Management & Treatment

Pediatricians and other pediatric health care professionals can use trauma-informed care as a framework which includes the spectrum of primary prevention, secondary detection, and tertiary treatment. Tertiary care involves management and treatment of trauma-related health concerns.  

If a child or teen is experiencing symptoms of trauma, it’s important for the pediatrician to begin by with validating both the child and caregiver. This includes thanking them for sharing their experience and expressing appreciation for their trust. Creating a sense of safety is essential and can be supported through a calm, open, and engaging tone of voice and body language. 

Early steps may include normalizing the child’s experience, providing basic psychoeducation about how trauma affects children, and conveying a confident expectation of recovery. These initial responses can be powerful in helping the child and family feel supported. 

Pediatricians should also focus on supporting caregiver regulation first, as this helps promote co-regulation for the child. This can include using reflective listening and teaching basic affect management skills. Providers can then introduce practical strategies to help both the child and caregiver manage trauma-related stress. 

As appropriate, pediatricians should set clear expectations, prioritize the needs of the most affected children, and offer guidance to support ongoing recovery. If clinically indicated, a pediatrician may refer a patient to evidence-based trauma-informed mental health services. Common therapies with demonstrated efficacy for children and teens who have experienced trauma include:  

• Attachment and Biobehavioral Catchup (ABC)
• Child-Parent Psychotherapy (CPP)
• Parent Child Interaction Therapy (PCIT)
• Child and Family Traumatic Stress Intervention (CFTSI)
• Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
• Eye Movement Desensitization and Reprocessing (EMDR) 

Pediatricians can play an important role by clearly identifying the type of treatment needed and explaining the rationale for that treatment to the family. They should document any barrier to referral, such as trauma triggers or family dynamics that would affect engagement in care. Maintaining a connection with the therapist and following up with the caregiver can help to reinforce treatment attendance and continuity of care. 

The use of medication to address trauma-related symptoms in children is generally limited. When considering pharmacologic treatment, providers should do so cautiously and in conjunction with evidence-based behavioral interventions. For additional guidance on when and how to consider medication for children who have experienced trauma, refer to this ECHO session recording: Referrals and Medication.