Trauma-Informed Care Strategies in Pediatric Therapy

by | Apr 16, 2019 | Blog

Contributing Author(s):

Your body stiffens in response to the traumatic memory – the smell of burning rubber, the crushing sounds from metal and glass, and the surrounding chaos of the massive freeway pile-up. We often struggle to make sense of such events.  Our body naturally seeks safety from traumatic experiences, such as war, abuse, and tragedy. Triggers act as signs of potential danger and caution us to respond.

Because we respond to situations based on our own history and experiences, we are constantly scanning for threatening sights, sounds, and smells. Fight, flight, and freeze are responses to situations that we perceive as dangerous. Further, such responses lead to a set of emotional, physiological, and behavioral responses that arise to maintain our body’s homeostasis. We desire stability! However, triggers are more about one’s perceptions that are experienced as reality. We see things as WE are and not always as they actually may be.

Understanding the Impact of Trauma

Trauma-informed care techniques are spreading quickly in the therapy community. When utilizing a trauma-informed approach, we change our way of thinking. The interventions are directed by a thorough understanding of the profound effects trauma has on an individual (neurological, biological, psychological, and social). No one experiences a situation in the same way. Some are more resilient than others. We recognize that a person’s need is for safety, to make connections, and find adaptive ways to manage emotions and impulses. A critical and ongoing study at Kaiser Permanente began in 1995 (Centers for Disease Control and Prevention, 2019):  The Adverse Childhood Experiences (ACEs) Study.

The Adverse Childhood Experiences (ACEs) Study

Over 17,000 Health Maintenance Organization members from Southern California receiving physical exams completed confidential surveys regarding their childhood experiences and current health status and behaviors. The study, called the Adverse Childhood Experiences (ACEs) Study, investigates the long-term health and well-being of individuals. It is based on a ten-question survey to determine the number of ACEs a person has experienced in their lives (learn more and take the survey here). Researchers determined that ACEs have a tremendous impact on future health and well-being throughout life (Aces Too High, 2019). When filling out the form, ACEs are considered when they occur prior to your eighteenth birthday.

Trauma-Informed Care in Pediatric Therapy

Fortunately, therapists can provide support for traumatic experiences. Speech-language pathologists, occupational therapists, physical therapists, and others may obtain evidence-based training to provide effective care to such vulnerable populations. For example, I’ve developed a three-hour course as one resource that is available to provide trauma-informed care training. Key aspects of trauma-informed care include:

  • Recognizing Our Own Traumatic Experiences
  • The Importance of Self-Care
  • Share Tools for Success

Recognizing Our Own Traumatic Experiences

We can help others by recognizing our own traumatic experiences. None of us goes through life unscathed. Building healthy attachments, creating safe environments, maintaining cultural sensitivity, and utilizing a team approach in all facilities are first steps. When a traumatic event (or one perceived as traumatic) occurs, one person may cry while another may feel physically ill. Some people lose sleep while others become enraged and full of energy. Realizing that there is no right or wrong (and understanding your own responses to events) brings a feeling of control to the situation. We all need a cozy place in which to self-regulate. It is critical to create a similar space for children who may not know the words or understand emotions.

The Importance of Self-Care & Facilitated Introspection

Self-care is an essential behavior when caring for others. A best practice when working in a team environment is to encourage short breaks to allow mindfulness moments. These moments benefit each team member and increase productivity.  Similarly, those moments to reflect are essential for trauma care.

We all have an innate desire to feel heard – even to hear and understand ourselves! Yet, communication is often challenging for those suffering from trauma or who have speech limitations.

When working with pediatric clients, provide pretend play opportunities to allow non-verbal demonstrations of sadness and frustration. Trauma often manifests as behavioral issues and physical ailments in children. Sometimes traumatizing events are so awful that words simply cannot describe them. Allow children and adults to draw or use a journal. Create de-escalation and sensory-based calming strategies for your clients. Encourage words such as “trauma survivor” instead of “victim.”  These strategies provide critical, structured moments for clients to reflect.

Share Tools for Success

Human interactions make the biggest changes in those with high numbers of ACEs. In addition to providing interactions for our clients, we also want to build upon our knowledge to increase the effectiveness of trauma-informed care. As therapists, we are already in the business of helping others and we want all of our clients to succeed. Joining a community of learners and clinicians and participating in your professional association are excellent ways to empower each other with tools for success!

For more information on RMUoHP’s post-professional Doctor of Occupational Therapy program or pediatric science programs, visit the following websites:


About the Guest Blogger


RMUoHP Doctor of Occupational Therapy student Cara Koscinski is the mother to two sons on the autism spectrum. She is a veteran pediatric OT and has published six books in the field. Known as The Pocket Occupational Therapist, Koscinksi speaks to groups of therapists, caregivers, and educators across the US. As successful entrepreneur, Koscinski founded two pediatric occupational therapy companies and her books are found in special needs catalogues and websites across the US and UK. In addition to her books, Koscinski regularly blogs and creates fun products for those who work with special needs children. She serves on the Advisory Board of Autism Asperger’s Digest Magazine and Asperkids.  Additionally, her articles and courses have been featured in many special needs publications.  For more information, visit her website at