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.

high13 referencesUpdated 11 July 202614 min readVerification in progress

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Target exams

RACP General PaediatricsRACP DWERACP DCERCPCH Progress+MRCPCH TheoryMRCPCH ClinicalABP General PediatricsACGME PediatricsRCPSC Pediatrics

Red flags

A child who freezes, dissociates or becomes aggressive during a routine examinationDevelopmental regression following an injury, hospital admission or frightening procedureRestraining a distressed child for a non-urgent procedure without offering choice or comfortAsking about adverse childhood experiences without any follow-up or support pathway in placeIgnoring historical and intergenerational trauma in Indigenous, refugee or asylum-seeking familiesA clinician showing signs of vicarious trauma after repeated work with traumatised children

Life stages

neonateinfanttoddlerpreschoolschool-ageadolescent

Care settings

preventive-medical-homecommunity-schooloutpatientwarded-acutenicupicurural-remotetelehealth

Clinical exam formats

written-onlyracp-dce-long-caseracp-dce-short-casemrcpch-communicationmrcpch-history-managementrcpsc-structured-oral

Board mappings

General and Community PaediatricsDevelopmental and behavioural paediatricsSafeguarding and child protection themesRenewed curriculum — Learning goal: social determinants of health and trauma-informed practiceMental health and psychosocial aspects of chronic illnessProfessional practice and ethicsWritten assessment of social determinants and child developmentLong Cases involving a child with complex psychosocial adversityStructured discussion of trauma-informed approachCommunication stations involving distressed families2. Professional skills and knowledge: safeguarding and psychosocial health4. Areas of practice — child protection and mental health themesLeadership and team working in trauma-informed systemsFoundation of Practice (FOP)Applied Knowledge in Practice (AKP)CommunicationHistory taking and managementChild development and safeguardingGeneral Pediatrics Content Outline — developmental and behavioural paediatricsGeneral Pediatrics Content Outline — child abuse and neglectSocial determinants of health and psychosocial aspectsPatient Care: psychosocial aspects and trauma-informed practiceSystems-Based Practice: organisational trauma-informed careProfessionalism and wellbeing: vicarious traumaCommunicatorCollaboratorHealth AdvocatePediatric EPA — psychosocial assessment and trauma-informed care

Your progress

Saved locally on this device.

Practise this topic

Target exams

RACP General PaediatricsRACP DWERACP DCERCPCH Progress+MRCPCH TheoryMRCPCH ClinicalABP General PediatricsACGME PediatricsRCPSC Pediatrics

Red flags

Life stages

neonateinfanttoddlerpreschoolschool-ageadolescent

Care settings

preventive-medical-homecommunity-schooloutpatientwarded-acutenicupicurural-remotetelehealth

Clinical exam formats

written-onlyracp-dce-long-caseracp-dce-short-casemrcpch-communicationmrcpch-history-managementrcpsc-structured-oral

Board mappings

The fellowship answer

Assume every child may carry a trauma history. Trauma-informed paediatric care (TIC) is a whole-organisation approach — not a counselling technique or a referral form — built on the SAMHSA four Rs (Realise, Recognise, Respond, Resist re-traumatisation) and six principles (Safety, Trustworthiness, Peer Support, Collaboration, Empowerment, Cultural issues). The mechanism is biological: childhood adversity drives chronic toxic stress that reshapes developing brain architecture and immune function, linking ACEs to lifelong disease in a dose-response pattern. Your bedside job is to create a calm and predictable environment, recognise trauma cues, offer choice and control, avoid re-traumatising through restraint or powerlessness, connect the family to supports, and strengthen the single most powerful resilience factor — a safe, stable, nurturing adult relationship. [10] [9] [13]

Two things that get mixed up

Trauma-informed care

Trauma-focused treatment

The 4 Rs of trauma-informed care

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]

Paediatrics Fellowship Pro

You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References13Show ledger

[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

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

high13 referencesUpdated 11 July 202614 min readVerification in progress

Practise this topic

Overview & Definition

Paediatrics Fellowship Pro

You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References13Show ledger

[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