Disruption of sleeping and toileting

Startle response to loud/unusual noises; hypervigilance

"Freezing" (sudden immobility of body)

Fussiness, excessive crying, and neediness

Loss of acquired speech and motor skills

Separation fears and clinging to caretakers

Withdrawal; lack of responsiveness

Avoidance of or alarm response to specific trauma-related reminders involving sights, smells and physical sensations

Memory of trauma may be evident in behavior or play

Snatches of incomplete memory or visual images may remain in memory and be given verbal description by toddlers

Maintain child's routines around sleeping and eating

Avoid unnecessary separations from important caretakers

Provide additional soothing activities

Maintain calm atmosphere in child's presence

Avoid exposing child to reminders of trauma

Expect child's temporary regression; don't panic

Help verbal child to give simple names to big feelings; talk about event in simple terms during brief chats

Give simple play props related to the actual trauma to a child who is trying to play out the traumatic situation; a doctor's kit, a toy ambulance, toy dog, lots of beds & babies for orphanage

Repeated retelling of traumatic event

Behavior, mood and personality changes

Obvious anxiety and fearfulness

Withdrawal and quieting

Specific, trauma-related fears; general fearfulness

Post-traumatic play often obvious

Involvement of playmates in trauma-related play at school and day care

Regression to behavior of younger child

Loss of recently acquired skills (language, toileting, eating, self-care)

Separation anxiety with primary caretakers

Loss of interest in activities

Sleep disturbances; nightmares, night terrors, sleepwalking, fearfulness of going to sleep and being alone at night

Confusion and inadequate understanding of traumatic events most evident in play rather than discussion

Unclear understanding of death and the causes of "bad" events

Magical explanations to fill in gaps in understanding

Complaints about bodily aches, pains, or illness with no medical explanation

Visual images and unpleasant memories of trauma that intrude in child's mind but will seldom be discussed spontaneously

Hyperarousal/hypervigilance

Loss of energy and concentration at school

Fear of trauma's recurring

Increased need for control

Vulnerable to anniversary reactions set off by seasonal reminders, holidays, and other events

Memory of at least some visual images from traumatic event is likely for youngest children; many demonstrate recall in words and play

At the older end of this age range, children are more likely to have lasting, accurate verbal and pictorial memory for central events of a recently occurring trauma

Listen to and tolerate child's retelling of event

Respect child's fears; give child time to cope with fears

Protect child from re-exposure to frightening situations and reminders of trauma, including scary TV programs, movies, stories, and physical or locational reminders of trauma

Accept and help the child to name strong feelings during brief conversations (the child cannot talk about these feelings or the experience for long)

Expect and understand child's regression while maintaining basic household rules

Expect some difficult or uncharacteristic behavior

Set firm limits on hurtful or scary play and behavior

Avoid nonessential separations from important caretakers with fearful children

Maintain household and family routines that comfort the child

Avoid introducing new and challenging experiences for child

Provide additional nighttime comforts when possible; family bed, night lights, stuffed animals, physical comforting after nightmares

Explain to child that nightmares come from the fears a child has inside, that they aren't real, and that they will occur less and less over time

Provide opportunities and props for trauma-related play Use detective skills to discover triggers for sudden fearfulness or regression

Monitor child's coping in school and day care by communicating with teaching staff and expressing concerns

Listen for child's misunderstandings of a traumatic event, particularly those that involve self-blame and magical thinking

Gently help child develop a realistic understanding of event Remain aware of your own reactions to the child's trauma Provide reassurance to child that feelings will diminish over time

Be mindful of the possibility of anniversary reactions

Repeated retelling of recent traumatic event

Obvious anxiety and fearfulness

Specific post-traumatic fears

Post-traumatic reenactments of traumatic event that may occur secretly and involve siblings or playmates

Fear of trauma's recurring

Intrusion of unwanted visual images and traumatic memory that disrupt concentration and create anxiety, often without parents' awareness

Loss of ability to concentrate and attend at school

"Spacey" or distractible behavior

Behavior, mood, or personality changes

Regression to behavior of younger child

Toileting accidents

Withdrawal and quieting or excesses of aggression and limit testing

Loss of interest in previously pleasurable activities Sleep disturbances: nightmares, sleepwalking, night terrors (rare for this age), difficulties falling or staying asleep

Complaints about bodily aches, pains, or illness with no medical explanation

Concern about personal responsibility for trauma

Hyperarousal/hypervigilance

Acute awareness of parental reactions; wish to protect parents from their own distress

Frightened by intensity of own feelings

Vulnerability to anniversary reactions set off by seasonal reminders, holidays, or other events

Child is likely to have detailed, long-term memory for recent traumatic event

Factual accurate memory may be embellished by elements of fear or wish; perception of duration may be distorted

Listen to and tolerate child's retelling of event

Respect child's fears; give child time to cope with fears

Increase monitoring and awareness of child's play, which may involve secretive reenactments of untreated trauma with peers and siblings; set limits on scary or hurtful play

Permit child to try out new ideas to cope with fearfulness at bedtime: extra reading time, radio on, listening to a tape in the middle of the night to undo the residue of fear from a nightmare

Reassure the older child that feelings of fear or behaviors that feel out of control or babyish (e.g. night wetting) are normal after a frightening experience and that the child will feel more like him/herself with time

Encourage child to talk about confusing feelings, worries, daydreams, mental review of traumatic images, and disruptions of concentration by accepting the feelings, listening carefully, and reminding child that these are normal but hard reactions following a very scary event

Maintain communication with school staff and monitor child's coping with demands at school or in community activities

Protect child from re-exposure to frightening situations and reminders of trauma, including scary television programs, movies, stories, and physical or locational reminders of trauma Expect and understand child's regression while maintaining basic household rules

Expect some difficult or uncharacteristic behavior

Listen for child's misunderstandings of a traumatic event, particularly those that involve self-blame and magical thinking

Gently help child develop a realistic understanding of event Remain aware of your own reactions to the child's trauma

Provide reassurance to child that feelings will diminish over time

Provide opportunities for child to experience control and make choices in daily activities

Be mindful of the possibility of anniversary reactions

Trauma-driven acting out behavior: sexual acting out or reckless, risk taking behavior

Efforts to distance from feelings of shame, guilt, and humiliation

Flight into driven activity and involvement with others or retreat from others in order to manage inner turmoil

Accident proneness

Wish for revenge and action-oriented responses to trauma

Increased self-focusing and withdrawal

Sleep and eating disturbances; nightmares; hypervigilance

Acute awareness of and distress with intrusive imagery and memories of trauma

Vulnerability to depression, withdrawal, and pessimistic world view

Personality changes and changes in quality of important relationships evident

Flight into adulthood seen as way of escaping impact and memory of trauma (early marriage, pregnancy, dropping out of school, abandoning peer group for older set of friends)

Fear of growing up and need to stay within family orbit

Acute awareness of distress with intrusive imagery and memories of trauma

Vulnerability to flashback episodes of recall

May experience acute distress encountering any reminder of recent trauma

Encourage younger and older adolescents to talk about traumatic event with family members

Provide opportunities for young person to spend time with friends who are supportive and meaningful

Reassure young person that strong feelings - whether of guilt, shame, embarrassment, or wish for revenge - are normal following a trauma

Help young person find activities that offer opportunities to experience mastery, control, and self-esteem

Encourage pleasurable physical activities such as sports and dancing

Address acting out behavior involving aggression or self-destructive aspects quickly and firmly with limit setting and professional help

Monitor young person's coping at home, school, and in peer group

Take signs of depression, accident proneness, recklessness, and persistent personality change seriously by seeking help

Help young person develop a sense of perspective on the impact of the traumatic event and a sense of the importance of time in recovering

Encourage delaying big decisions