chevron-down Created with Sketch Beta.
February 01, 2014

Special Considerations for Traumatized Infants

Bruce D. Perry

The views expressed herein have not been approved by the House of Delegates or the Board of Governors of the American Bar Association, and accordingly, should not be construed as representing the policy of the American Bar Association.

1. Can infants recall a traumatic experience later in life? 

The key word in this question is “recall.” Unfortunately, for most, the concept of memory is limited to the storage and recall of cognitive, narrative memory. In this conceptualization, a preverbal infant would not be capable of “remembering” and “recalling” any event. 

We are all familiar with the developmental amnesia that occurs at approximately age three. In this normal developmental phase, there appears to be a reorganization of cognitive and memory functions such that narrative memory for events prior to age three or four are difficult to access later in life. These two points have led to the pervasive, inaccurate and destructive view that infants do not recall traumatic experience, including sexual abuse. Nothing could be further from the truth. 

The human brain has multiple ways to “recall” experience. Indeed, the brain is designed to store and recall information of all sorts—motor, vestibular, emotional, social and cognitive. When you walk, play the piano, feel your heart race in an empty parking lot at night, feel calmed by the touch of a loved one or create a “first impression” after meeting someone for the first time, you are using memory. All incoming sensory information creates neuronal patterns of activity that are compared against previously experienced and stored patterns. New patterns can create new memories. 

Yet the majority of these stored memory templates are based upon experiences that took place in early childhood—the time in life when these patterns of neuronal activity were first experienced and stored. And the majority of our ‘memories’ are noncognitive and preverbal. It is the experiences of early childhood that create the foundational organization of neural systems that will be used for a lifetime. 

This is why, contrary to popular perception, infants and young children are more vulnerable to traumatic stress—including sexual abuse. If the original experiences of the infant with primary caregiving adults involve fear, unpredictability, pain and abnormal genital sensations, neural organization in many key areas will be altered. 

For example, abnormal associations may be created between genital touch and fear, thereby laying the foundation for future problems in psychosexual development. 

Depending upon the specific nature of the abuse, the duration, the frequency and the time during development, a host of problems can result. In many ways, the long-term adverse effects of sexual abuse in infancy are the result of memories—physiological state memories, motor-vestibular memories, and emotional memories, which in later years can be triggered by a host of cues that are pervasive. 

Incestuous abuse in infancy is most destructive in this regard. It will result in the association of fear, pain and unpredictability into the very core of future human functioning—the primary relational templates. If these original ‘templates’ for all future relationships are corrupted by sexual exploitation and abuse, the child will have a lifetime of difficulties with intimacy, trust, touch and bonding—indeed the core elements of healthy development and functioning throughout the lifecycle will be altered. 

Furthermore, if the child is maltreated or abused during early childhood, they may not have any cognitive “memory” and be completely unaware that the source of their fears, difficulties with intimacy and relationships has its roots in this betrayal in infancy. This can lead to problems with self-esteem and, will make any therapeutic efforts more difficult. 

2. Can trauma during infancy arrest cognitive, emotional or behavioral development? 

The abuse of an infant is often accompanied by extreme disruptions of normal caregiving behaviors and by extreme and prolonged stress responses. Altered caregiving and a prolonged stress response will alter the development of the infant. 

The major mediators of emotional, cognitive and social environment and, therefore, learning during infancy are the primary caregivers. Development in all domains can be disrupted if these primary relationships are compromised. As mentioned above, it is almost inevitable that emotional, behavioral and cognitive development will be arrested by early traumatic experience. 

3. Are there physiological changes in the brain resulting from a traumatic event? 

As mentioned above, the brain is designed to change in response to experience. 

Indeed, all experience changes the brain. With traumatic experiences, the changes are in those parts of the brain involved in the stress and fear responses. Many studies with adults and, now with children, have demonstrated a host of neurophysiological changes that are related to traumatic stress. While many more well-controlled studies are needed, it is likely that certain brainstem catecholamine systems (e.g., locus coeruleus noradrengergic), limbic areas (e.g., amygdala), neuroendocrine (e.g., hypothalamic-pituitary-adrenal axis) and cortical systems involved in regulating stress and arousal may all be altered in traumatized children. 

4. Do infants display problems similar to older children who are traumatized or abused? 

The long-term problems that result from maltreatment will vary as a function of several keys factors: what is the nature of the abuse, the duration, frequency, intensity, time during development and the presence of attenuating factors such as other caring, attentive caregivers in the child’s life. In general, however, with all traumatic experiences, the earlier in life, the less “specific” and more pervasive the resulting problems appear to be. 

For example, when traumatized as an adult, there is a specific increase in sympathetic nervous system reactivity when exposed to cues associated with the traumatic event. With young children, following traumatic stress, there appears to be a generalized increase in autonomic nervous system reactivity in addition to the cue-specific reactivity. 

Due to the sequential and functionally interdependent nature of development, traumatic disruption of the organization and functioning of neural system can result in a cascade of related disrupted development and dysfunction. Examples of this include the motor and language delays in traumatized children under age six. The “causes” of these delays are likely due to the primary, trauma-induced alterations in other domains (e.g., the stress response systems, thereby influencing physiological reactivity, hypervigilance, concentration), which, in turn, impair the young child’s willingness to explore, capacity to process new information and ability to focus long enough on new information to learn.


Key Points: Helping Traumatized Infants 

  • Anything that can decrease the intensity and duration of the acute fear response (alarm or dissociative) will decrease the probability of that the infant or young child will have long-term emotional, behavioral, social or cognitive problems. The longer an infant stays in a fear state, the more likely it will be that she will have problems. 

  • In general, structure, predictability, and nurturing are key elements to a successful early intervention with a traumatized infant. 

  • The primary source of these key elements is the primary caregiver. Therefore, it is critical to help the caregivers understand as much about post-traumatic responses as possible. Further it is crucial to be sensitive to the needs of the caregiver. 

  • If the primary caregivers are impacted by the same trauma, it is imperative that they get treatment that compliments the work with the child. Indeed, the best intervention for infants and young children is treating the primary caregiving adults. As they become less anxious, fearful and impaired, the more available they are to the infant and toddler. 

  • Early assessment and intervention can be prophylactic—helping prevent a prolonged acute neurophysiologic, neuroendocrine and neuropsychological trauma response. If an infant or young child has been in a traumatic event, or if the primary caregiver of young children has been traumatized, early aggressive intervention can be crucial. 

  • Contrary to popular belief, even infants and very young children experiencing traumatic events can be affected. Indeed, there is increasing evidence to suggest that the younger a child, the more pervasive are the post-traumatic problems. These are a few simple points to keep in mind. The infant’s world is defined by his or her caregivers. If the caregivers are preoccupied, depressed, anxious, exhausted or absent due to post-traumatic symptoms, this will adversely impact the infant and toddler.


Bruce D. Perry, MD, PhD, is the founder and senior fellow at The Child Trauma Academy.


Reprinted with permission from Brief Reflections on Childhood, Trauma and Society, by Bruce D. Perry, The ChildTrauma Academy Press, Houston, 2013 (eBook available on Amazon or iBooks). Copyright 2013, Bruce D. Perry, The Child Trauma Academy. All rights reserved.