Understanding childhood trauma and Adverse Childhood Experiences

image credit: Kat Jayne, Pexels.

Childhood trauma is a growing public health crisis for children today. Research shows that traumatic childhood experiences are increasingly common. It also shows that these negative experiences have a profound impact on the function and development of children. Children exposed to parental substance abuse and domestic violence rarely have secure childhood experiences. The symptomatology tends to be complex and multi-dimensional.

A natural response

Children learn to regulate their behavior by anticipating their caregivers’ responses to them. A caregiver’s response encourages that child to develop an attachment to the caregiver and the environment. Attachments can be both secure and insecure, resulting in a child’s ability to form and engage in relationships for the rest of his or her life. Children’s attachments also impact their ability to regulate their own emotions and senses, as well as adapt to their environment.

Children who experience developmental trauma are often stuck in the “primitive brain,” which is responsible for automatic body functions (breathing, heart rate, and temperature control) and protects us by switching us to survival mode. Survival mode requires an immediate response (fight, flight or freeze) to all possible harmful stimuli. Children who are stuck in their primitive brain due to Adverse Childhood Experiences (ACE) will respond with one of the survival responses and will require co-regulation. These children will require co-regulation much longer than their typically developing counterparts.

Also, children who experience developmental trauma cultivate coping strategies that aid in ensuring safety. However once the child is removed from the unsafe environment, those coping strategies become unhealthy. They inhibit healthy growth and the development of daily life skills that are important for managing impulses, problem solving, and learning and developing higher level thinking and planning skills. These skills take place in higher levels of the brain that are often “offline” and inaccessible due to the quick response of the primitive brain. This limits the ability for information to pass into the higher levels responsible for attachment, relationships, learning, thinking and language. Often these children are misdiagnosed and misunderstood by professionals, friends and family. These misdiagnoses and misunderstandings tend to reinforce the already disorganized patterns of attachment and regulation.

Trauma at an early age

Many professionals and individuals who aren’t educated in the effects of early childhood trauma believe if the child experiences the trauma as an infant or toddler, then the child doesn’t remember the trauma and therefore won’t be affected by it. However that is not the case.

Because language hasn’t developed at that young of an age, memories of the trauma aren’t stored in language, so the child cannot necessarily describe or recall the event in words. Instead it is stored “physically” in sensations and sensory memories.

Infant brains function mainly in the brainstem, the primitive brain, therefore their experience of trauma is held in primitive responses (heart rate, temperature, respiration rate). The child’s sensory system develops with limited ability to effectively filter sensory input due to its over or under response for survival. As a result, the child grows up re-living the trauma through natural body functions, without the ability to put words to the trauma. The child also has difficulty telling the difference between danger or natural body responses to safe experiences that cause activation of the automatic brainstem (aka primitive brain).

Trauma in infancy causes disturbances to the sensory system, which often brings the children challenges in making sense of the world through their senses, including knowing how much pressure their body is exerting, differentiating differed textures, and understanding where their or her head and body are in space (balance and coordination). It also makes it difficult for the child to manage his or her own emotions and regulate responses. Often there may be an increase in anxiety and depression, with the child expressing this through behavioral issues and anger outbursts.

Treatment is available

Beaumont’s Trauma Regulation Treatment team uses a multidisciplinary approach within a medical model for children who have experienced abuse, neglect, peri- and post-natal substance exposure, invasive medical treatments, and/or exposure to community trauma. Our goal is to provide education and support to aid parents and caregivers in understanding the impacts of trauma on their children. Our team is composed of an occupational therapist, a behavioral health therapist, and a physical therapist who work closely to address underlying issues caused from trauma exposure. This interdisciplinary approach supports a combination of bottom-up (occupational and physical therapy) and top-down (behavioral health) treatment to calm the response of the child’s primitive brain and encourage increased access to the relationship and executive functioning parts of the brain. This lets the child develop use of all parts of the brain for neurological growth and development while addressing attachment, regulation, sensory motor challenges, and natural processing of trauma experiences. Our treatment approach values the efforts and inclusion of the caregiver into the treatment team to provide education and resources, empowering the caregiver’s efforts to better support their children through daily growth and development.


The information above is derived from pioneers in the areas of trauma and child trauma: Bessel van der Kolk M.D. and the National Child Traumatic Stress Network, Bruce Perry M.D. Ph.D and the Child Trauma Academy, and Vincent Felitti M.D. and his work with the Adverse Childhood Experience (ACE) study.

For more information on childhood trauma and treatment options refer to:

– Sara Gariepy, MS OTRL, CATP and Kristin Rosales, MSW, CATP are with the Beaumont Center for Children’s Rehabilitation team in Macomb.

Child life specialists: Improving your child’s hospital visit

child life specialist with little boy patient

As certified child life specialists with Beaumont Children’s, our role in the hospital is unique. We are trained professionals in the developmental impact of illness and injury. But what does that even mean?

What we do

Child life specialists help infants, children, youth and families cope with the stress and uncertainty of acute and chronic illness, injury, trauma, disability, loss and bereavement. We provide evidence-based, developmentally and psychologically appropriate interventions, which include therapeutic play; preparation for procedures; and education to reduce fear, anxiety, and pain. We work with the multidisciplinary team, as well as the entire family, to meet the needs of patients, siblings and parents alike to promote a culture of family-centered care throughout all hospital encounters.

We help children by:

  • Educating them on diagnosis, procedures and treatment plans through the use of medical play.
  • Preparing for tests, procedures, and/or surgeries (patients, siblings and family).
  • Supporting them during invasive procedures through the use of distraction and coping skills.
  • Engaging patients in therapeutic and expressive activities to help them cope with fears and anxiety.
  • Advocating for the unique needs of patients and families during and after hospitalization.
  • Promoting family-centered care through psychosocial and emotional support.
  • Normalizing the hospital environment in an effort to promote optimal growth and development.

child life specialist drawing with a young patient and her mom

In order to create a comforting and normalizing environment for patients and families, our department provides additional services. These include pet therapy visits, daily recreational activities that give patients an opportunity to meet and socialize with one another, and special events like our annual holiday parties and Dream Cruise Parade. We also have a schoolteacher and board-certified music therapist on staff.

Where we work within the hospital

Beaumont child life specialists cover multiple areas, including the Center for Children’s Surgery, Pediatric Oncology and Hematology, the inpatient Pediatric and Pediatric Intensive Care Unit, Short Stay and the Emergency Center. We also have part-time coverage at Beaumont, Troy in its inpatient pediatric unit and emergency center.

Our department attempts to see all children who are hospitalized to provide an assessment of their coping and psychosocial needs. Much like other disciplines, we receive consults from the medical team for patients and families in need.

child life specialist working with young boyChild Life Services is able to do this with the support of Children’s Miracle Network. We hope to expand our services in the future to reach all pediatric patients in Beaumont Health, including the Neonatal Intensive Care Unit, pediatric specialty clinics, Pediatric Radiology, etc. We truly love what we do as well as the patients and families we serve! 

Favorite moments from our child life specialists

  • “I had a patient who was afraid of her anesthesia mask. I built rapport with the patient and got her to engage in activities with me to build rapport and trust. I provided preparation with the anesthesia mask to help her become familiar with it. I was able to have her lay down while I was blowing bubbles at her. In the end, she was breathing with the anesthesia mask on while popping bubbles to make it less traumatic.”
  • “We had a 4-year-old who refused to walk admitted to the pediatric unit. She wouldn’t even walk to the playroom. We brought in our pet therapy dog and she walked the dog around the unit multiple times.”
  • “A 7-year-old in the emergency room was screaming and crying whenever a nurse tried to touch her cut. I overheard the nurse say they were going to sedate this patient in order to clean out her wound. After talking calmly with this little girl and explaining (in a developmentally appropriate manner) the procedure of cleaning out her wound, she realized it wasn’t so scary. She engaged in deep breathing with me as the nurse cleaned and wrapped her cut without having to sedate her.”
  • “There was an 11-year-old patient who had severe second degree burn. The patient was extremely anxious and fearful of the painful daily dressing changes and physical therapy sessions. After a medical play session and extensive preparation, the patient worked with me to come up with a positive coping plan that included deep breathing, use of a stress ball, parental presence, and taking 10-second breaks every minute. All of these things helped with coping and compliance with the treatments she was undergoing during this stressful hospitalization.”
  • “A 10-year-old patient came to the emergency center and needed an IV. Her nurse informed me that this patient was very anxious and could use child life services for preparation and procedural support. I worked with this patient by providing education, preparation, and familiarization so that she knew what to expect during the procedure. To provide her with more control and mastery, she performed the procedure on a medical play doll before her own IV start. When it came time for her IV, she was no longer anxious and knew exactly what to expect and how to help make it less painful with deep breathing and distraction.”
  • “I helped create a school program that was manageable for a heart transplant patient. All of his second semester of senior year was spent inpatient. Even though every day was a challenge for him, he was able to graduate on time with his class!” – Schoolteacher
  • “I have many favorite memories of being a music therapist, but there are two that stand out above the rest. My first memory is of a cancer patient using songwriting through her journey and how she used music to express her emotions. The second is developing a heartbeat bereavement program to give parents the gift of music and a piece of their child to hold on to.” – Music Therapist

– Beaumont Children’s Child Life Team: Lisa Kristoff (CCLS), Rose Freigeh (CCLS), Michelle Staubach (CCLS), Amanda Lefkof (CCLS), Jenn Ernst (CCLS), Caroline Wall (CCLS), Holly Platis (MT-BC), Janis Traynor (Schoolteacher), Kathleen Grobbel (CCLS, Manager)

Helping your child through difficult times

sad girl holding teddy bear

Life happens!

Life events (whether good, bad, or ugly) are sometimes difficult to deal with and often stressful to children. Why? Our children try to make sense of what is happening to them or around them and can have difficulty understanding and adapting.

Stressful times

Even as adults, there are times when we seek understanding and reassurance that what has happened to us is something that others have also experienced. However, children may not have the life experiences and knowledge of events such as death, or divorce. They may be unaware that other children their age have experience with these events.

Other times, people in our lives who we consider friends may be mean to us and cause us to be anxious or afraid. Being the target of a bully or watching a bully incite fear in another is not a pleasant thing to see and can be confusing to a child.

Then there are also the occasions that children need to learn from their mistakes. Learning to share, be a friend, and self-awareness are also characteristics that we hope to instill in our children.

Helping make sense of difficult situations

As parents we take pride in taking care of our children. We often think we are helping them with their problems by our daily talks at the dinner table or at bedtime just before tucking them in with that last good night kiss.

We try to explain things to our children. We talk to their teachers or care givers and do what we can to make the situation better for them. Innately, we don’t like to see our children struggle with things that we may perceive as a natural part of growing up.

A child’s behavior speaks volumes. When a child struggles with something, we often see acting out, crying more often, or even withdrawal. To a child, his problem is very real and he is seeking ways to deal with his feelings. Oftentimes, a child will feel alone or like he is the only one who has had these experiences. But knowing that others their age have experienced the same issues can help a child get through these difficult events in their life. Like adults, children need tools to help them understand what is happening in their world.

Books as tools

As adults, we seek out books and resources to help us when we need a better understanding of what we’re facing. We need to remember that books are valuable tools for people of all ages.

Books can be a key to unlock those feelings of fear, isolation or sadness to a child. They can validate a child’s feelings and empower him to handle issues that come his way.

There are many developmentally appropriate books to help our children over the hurdles to gain insight and understanding. The spectrum of books ranges from simple picture books to chapter books with characters solving their problem.

Below is a list of challenges that occur in all of our lives, along with selected books that may be helpful to your child.

Death of a loved one

Death of a pet






Individual uniqueness


 Overcoming Challenges



Coping with a disability 

– Lori Irwin, M.Ed., is a Parenting Program volunteer. She’s a former teacher of children with severe disabilities in reading, a consultant with a leading educational book publisher, and a mother of two adult children.


The difference between rewards and bribes

serious looking girl with ice cream

Unaltered image. Marcin Kargol, Flickr. CC license.

When working with parents of challenging children, the topic of rewards (or, in behavioral language, “positive reinforcement”) typically comes up early in consultation or treatment. Parents often express some concerns about rewarding their children for acting appropriately, and invariably I’m asked if providing rewards is simply a dressed-up version of bribing kids to behave well. This is a great question and I’m always happy to take the opportunity to explain the differences between rewards and bribery to wary caregivers.

First, let’s take a look at some definitions as they appear in the Oxford Dictionary:

  • bribe /brīb/ verb: to dishonestly persuade (someone) to act in one’s favor by a gift of money or other inducement
  • re·ward /ri-ˈwȯrd/ verb: to give something to (someone) in recognition of their services, efforts, or achievements; to show one’s appreciation of (an action or quality)

The differences should start to become clear simply from reading these two definitions. Consider the following three factors attempting to distinguish between these two very different methods of influencing behavior.

  1. Intent. Right off the bat, it’s clear that bribery has a negative connotation as it tends to be associated with questionable morals and/or conduct. For example, one might envision a sports referee being offered a monetary bribe in return for deliberately influencing the outcome of a game. So, the first way in which bribery differs from offering a reward is that it is usually intended to promote questionable or dishonest behavior, rather than encouraging “good” behaviors one might define as constructive, prosocial or fair.
  2. Timing. The second major way in which bribery differs from rewards, particularly as it pertains to changing child behavior, is in the timing of the delivery. While an effective reward is generally set up ahead of time (i.e., before the behavior has had the chance to occur), a bribe is offered in the middle of a challenging behavior episode, usually in the desperate hope that it will turn things around.
    Here’s a classic example. A parent takes a child to the grocery store. About halfway through the trip, the child starts to whine and complain. This quickly escalates into a full-blown tantrum. In an effort to stop this disruptive (and embarrassing) behavior, the parent offers to buy the child a donut at the bakery counter in return for better behavior for the rest of the shopping trip. The child stops crying, and the parent buys the child a donut (while making every effort to finish up the shopping as quickly as possible before another meltdown can occur!). In this instance, the parent delivered a bribe in exchange for improved behavior.
    Now, let’s consider the same scenario with the parent choosing to provide a reward instead of a bribe. Before the shopping trip, the parent tells the child that she will be able to select a treat from the bakery if she can stay seated in the cart and refrain from begging or throwing a tantrum while they shop together. (Note that the parent was very specific about the desired behavior, rather than simply telling the child to “be good”). If the child successfully demonstrates the desired behavior, the parent will reward the child with the bakery treat for a job well done. However, if the child is unsuccessful (e.g., does not remain seated or has a tantrum in the middle of the store), she will not receive a donut during this shopping trip. If she asks her parent if she can have the treat, the parent explains that the child she receives a reward when she behaves well in the store, and this time she did not behave well. The parent can then decide if the shopping trip will continue despite the undesirable behavior, if the child takes a consequence (e.g., time out in the car), or if shopping gets postponed for another time and everyone goes home. This decision will depend on the severity of the child’s behavior and the parent’s remaining reservoir of patience at the given time!
  1. Long-term impact on behavior. Both rewards and bribes have the power to influence child behavior. However, bribery tends to have only short-term positive effects and can often encourage undesirable patterns of behavior in the long run. In the aforementioned example, the donut bribe did result in an end to the tantrum in the grocery store. The parent might leave the store that day thinking that a donut was a small price to pay for a few moments of peace and a successfully completed shopping trip! However, the take-away message for the child is that a tantrum can lead to donut treats, while being helpful and cooperative in the store from the start has no positive consequences at all. The next time this child accompanies her parent to store, it is likely that a bribe may be necessary again (and it might take more than a donut to appease her). In other words, bribes can teach children to behave badly to get the things they want. A well-planned reward, on the other hand, encourages desirable behavior in children. In our example, the child earned a donut for displaying the “good” behavior the parent defined for her ahead of time. She earns nothing for a tantrum, which means that in the long run, she is more likely to display “good” behavior on shopping trips with mom or dad. Parents sometimes find it helpful to think of the use of rewards as a “contract” between themselves and the child. And for those concerned that their children will still be expecting treats at the grocery store until they leave for college, I offer the reassurance that rewards are typically faded out when desirable behaviors become habitual and they are no longer necessary to help shape the child’s behavior.

Do you have a strong-willed child? Are you ready to learn more about how to change his or her behavior for the better? Consider joining us for the The Challenging Child: Positive Parenting for Family Harmony, a six-session workshop where you can learn evidence-based strategies to help you reverse coercive cycles of child noncompliance, improve parent-child communication, and rediscover the things you love about your son or daughter.

– Sarah E. Baker, Ph.D., Licensed Clinical Psychologist, Center for Human Development at Beaumont Health

Beaumont’s Big Brother – Big Sister Class

big brother holding baby brother

The Big Brother – Big Sister Class continues to be popular among families year after year. Beaumont’s Prenatal and Family Education department offers approximately one or two classes per month at Beaumont Royal Oak, Troy, and Grosse Pointe.

This lively, interactive class is designed for children ages 3 to 8 years old (although 9- and 10-year-old children are also welcome). During the class, your child will learn what new babies are like and how to prepare them for their new role as a big brother or big sister. We use dolls and an educational DVD to keep your child interested and engaged.

Your child will learn the day-to-day care that a new baby needs. Children also learn how they can help mom and dad when the new baby comes home. Safety is discussed and stressed to the young child. Hand hygiene is another component taught.

A parent joins the child for the class. As your child learns about his or her new baby sibling, we will share written information with you on how you can prepare your child for the new baby’s arrival and how to help the big sibling adjust to the newest member of the family. Techniques are discussed to help the sibling understand the normal range of emotions during this time of family transition and how to express these feelings based on their age.

The Big Brother – Big Sister Class should be taken approximately four weeks before your new baby arrives.

Click here for more information or to register for an upcoming session.

– Maribeth Baker, RN, LCCE, HBCE, Program Coordinator, Beaumont Health Prenatal and Family Education