Helping a Child Through Trauma
QUESTION:
My 2-year-old nephew had a serious accident at his childcare center and had to be in a body cast for many weeks. (The center handled this badly, failing to seek immediate care and waiting a long while before calling his mother). My mom stayed at my sister's house for three months after the accident to help care for my nephew during his recovery, and he became very attached to her. A few weeks ago she returned to her home in Germany. Now my nephew is physically well and has started at a new childcare center while his mom works. However, he's talking much less than he used to, he rarely smiles, and he wakes up screaming every night. Because I have worked in mental health (in Germany), my sister is looking to me for advice, but I'm not sure what resources are available or what approaches are appropriate for such a young child. Can you offer some suggestions? And is this behavior cause for serious concern? My sister is not naturally a very warm mother, but I do think she'll take my advice.
ANSWER:
Your nephew has experienced a huge trauma, complicated by the fact that he is so young and therefore can't rely much on language to help him understand what happened or to manage the intense pain and fear he has experienced. Getting hurt in the first place, suffering during the time the caregivers delayed getting help, and then spending long weeks confined in a cast all add injury to injury. On top of all that, he now has lost his loving grandmother. Again, the limited language understanding of a two-year-old makes it even harder to cope with such a loss. And of course now he's trying to adapt to a new group of children and caregivers at the new childcare center, a big adjustment for any young child, even under ordinary conditions.
So, it is no wonder your nephew is more quiet and subdued, nor is it surprising that he wakes at night, perhaps with nightmares of his accident or simply with a powerful need to know that his mother is there for him. To help him work through this difficult time and regain his security and sparkle, here's what I suggest:
*Encourage your sister to provide lots of extra comfort and reassurance at home. Since you say she is not naturally warm, some concrete suggestions may help her express her love more easily. For example, encourage her to allow for a long, relaxed bedtime routine--a slow, warm bath, a story, rocking and a lullaby, and a gentle backrub once her son is tucked into bed. When he wakes in the middle of the night, his mother should go to him, rub his back or hold him and, in a soft voice say, "You're scared, but mommy's here." Not only will this provide the reassurance he needs, but labeling his feelings will help him develop the words to express and manage them.
*Suggest that your sister talk with the childcare providers at the new center to be sure they understand her son's need for extra support following this upheaval in his life. Perhaps one person could be designated as the primary caregiver for him, providing extra encouragement and support while your nephew gets more comfortable in the new environment. This primary caregiver also would be in a good position to monitor changes in your nephew's behavior and to communicate regularly with his mom.
*It would be wise to maintain contact between our nephew and his grandmother, even across the distance. Photographs, phone calls and exchange of audio or videotapes--perhaps with Grandma reading a favorite story--will help your nephew know he's loved. As he gets older, this long-distance connection will become increasingly meaningful to him.
*If, despite these extra efforts, your nephew continues to be overly subdued and/or to cry in the night, your sister will need to seek professional help. She could start by asking her pediatrician to recommend a mental health professional specializing in young children. Play therapy often helps a young child work through fears. Or a psychologist may suggest ways your sister can use stories, art or creative play to help her son manage his feelings. A good therapist also will attend to your sister's needs, recognizing that this whole experience has been traumatic for her as well.
Whether or not professional help becomes necessary, recognize that time, predictable routines and lots of tender loving care are keys to helping your nephew and your sister get back on track. They are fortunate to have you to offer love and support.
Editor's Note: Dr. Martha Farrell Erickson, director of the University of Minnesota's Children, Youth and Family Consortium, invites your questions on child rearing for possible inclusion in this column. E-mail to mferick@tc.umn.edu or write to Growing Concerns, University of Minnesota News Service, 6 Morrill Hall, 100 Church St. S.E., Minneapolis, MN 55455.
