Trauma-informed Care Approach to Child Traumatic Stress

Children exposed to violence, injury, and other potentially traumatic events are at risk for developing traumatic stress reactions. Additionally, some children seen in the health care setting have had chronic exposure to poverty and violence within neighborhoods or homes.

This chronic exposure can create "toxic stress," which has been associated with behavioral and learning challenges as well as physical and emotional consequences through adulthood.

Pediatric healthcare providers play a key role in preventing injury- and violence-related posttraumatic stress by providing “trauma-informed” pediatric care, which includes recognizing pre-existing trauma, addressing acute traumatic stress reactions associated with the traumatic event, minimizing potentially traumatic aspects of treatment, and identifying children who need additional monitoring or referrals for more help.

The Center for Violence Prevention (CVP) at CHOP promotes a systems approach to trauma-informed care for those who work with children and families in any setting, including healthcare, schools, social agencies, and law enforcement).

With training and awareness, individuals working in these settings can better appreciate the challenging context in which many youth live, understand the impact of trauma exposure, and realize the importance of their interactions with children and families in promoting recovery and reducing traumatic stress responses.

Many adults have a key role in supporting youth and helping them more quickly return to their normal functioning following exposure to trauma. Actively helping to build resiliency within families and supporting positive parenting can help a child recover after acute trauma, change typical reactions to toxic stress, and support healthy development.

Recommended Resources

 Relevant Publications

• Fischer KR, Bakes KM, Corbin TJ, Fein JA, Harris EJ, James TL, Melzer-Lange MD. Trauma-Informed Care for Violently Injured Patients in the Emergency Department. Annals of Emergency Medicine. 2019;73(2): 193-202.
• Cutuli JJ, Alderfer MA, Marsac ML. Introduction to the Special Issue: Trauma-informed Care for Children and Families. Psychology Services. 2019;16(1): 1-6.
• Kassam-Adams N, Butler L. What Do Clinicians Caring for Children Need to Know About Pediatric Medical Traumatic Stress and the Ethics of Trama-informed Approaches? AMA Journal of Ethics. 2017;19(8): 793-801. 
• Weiss D, Kassam-Adams N, Murray C, Kohser K, Fein JA, Winston FK, Marsac ML. Application of a Framework to Implement Trauma-informed Care Throughout a Pediatric Health Care Network. Journal of Continuing Education in the Health Professions. 2017;37(1): 55-60.
• Marsac ML, Kassam-Adams N, Hildenbrand AK, Nicholls E, Winston FK, Leff SS, Fein JA. Implementing a Trauma-informed Approach in Pediatric Health Care Networks. JAMA Pediatrics. 2016;170(1): 70-77.

Learn More

• After The Injury -- A site dedicated to helping parents understand their child's reactions to injury and learn how to help children cope with trauma in a healthy way.
• Health Care Toolbox -- This site is for health care professionals, with training courses and downloadable patient handouts to help improve comprehensive, trauma-informed care for children and their families.
• National Child Traumatic Stress Network -- The mission of the National Child Traumatic Stress Network is to raise the standard of care and improve access to services for traumatized children, their families, and communities throughout the United States.
• International Society for Traumatic Stress Studies (ISTSS) -- ISTSS is an international interdisciplinary professional organization that promotes advancement and exchange of knowledge about traumatic stress. ISTSS offers a variety of educational materials to contribute to the health and resilience of individuals and communities in the face of traumatic events.
• American Academy of Pediatrics (AAP): A Public Health Approach to Toxic Stress -- This report looks to apply developmental science to the clinical setting, so pediatricians can better help their patients dealing with toxic stress.
• The Center on the Developing Child- Harvard University -- The mission of this Center is to leverage rapidly growing knowledge about how early childhood is a time of both great promise and considerable risk to drive science-based innovation that achieves breakthrough outcomes for children facing adversity. This selection specifically looks at how the AAP is addressing adverse childhood experiences.
• ACEs Connection -- The mission of ACEs Connection is to accelerate the global adverse childhood experiences (ACEs) science movement, recognize the impact of ACEs in shaping adult behavior and health, and promote trauma-informed and resilience-building practices and policies in all communities and institutions to help heal and develop resilience instead of traumatizing already traumatized people.
• The Sanctuary Model --The mission of the Sanctuary Model is to teach individuals and organizations the necessary skills for creating and sustaining nonviolent lives and nonviolent systems.

Watch an introductory webinar on trauma-informed care: