Signs and symptoms of trauma in children and young people

Some children and young people will have potentially traumatic experiences related to coronavirus. Many will recover from their experiences with support from family and friends, while others will need clinical intervention.

This short guide outlines how the coronavirus pandemic may be potentially traumatic, the difference between normal reactions to a highly abnormal situations and reactions that could be considered more traumatic, and what adults around a child should do if they are concerned.

The potentially traumatic impact of the coronavirus pandemic

When we talk about the impact of the coronavirus pandemic, we are not just talking about a deadly virus that spreads easily. Listed below are the indirect effects of the illness as well as measures taken in the UK to reduce its spread that can be considered as potentially traumatic:

• The number of deaths directly or indirectly caused by the virus in the UK has exceeded 50,000. This means that many children and young people will have had family or friends die because of the virus. These deaths are likely to have been sudden and unexpected, and the children and young people may not have had the chance to say goodbye either beforehand or at a funeral.
• Children and young people who have not been directly bereaved, will have heard a lot of ‘death talk’ around them – either by friends and family or on news or social media.
• Access to social support from outside of the household will have been compromised during lockdown, and we know that lack of social support is a risk factor that makes events more likely to be traumatic.
• For many children and young people there will have been additional losses and stresses: they may have lost their normal daily structure, they may have lost contact with friends, they may have missed out on various important milestones in their lives, their carers may have financial difficulties, their families may be arguing more, they may be more exposed to domestic violence between the adults in their household, they may have experienced abuse with no-one outside of the household to turn to for protection.

Normal reactions to a highly abnormal situation

It is completely normal, even healthy, for many children and young people to react to an ongoing stressful situation in all sorts of ways. Some normal reactions to this very abnormal situation include:

• Increased anxiety – about the virus and the death of those around them and their own death. This is not just normal, it could actually be helpful – a degree of anxiety could drive behaviour such as social distancing and hand washing that will reduce the spread of the virus. However, if the anxiety becomes too much (e.g. causes distress or gets in the way of the young person doing things that they want to do), then it might be worth exploring this in more depth and considering getting some additional support. Children and young people may be more anxious about other things as well, and may dwell on things as they try to make sense of them. They may seek information and find ‘sensationalised’ information from news media or social media which can fuel their anxiety.
• Sleep – children and young people may find it more difficult to get to sleep because they are thinking about the virus, or simply because they are more on edge. Once they get to sleep, they may wake easily. They may also have bad dreams, in which themes related to the situation are included.
• Low mood – many children and young people will start to feel low. They may be more lethargic and less motivated. As they do less, they may feel less motivated, and as they feel less motivated they may do less. This can be a vicious circle. They may be more tearful, more distant and more hopeless. This is a very understandable reaction to the virus and the lockdown.
• Regression – some children will start to play with toys that they had seemed to have grown out of, they may start to speak in baby voices and they may be more clingy with their carers.
• Irritability and tempers – some children and young people will become more irritable and lose their temper more often.

Psychological recovery

A majority of these children and young people will recover, particularly if provided with appropriate support and calm reassurance, which helps them to develop a realistic and balanced view of the situation and the impact on them.

When should you be more worried?

Traumatic reactions may be similar to normal reactions, but are likely to be different in terms of:

• Severity – How extreme is their reaction? For example, do they just avoid people in line with social distancing measures, or do they avoid everyone even those in their own households? Do they start to avoid leaving the house even when they need to? Do they have terrible nightmares which wake them up and they are then inconsolable?
• Frequency – How often does it happen? Do they have nightmares once every 10 days or so, or several times a night? Do they lose their temper several times a day or just occasionally?
• Duration – When these things happen, how long do they last? If they lose their temper first thing in the morning, does that then last all day, or are they suddenly as right as rain? If they start to feel sad or low, do they bounce back quickly, or do they spiral downwards for long periods of time?
• Persistence – How long have these reactions persisted? Have they been reacting like this for just a few days and weeks, or have the reactions persisted for weeks and months, even when things in the world have begun to improve?

What to do?

It’s ok to keep an eye on things to see if they get better or not. NICE (the National Institute for Health and Care Excellence) guidelines recommend this and call it “active monitoring”.

If you are worried about a child or young person, because of the severity, frequency, duration or persistence of their reactions, then there will be support and advice available. Your GP or the child or young person’s school are likely to be good places to start. You can also visit the websites of the following organisations for more information on supporting children and young people in the context of the coronavirus:

• Anna Freud National Centre for Children and Families​
• NSPCC​
• The Children’s Society​
• Child Bereavement UK​
• Winston’s Wish​
• Cruse Bereavement Care

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Learn more

You can find related information and support in the Coronavirus and Trauma: Implications for Children and Young People resource.

This video was generously funded by the National Lottery Community Fund and St James’s Place Charitable Foundation.