of chronic illness
- Professional practice and ethics
- Written assessment of social determinants and child development
- Long Cases involving a child with complex psychosocial adversity
- Structured discussion of trauma-informed approach
- Communication stations involving distressed families
- 2. Professional skills and knowledge: safeguarding and psychosocial health
- 4. Areas of practice — child protection and mental health themes
- Leadership and team working in trauma-informed systems
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Communication
- History taking and management
- Child development and safeguarding
- General Pediatrics Content Outline — developmental and behavioural paediatrics
- General Pediatrics Content Outline — child abuse and neglect
- Social determinants of health and psychosocial aspects
- Patient Care: psychosocial aspects and trauma-informed practice
- Systems-Based Practice: organisational trauma-informed care
- Professionalism and wellbeing: vicarious trauma
- Communicator
- Collaborator
- Health Advocate
- Pediatric EPA — psychosocial assessment and trauma-informed care
Two things that get mixed up
Trauma-informed care
Trauma-focused treatment
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 you serve. [10]
Overview & Definition
An eight-year-old freezes and becomes mute when you reach for the otoscope. A toddler in the ED screams through a cannula insertion while being held down by three adults. A teenager in foster care refuses to speak to any clinician. Each of these is a trauma response, and each is an invitation to do harm or to do better. [10] [11]
Trauma, in the SAMHSA definition, means an event or set of circumstances experienced as physically or emotionally harmful or life-threatening, with lasting adverse effects on functioning and wellbeing. It is the lived experience and its aftermath — not the event alone. [10]
Trauma-informed care is the organisational and clinical approach that follows from that realisation. The SAMHSA framework asks every member of the workforce to realise the prevalence of trauma, recognise its signs, respond by integrating that knowledge into practice, and resist re-traumatising the people they serve. [9] [10]
This page owns the practice, framework and evidence of TIC. Cross-link dedicated leaves for child maltreatment and safeguarding, breaking bad news, shared decision-making, consent and mature-minor frameworks, and working with interpreters — do not rebuild their content here. [10]
References13ShowHide
- [1]Felitti VJ Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine, 1998.PMID 9635069
- [2]Shonkoff JP The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 2012.PMID 22201156
- [3]Garner AS Early childhood adversity, toxic stress, and the role of the pediatrician: translating developmental science into lifelong health. Pediatrics, 2012.PMID 22201148
- [4]Hughes K The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. The Lancet Public Health, 2017.PMID 29253477
- [5]Bellis MA Life course health consequences and associated annual costs of adverse childhood experiences across Europe and North America: a systematic review and meta-analysis. The Lancet Public Health, 2019.PMID 31492648
- [6]Finkelhor D Violence, abuse, and crime exposure in a national sample of children and youth. Pediatrics, 2009.PMID 19805459
- [7]Kerker BD Do Pediatricians Ask About Adverse Childhood Experiences in Pediatric Primary Care? Academic pediatrics, 2016.PMID 26530850
- [8]Szilagyi M Factors Associated With Whether Pediatricians Inquire About Parents' Adverse Childhood Experiences. Academic pediatrics, 2016.PMID 27157045
- [9]Marsac ML Implementing a Trauma-Informed Approach in Pediatric Health Care Networks. JAMA pediatrics, 2016.PMID 26571032
- [10]Forkey H Trauma-Informed Care. Pediatrics, 2021.PMID 34312292
- [11]Goddard A Trauma-informed care for the pediatric nurse. Journal of pediatric nursing, 2022.PMID 34798581
- [12]Ridings LE Behavioral Health Screening and Follow-Up Services in Pediatric Trauma Centers Across the United States. Journal of pediatric psychology, 2023.PMID 37794767
- [13]Masten AS Ordinary magic. Resilience processes in development. American psychologist, 2001.PMID 11315249