Children in foster care are among the most vulnerable patients pediatricians see. These children almost universally have a history of trauma, whether it is physical, psychological, or neglect. The signs and symptoms of this can be difficult to identify, particularly in younger children. By shedding some light on the ways in which trauma can shape a child’s development, foster and adoptive parents — as well as their families and communities — can be empowered to respond in a healthy and positive way.

The first step is to identify the signs and symptoms of trauma. Physical manifestations of a traumatic history can be:

- Difficulty falling asleep, staying asleep, or nightmares

- Rapid eating, food hoarding, or loss of appetite

- Constipation, refusal to toilet, or bedwetting

Psychological manifestations include:

- Detachment, numbing, compliance, or fantasy

- Hypervigilance, aggression, anxiety, or exaggerated responses

Any of these symptoms can be very normal in a child. However, the combination of multiple symptoms, especially in the context of a child needing to be placed in a foster home, should be cause for investigation. This is where having a close relationship with a pediatrician can be helpful.

The second step after identifying the history of trauma is deciding how to respond. Most importantly, regardless of the child’s behaviors or attitudes, they are a normal and expected response to trauma. Your child is simply doing the best to cope with their experiences. Do not take these behaviors personally. With time and practice of new adaptive behaviors (both in the parent and the child), they can and will become more commonplace.

Things you can do to encourage adaptive behaviors in the child:

- Help the child understand facial expressions or tone of voice

- Tell the child it is okay to feel the way he or she feels and to show emotion

- Give the child words to label his or her emotions

- Develop breathing or relaxation techniques the child can use when upset (including counting to 10 or taking deep breaths)

Things you can do to help ease the situation:

- Avoid yelling or aggression; lower the tone and intensity of your voice

- Come down to the child’s eye level, gently hold her hand, and use simple, direct language

- Frequently remind the child that she is safe, wanted, capable, and worthwhile

- Remind the child that you as caretaker are available, reliable, and responsive

- Praise any improvement in behavior, even neutral behavior

- Be aware of your own emotional response to the child’s behavior

And finally, remember that you are not alone. In addition to the child’s pediatrician, social worker, therapists, family and friends, there is a robust online community with countless resources for foster families.

They include:

- Child Trauma Academy, www.childtrauma.org

- National Child Traumatic Stress Network, www.nctsn.org

- American Academy of Pediatrics Website for Parents, www.healthychildren.org

-A Message From A Child Formerly in Foster Care, www.aap.org/fostercare/MIA

Dr. Allen Ruan is a pediatric resident at Baylor Scott & White McLane Children’s Medical Center.