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Trauma-sensitive Health Care

Children who have experienced toxic stressors including abuse and neglect have responses which, while adaptive in the stressful situation, can be maladaptive outside of the toxic stressor. These responses may be variable, including aggression and anger, or alternately, as depression and dissociation. Identification and accurate diagnosis of these responses to trauma can have profound implications for the child and their recovery from trauma.

Pediatricians can assist caregivers by helping them recognize the abused or neglected child’s altered responses, formulate more effective coping strategies, and mobilize available community resources.

Understanding the Behavioral and Emotional Consequences of Child Abuse


  • An increasing body of evidence documents the robust relationship between adverse experiences in early childhood and a host of complications, both medical and psychological, that manifest throughout childhood and later in adult life. See “Introduction”…
  • Abused or neglected children often suffer impairments in their language abilities and cognitive skills. See “War of the Worlds.” page 3…
  • Victims of abuse or neglect are far more often identified as “problem children” that are their peers and show higher rates of diagnosis with attention problems and violent and oppositional behaviors. See “Positive Feedback of the Negative Kind,” page 3…
  • As abused children grow and develop, earlier trauma is revisited and reconsidered.  See “Interventions,” page 4 …

Symptoms when traumatic stress does not go away can be grouped into 3 main behavioral clusters:

  1. Reexperiencing through intrusive thoughts, dreams and “flashback” recollections
  2. Avoidance of reminders and numbing of responsiveness, including social withdrawal, restricted range of affect and constriction of play
  3. Physiological hyperarousal in the form of hypervigilance and exaggerated startle response, attention and concentration problems, and sleep disturbances

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