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14 Aug 2008

By Pieter van Zyl

Childhood trauma. The word conjures up upsetting images of cruelty or sexual abuse – which can easily make you overlook lesser difficulties your own child might be experiencing in life.

When she had a miscarriage the last thing on her mind was how it would affect her two-year-old daughter, a Stellenbosch woman says.

"Of course we explained her little brother would not be arriving any more but that he might come later," she says. "But six months later the play school called out of the blue. My daughter had started weeping inconsolably that morning, saying her brother had died. We thought she would have forgotten all about the miscarriage by then and had no idea it had affected her so deeply."

Trauma in childhood isn't always the result of cruelty or abuse, Manette de Jager, head of the Tygerbear Social Work Unit, warns. "Children can also be traumatised by things such as car accidents or the presence of chronic diseases such as diabetes."

As head of the social work unit at Tygerberg Hospital outside Cape Town, the only unit of its kind providing counselling for both traumatised children and their families, Manette deals with the rehabilitation of children who've been through terrible ordeals. Year after year they help thousands of children rebuild their shattered lives but Manette is nevertheless very aware that even common occurrences and unavoidable events in ordinary households can be devastating to a child.

A Cape Town woman for instance believed her three-year-old son was too young for a divorce to affect him on anything but a practical level. "But after we separated he started wetting his bed," she says.

It's a mistake to think a child is too young to be traumatised or that children forget certain things, cautions Marita Rademeyer, child psychologist at Pretoria's Child Trauma Clinic.

"Even babies can suffer trauma," she says. "Children often don't have the vocabulary to express their feelings but that doesn't mean they're not deeply affected."

This means parents, care-givers and other supervising adults need guidance to help children to be less exposed, and to recognise the signs when a child is in trouble.

Recovery is quicker and more complete the earlier a traumatised child receives help.

Advice that works

Adults aren't always right. And children are allowed to say no. ''We need to foster and strengthen children's desire to assert themselves,'' Tygerbear therapist Nocawe Frans says.

''Your children are allowed to say when there's something they don't want or want to do,'' therapist Helene Louw says. ''And they need someone they trust to talk to when a situation makes them feel uncomfortable.''

But you can't expect children to tell you their secrets unless you're open about what's happening in your own life. Secrets are problematic. ''And your reaction to your child's behaviour and mistakes can keep the communication channel open between the two of you or close it down,'' she warns.

''Children need to be reassured they can always approach you and talk without being judged.

"In so many of the cases that end up here teenagers have hidden something from their parents for fear of how they might react. They end up here when things start going wrong because they've had to carry secrets around.''

Explain to children that rules create safety. ''Kids hate rules but they need them to feel safe,'' therapist Sayeeda Dhansay says. ''Communication is important.''
In an ideal parent-child relationship the child feels able to talk to either parent about anything that captures their attention on TV or the internet, including sex or violence.

''Parents must handle questions about sex as naturally as possible,'' De Jager says. ''Parents make the best sex counsellors because they do it with love. No one knows your child better than you do. And kids will keep asking sex questions until they're satisfied with the answer.''

Always ask where your kids and going and with whom, even if it irritates them beyond measure, Dhansay says. ''They have the right to privacy but along with rights there are responsibilities.''

For example it's right that other people should respect your body but you're also responsible for not interfering with your friend's body. You have the right to be believed and trusted but you're responsible for telling the truth. Discussions about these issues promote emotional maturity.

Be concerned if . . .

Children don't always have the vocabulary to explain what has happened to them so keep an eye on them and be aware what's happening when they're playing.
''Kids don't always show they're having a rough time. Sometimes trauma reactions take weeks or months to appear,'' De Jager says. But children do often present with post-traumatic play. They may tie up a doll or enact a car accident, for example.

''Kids have their own way of telling you something traumatic has happened,'' De Jager says. ''It's important to meet them at an age-appropriate level.''

A little girl who had been abused became preoccupied with Tygerbear's toy kitchen. Her therapist simply couldn't tear her away and she tried to cut the plastic food with play cutlery. When the therapist started asking questions she discovered the child hadn't eaten in two days.

When the therapist gave her a sandwich she used the toy cutlery to cut it into pieces, which she gave to her brother and sister waiting outside with their mom before she would eat herself. ''She first had to act out her need in play," De Jager explains.

Abused children's behaviour can provide important clues about the circumstances that result in them ending up in a criminal's clutches. One of the southern Cape criminal Johannes Mowers' young victims drew painfully neat pictures and sought approval for them. It was this character trait – the desire to please everyone – her abuser exploited.

An observant teacher once noticed a young girl insisted on sitting on the floor while her classmates sat in chairs. Further investigation revealed her mother had used a chair to assault her.

''Beware of raising the alarm unnecessarily when it's only a suspicion that something's wrong,'' Dhansay says. ''And when you ask questions reassure the child you're not blaming anyone and that you're just concerned and willing to listen. Overreacting will only make the child feel guilty and withdraw.''

Alarm bells should ring when small children play inappropriate sexual games that make other children uncomfortable. Listen when young kids talk to one another. If a four-year-old talks about condoms all the time, it could be a cause for concern.

Know your child's friends

You should know your child's friends and their parents well enough to be in a position to ask sensitive questions.

''When playmates come over introduce yourself, ask them about themselves and make them feel welcome, child therapist Frans suggests.

''A successful introduction is all about tone of voice and body language. Be at ease and put them at ease in turn. This is how you build trust. You don't have to be their pal but you're on thin ice if you don't cultivate a relationship with your child's friends. You have the right to meet their parents.''

De Jager agrees. ''Your kids should only be allowed to sleep over at the homes of people you've met and visited and you know and trust.''

This article forms part of the writers' project for the Rosalynn Carter Fellowship for Mental Health Journalism.

To see the article as it appeared in YOU, click on the links below:

Trauma_pg1.pdf

Trauma_pg2.pdf

Copyright 2008. Used with permission from YOU.