Distress and trauma in children and young people

Distress and trauma can be confusing concepts, and these words are often used to describe different things.

It can be helpful for parents and carers, and their children, to understand the difference between distress and trauma. This is because the ways we should respond to distress and trauma, and the levels of support children need, are different.

Distress is a normal human response to challenging situations. We all experience it from time to time. People who are distressed can feel worried, upset, confused or overwhelmed.

Experiencing distress is not necessarily a bad thing. It is important for children to experience challenges from time to time, and to learn how to cope with and respond to them. They will often need the support of their parents or carers to do this.

What kinds of things cause children to become distressed?

Children are often distressed by very normal things. For example, they can become upset when they want something that they can’t have.

It is also normal for children to be upset or worried if something challenging happens in their lives. For example, if they have to move school, if they argue with friends, or if their parents are separating.

Why do some children become more distressed than others?

Not all children will be distressed by the same things. For example, one child might find the separation of their parents extremely distressing, while another child might not. The things children find distressing will depend on many factors, including:

• Their personality – For example, whether they become overwhelmed or upset easily.
• Their way of thinking and perceiving – Neurodevelopmental conditions like autism can affect whether children find things distressing or not. They can also affect how they express that distress.
• Their wider family context – For example, how emotions are talked about and responded to in their family.
• Their cultural context – For example, whether the thing that is happening is considered ‘normal’ or not in their culture.
• The meaning they take from what happened – We will look at this in more detail later on.

When should I be concerned about my child being distressed?

Children shouldn’t be distressed all or most of the time. Children also shouldn’t be so distressed that they aren’t able to do their usual daily activities.

What should I do if my child is distressed?

If your child is upset, angry or worried, allow them to express their feelings in a safe and supportive way. You can do this by asking them to share how they are feeling with you, or another trusted adult. If your child is old enough, you could encourage them to write down their feelings. Or for younger children, you could encourage them to draw their feelings, or explore their feelings through play.

Sometimes, if a child can simply share their feelings, it can be enough to help them to feel less distressed. In some cases, you might need to help them to find practical solutions for the things that are causing them distress. For example, if your child is worried about going to a new school, they might find it helpful to visit the school with you before they start. Or you could let their teacher know how your child has been feeling.

Trauma is a word that is often used to describe a horrible or terrifying event that has the potential to cause extreme distress. The word trauma is also sometimes used to describe the reactions to traumatic events. However, to avoid confusion this is not common practice in psychiatry.

Evidence shows that a substantial proportion of children experience traumatic events. According to one study, 3 in 10 children are exposed to potentially traumatic events by the age of 18. Many of these children do not go on to experience long-lasting mental health problems as a result.

Traumatic events can cause children to experience distress. However, children also often experience distress for non-traumatic reasons.

What are traumatic events?

Traumatic events can include:

• seeing someone die
• thinking you are going to die yourself
• being seriously injured
• experiencing sexual violence.

Traumatic events can happen in different ways:

• directly – it happened to you
• threatened – you thought something was going to happen, but it didn't
• witnessing – you saw it happen to someone else
• finding out – you found out that it had happened to someone very close to you.

Examples of typical traumatic events include:

• witnessing a violent or disturbing death
• serious accidents, such as a significant car crash
• physical or sexual assault
• serious (life-threatening) health problems or being in intensive care
• war and conflict
• terrorist attacks
• natural or man-made disasters, such as tsunamis or fires.

The above events are just examples. There are many events not covered here that can be experienced as traumatic.

After a particularly traumatic event, it is common for children to experience some of the following things:

Memories, dreams and flashbacks

Your child might have distressing memories, dreams or nightmares about the event. Dreams and nightmares might not always seem directly related to the traumatic event. Your child might also experience the event as if it is really happening again (known as a flashback).

Feeling upset when reminded of the event

Your child might feel particularly upset when something reminds them of the event. For example, if they are near where the event happened or in an environment that reminds them of the event.

Avoiding feelings and situations

Your child might try to avoid things, people and places associated with the event. They also might not want to talk about what happened.

Loss of memory

Your child might be unable to remember parts of the event.

Physical symptoms

Your child might get stomach aches or headaches.

Repetitive play

Your child might act out the traumatic event, or the themes of the event, through play. For example, if they were involved in a road traffic accident, they might re-enact the crash with toy cars.

Unpleasant feelings

These can include:

• feeling negatively about themselves, others, or the world
• blaming themselves or others for what happened, even if they or the people they are blaming did nothing wrong
• negative emotions like fear, horror, anger, guilt or shame
• seeming to be unable to feel happy, satisfied or loving towards others
• believing that their life will end soon or that they won’t grow up.

Changes in the way they act

These can include:

• losing interest in things they used to enjoy
• seeming to be detached from other people
• doing dangerous or reckless things
• acting angrily and aggressively towards people or things
• being ‘on edge’ and unable to relax as though they are expecting something to happen. This is sometimes called being hypervigilant.
• being easily startled by loud noises or unexpected things
• difficulty focusing
• difficulty sleeping.

Making meaning of the event

Many children who experience a traumatic event do not develop any lasting negative effects. Two children could also experience the same traumatic event, but take different meanings from it.

One child might experience the event and learn:

This bad thing happened. It was horrible, but people helped me. It probably won’t happen again, but if it does, people will help me again.

Another child might experience the event and learn:

This bad thing happened. This means bad things could happen again at any time, and there’s nothing I can do about it. The world is not safe.

How children come to take different meanings from the same event depends on lots of different things, including:

• What happened before the event – What other difficult experiences they have had in the past, and how they learned to respond to them.
• The event itself – For example, how long it lasted or how ‘extreme’ it was.
• What happened after the event – For example:
  • whether they received support
  • the kind of support they received
  • how people around them spoke about the event
  • whether they were given time to rest and recover
  • whether their caregivers were also affected by the event and were able to support them.

What about repeated traumatic events?

Unfortunately, some children experience repeated traumatic events throughout their childhoods. For example:

• witnessing domestic violence against a caregiver
• repeated sexual, physical or emotional abuse
• living through a war, conflict or genocide.

Repeated events can be much harder to recover from. This is partly because it is much more difficult to make sense of them.

If your child has experienced a traumatic event, there are things that you can do to support them.

Give them time

It can take time to recover from a traumatic event. Children shouldn’t be pressured to talk about the event, ‘get over’ it, or forget it happened.

Don’t expect your child to feel better straight away. Remember that experiencing some distress is common and does not necessarily mean your child is unwell. Remember that recovering from a traumatic event is not always a simple process. Your child might have ups and downs. In most cases, they will start to feel better over time, with patience and support.

Give them space to talk about the event

Research has shown that talking about traumatic events can help people to be more resilient, and to make sense of the event.

Don’t push your child to talk about the event if they don’t want to, but give them opportunities to talk if they want to. If your child has experienced a traumatic event you should try to discourage them from ‘avoidant behaviours’. For example, not talking about what happened. While these behaviours might reduce distress in the short term, if they go on for too long your child might struggle to make sense of their experience.

If you also experienced the event and feel able to do so, you could share your feelings with your child. It’s okay to tell your child that you are upset or that you were scared. This can help them see that emotions are not something to fear or hide.

It’s also okay if you and your child feel differently about the event. You can explain to them that most people experience some distress and then recover. You can also explain to them that different people react to the same event in different ways.

Maintain their routine

Having a routine helps children to feel secure and safe. Continuing this after your child has experienced something traumatic can be an important part of their recovery. This might mean:

• sticking to their mealtimes and bedtimes
• continuing to visit friends and family
• encouraging them to keep going to school.

However, it’s okay if your child can’t follow their usual routine for a while. Be flexible and patient, and don’t expect everything to go back to normal straight away.

Be careful with social media and the news

If the event your child experienced was very public or ended up on the news, they might be tempted to read about it online or on social media.

It can sometimes be helpful to read about a traumatic event after it has happened. This can help you to understand what happened and why. However, you should discourage your child from watching, listening to, or reading lots of media related to the event. This is especially important if doing so causes them distress. You could encourage them to speak to you or another trusted adult if they read anything that upsets them.

Try to find a balance between helping your child to make sense of what happened, and helping them to avoid becoming overly distressed.

Think about your own response

If your child has experienced something traumatic, this will probably have a significant effect on you and your wellbeing. You might need emotional or practical support to be able to be there for your child.

Expressing your emotions is normal and can help your child to process their own feelings. However, you should try to strike a balance.

Be cautious about how you talk about the event around your child, especially with other adults. If you consume a lot of media about the event, try to avoid doing this in front of your child. This is especially important if you can see that it makes them uncomfortable.

Ask for support

Where appropriate, you might want to ask for help from family, friends or other trusted people. They might be able to offer emotional support to you and your child, help you with practical tasks, or spend time with you and your child doing ‘normal’ things.

Speak to their school

It might be helpful for you to let someone at your child’s school know that they have experienced a traumatic event. This can help your child’s teachers to be aware of their feelings, and to be patient if they are unable to take part in school like they did before the event. Your school might also be able to make reasonable adjustments. For example:

• letting your child come to school for part of the day or week
• giving them more frequent breaks or ‘quiet time’ outside of the classroom
• checking in with them each day
• letting them call you during the school day.

Information for adoptive or foster parents

If you are an adoptive or foster parent, your child might have experienced one or more traumatic events before you knew them. As well as the ideas above, you might find it helpful to speak to the adults who have been involved in your child’s care in the past. They might be able to help you understand the following:

Things that have helped your child

For example:

• If they have had any treatment or support in the past, and how this has helped. This could be medical treatment, or other kinds of support.
• Any things they have learned that you can continue to practice with them. For example, mindfulness or CBT practices.
• Any medications they might be taking, or therapy they might be having.
• Things that they find comforting. For example, routines, favourite toys or nightlights.

Things that your child has found difficult

For example:

• If there are things, events or places that they avoid or find difficult.
• If they find the anniversary of the event or events difficult.
• If they have taken part in any treatments that they did not engage with. Or if they had any treatments that were counter-productive to their recovery.

You might not be able to get answers to all of your questions, but it can help you to understand more about how to support your child.

Everyone deals with traumatic experiences differently, but children are generally very resilient. Most children will be able to recover after a traumatic event with the support of their family, friends and school.

Recovering doesn’t mean that they will forget about the event or never find it upsetting to think about. Instead, it means that thinking or talking about the event won’t cause them extreme distress or stop them from doing the things they enjoy.

You should ask your GP for help if your child is:

• still very distressed after one month
• doesn’t seem to be getting better
• or is getting worse.

You should ask your GP for help after three months if your child:

• has improved but is still distressed
• and this is affecting their ability to do normal activities.

Post-traumatic stress disorder (PTSD) is a mental illness that can develop when someone is exposed to a traumatic event, or lots of traumatic events.

Will my child get PTSD?

Most children who experience traumatic events will not go on to develop PTSD, or any other mental illness. However, around 2 to 3 in every 20 children and adolescents who experience trauma will go on to develop PTSD by the age of 18.

PTSD is more common in children who have experienced ‘interpersonal’ traumas. This means that the trauma happened as a result of other people. For example, living through a war or conflict, or experiencing physical or sexual abuse.

How can I tell if my child has PTSD?

The symptoms of PTSD are the same as the symptoms described in the section ‘How might my child feel after a traumatic event?’. However, with PTSD, these symptoms do not improve over time and can get worse.

You should speak to your GP if your child has experienced a traumatic event and:

• they are experiencing some of the symptoms described at the beginning of this resource and
• these symptoms continue for longer than one month or are significantly affecting your child’s life.

You should also speak to your GP if your child is experiencing any significant changes in their mood or behaviour.

If you believe your child, or someone else’s child is in immediate danger, you should contact the police. You can do this by calling 999, or 101 for non-emergency enquiries.

If you are worried about a child but are not sure if they are in danger, contact the National Society for the Prevention of Cruelty to Children (NSPCC). Speak to them about your concerns, and they can take the next steps if a child is in danger.

You can find out more about the steps involved in reporting abuse or suspected abuse to the NSPCC on their website.

Safeguarding

The NSPCC defines safeguarding as “action you take to promote the welfare of children and protect them from harm”. All organisations that come into contact with children should have a safeguarding policy. This includes:

• schools
• clubs such as after school clubs, social clubs and sports clubs
• social services
• the NHS.

If a child is experiencing any form of abuse, violence or bullying, it is the responsibility of any professionals that come into contact with them to safeguard that child. This might mean reporting what is happening to the police or social services.

Other resources

Take a look at some of our other information resources for children and young people:

• When bad things happen
• Coping with stress
• Anxiety
• Depression

Take a look at our resources for adults on trauma and PTSD:

• Coping after a traumatic event
• Post-traumatic stress disorder (PTSD)

Other organisations

• UK Trauma Council – The UK Trauma Council provides resources, guidance and training on responding to traumatic events that impact children and young people.
• Trauma, ACAMH – Information from the Association for Child and Adolescent Mental Health on trauma in children and young people.

Helplines

• NSPCC – The NSPCC is a child protection charity, which has helplines for adults worried about a child, and for children and young people.
• Childline – Childline is a free, private and confidential service for young people under 19.
• Young Minds – Young Minds have a free, confidential helpline service for parents and carers of children and young people aged 25 or under. This service is available across the UK.

Books

Helping Your Child with Loss and Trauma: A self-help guide for parents by David Trickey and Vicky Lawson

This information was produced by the Royal College of Psychiatrists’ Child and Family Public Engagement Editorial Board (CAFPEB). It reflects the best available evidence at the time of writing.

Expert authors: Professor Andrea Danese, Professor Neil Greenberg and David Trickey

Experts by experience: Abiola Johnson, Emma Wakefield and Toni Wakefield

Full references available on request.