The role of early care and education in addressing early childhood trauma

Young children's experience of trauma is associated with a wide range of adverse events and circumstances, including abuse and neglect, domestic violence, loss of a parent, and community violence. Policymakers and practitioners are increasingly aware that trauma during the first few years of life is especially widespread, and there is growing interest in new ways to support these young children and their families. Many young children who experience trauma attend early care and education (ECE) programs, and these settings offer important opportunities to promote their well-being. This paper examines strategies currently being implemented in ECE to address early childhood trauma. The paper first examines research on how trauma affects young children's development, ECE environments, and society. We then describe the unique needs of young, traumatized children and features of trauma-informed care that can address their needs, along with emerging interventions and supports that can be incorporated into or linked with ECE settings as part of a trauma-informed approach. We conclude with a discussion of future directions for ECE and trauma research, policy, and practice, bearing in mind both the promise of new approaches and a limited evidence base to date.

Psychological impact of esophageal atresia: review of the research and clinical evidence

Esophageal atresia (EA) occurs in one out of 2500 to 4500 live births. As the vast majority of infants are now surviving neonatal corrective surgery, the focus has shifted from mortality to morbidity associated with EA. However, little is known about its psychological morbidity. This paper synthesizes research and clinical evidence to highlight the psychological sequelae of EA, including its impact on parents' psychological functioning and its effects on child development from infancy to adulthood. Whether it is discovered at birth or prenatally, EA is a psychologically traumatic event, and parents are at risk for developing traumatic stress reactions following diagnosis. Neonatal surgery and intensive care, risk of complications, associated anomalies, and genetic etiologies multiply risk for parents' acute and post-traumatic stress disorders (PTSD). Parental PTSD has a negative impact on infant and child development through its effects on parenting skills and parent-child interactions. EA children are also at risk for PTSD because of invasive and stressful procedures they undergo during the neonatal period. Consequences of EA can have an important long-term impact on children's psychological and social development. The scant studies pertaining to cognitive functioning suggest that EA does not affect mental development during infancy, but may be associated with deficits as children reach school age. Long-term sequelae are unclear because psychological functioning in adults has not yet been adequately examined. Research and clinical evidence of psychological morbidity associated with EA has implications for clinical practice. Psychological support for parents must begin during the neonatal period and should continue as an integral component of long-term follow up for both children and parents. Support is best provided within the context of a multidisciplinary treatment team that follows patients from birth through childhood and adolescence. Psychological follow up should continue into adulthood, as patients grow up and transition from pediatric to adult health-care settings.

Infant trauma

Trauma forms the second largest cause of death in children under 1 year of age. Infants form a difficult cohort of patients; their range of development, differing physiology and inability to communicate or understand treatment makes them a challenge for any healthcare worker. Several factors compound this problem including a general lack of familiarity within non-specialised trauma services and the difficulty in studying infants as a cohort in academic research. This article aims to summarise the common problems encountered in dealing with infants in a trauma setting and specific differences in their management compared to other children or adults. Where possible it details current evidence most appropriate to the age group.

Mental health in infants with esophageal atresia

Chronic somatic illness in infancy may challenge the development of mental health and impinge the infant's capability to form close interpersonal relationships. Esophageal atresia (EA) is a congenital anomaly requiring neonatal surgery, medical aftertreatment, and extended hospitalization. The aim of the study was to assess mental health and to find prognostic factors for mental health among infants with EA. Thirty-nine infants treated consecutively during 2000 to 2003 and their mothers were included. Infant mental health was assessed by Diagnostic Classification: 0-3 (Zero to Three, 1994). Medical and environmental data were collected from medical records and semistructured interview with the mothers. Child development was assessed with the Bayley scales, second edition (N. Bayley, 1993). Maternal psychological distress, anxiety, and child temperament were assessed by self-report questionnaires: the General Health Questionnaire, 30-item version (D. Goldberg & P. Williams, 1988); the State Trait Anxiety Inventory (C.D. Spielberger, R. Gorsuch, & R. Lushene, 1970); and the Infant Behaviour Questionnaire (M.K. Rothbart, 1981). Thirty-one percent of the infants with EA showed mental health disorders by 1 year of age. Prognostic factors predicting mental health were posttraumatic symptoms reported by mother, more than one operation, mechanical ventilation beyond 1 day, and moderate/severe chronic family strain. Relational trauma, vulnerable attachment, and impaired self-development are highlighted as possible pathways for psychopathology. Children with EA are vulnerable to mental health disorders, and this study may help clinicians to identify children at risk.