KKH psychologists share child trauma warning signs as cases rise 30%

SINGAPORE – The number of child trauma referrals at the KK Women’s and Children’s Hospital (KKH) has risen by about 30 per cent since 2017, with 210 last year.

Such children may have experienced a wide variety of traumatic events, such as road traffic accidents, sexual abuse, bullying, physical assaults, family violence and loss of a loved one.

And without proper support, such trauma can lead to future mental health issues such as anxiety, depression and post-traumatic stress disorder, said Ms Jemi Chen, principal psychologist at KKH’s Psychosocial Trauma Support Service (PTSS) on Monday (March 22).

Her service provides support to those aged three to 18, as well as girls and women of all ages.

Though Ms Chen could not say for certain whether the Covid-19 pandemic had led to the rise in child trauma cases at KKH, she noted that her clinic had lately seen an increase in young patients suffering from “non-accidental injuries”, such as domestic abuse.

“With the pandemic, a lot more people were at home, so there are a lot more adjustments and stressors,” she said.

But working with young patients requires a different approach from working with adults, said Ms Chen.

So the team at PTSS will typically use techniques such as drawing, games and toys to help children understand what they have experienced, and how to cope with their trauma.

For instance, breathing techniques are sometimes taught by getting children to blow bubbles, or place a toy on their stomachs and watch it rise and fall with their breathing.

“Anything to make the examples more concrete – something (the children) can touch and see… things that help to make the experience more visual,” said Ms Chen.

She and her colleagues also developed two short animated videos about easy-to-understand scenarios to teach children about what crisis events are, the reactions they may experience after exposure to a traumatic or event, and to encourage them to get help.

Senior psychologist Goh Sin Er, also from PTSS, said that they also tried to include local examples in the videos to make them easier for the children to relate to.

For instance, since encountering cats at void decks is a common experience here, the team decided to include an animation of a child being scratched to teach viewers about trauma.

The animations are typically shown to children and their caregivers towards the start of their treatment sessions, as well as when the PTSS team is carrying out training and education sessions in other organisations.

Ms Goh said that caregivers who were shown the videos said they found it easier to understand what their children were going through, and children tended to refer to the videos as well during their counselling sessions, using them to understand their own experiences.

“Research tells us that a better understanding of the impact of trauma helps the caregiver and the child to have more commitment to therapy,” said Ms Goh.

For their efforts, the PTSS team received the Allied Health Innovative Practice – Ground-Breaking, Effective, Momentous Award on March 9.

The videos can be found on this website.

Ms Chen noted that certain events which may not seem scary or serious to adults may still be traumatic to children, such as the death of a pet, getting scratched by an animal, or even falling off the monkey bars.

“Because of the child’s developmental stage, they might think they could have died from it… It’s always the perception of an event that would impact on whether it’s traumatic or not,” she explained.

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And because of a child’s young age, they may not be able to ask for help or express how they are feeling. But there are signs caregivers can look out for, said Ms Chen.

These usually take the form of changes in sleeping and eating habits, having outbursts or becoming more withdrawn, and either refusing to talk about a certain event or insisting on revisiting it over and over – whether while talking, drawing, or playing with their toys.

Caregivers should look out for these signs in children and check in if they notice anything unusual.

When a child brings up something that bothered them, it is also important to acknowledge that the incident happened and not brush it aside or minimise their experience.

If the child’s condition continues to worsen, caregivers should seek further help, either from the child’s school, neighbourhood family service centres, or at a clinic.

“The support that a caregiver can give, either through soothing (the child) or helping them get back to a normal routine, is a factor that influences their outcome as well… A majority of children actually do okay if they have a supportive environment,” said Ms Chen.

She added: “Everybody can play a part in supporting children and ensuring that they can get the help that they need.”

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