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Are infants too young to experience and remember painful emotions or traumatic events? A growing body of research suggests no, and researchers believe that if left untreated, trauma experienced in infancy <a href="https://pubmed.ncbi.nlm.nih.gov/29088514/">can sometimes result in lifelong health consequences</a>.

Beyond such obvious triggers as war and terrorism, exposure to domestic violence, natural disasters such as  a house fire, physical abuse and community violence are examples of experienced <a href="https://www.cdc.gov/violenceprevention/aces/fastfact.html" target=_blank>events that can be traumatic</a> for infants, experts say. 

Experts in infant mental health, which goes from the prenatal period up to age 3, say that babies and very young children who experience such things have <a href="https://46y5eh11fhgw3ve3ytpwxt9r-wpengine.netdna-ssl.com/wp-content/uploads/2008/05/Establishing-a-Level-Foundation-for-Life-Mental-Health-Begins-in-Early-Childhood.pdf" target="_blank">higher incidences of anxiety disorders or depression that can persist into adulthood </a>if left untreated.

“It is easy to assume that  babies don’t remember trauma because they express their experiences differently,” <a href="https://scholars.okstate.edu/en/persons/tessa-chesher">Tessa Chesher</a>, an clinical assistant professor of psychiatry and behavioral sciences at Oklahoma State University who specializes in infant and early childhood mental health, says in an email. “At [8 to 12]  weeks of age, babies have stored enough memories that [the babies] start to anticipate their caregiver’s behavior based on previous behaviors. They start to respond based on the experiences they have had.”

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Evelyn Wotherspoon, a social worker specializing in infant mental health, said that as they reach adulthood “infants and very young children who have had early exposure to trauma and chronic stress … are more vulnerable to stress-related health outcomes, like diabetes, and mental health issues, addiction and obesity. These children are much more vulnerable to all of these stress-related illnesses, and their brain may not develop the way it should.”

Although infants and young children are just developing, experts in infant mental health say they can experience a wide range of feelings that includes negative emotions, sadness or anxiety. A report by the <a href="https://publications.aap.org/pediatrics/article/148/2/e2021052580/179745/Trauma-Informed-Care">American Academy of Pediatrics </a>found that, by age 16, more than 2 in 3 children had said they had experienced a traumatic event.

According to a<a href="https://pubmed.ncbi.nlm.nih.gov/29088514/"> </a><a href="https://pubmed.ncbi.nlm.nih.gov/29088514/">Report of the Task Force of the World Association for Infant Mental Health,</a> rates of mental health disorders in infancy (which generally includes birth to age 3) are comparable to that of older children and adolescents. And one small study of 1-year-olds found that <a href="https://pubmed.ncbi.nlm.nih.gov/16466789/">44 percent of those who had w</a>itnessed severe violence against their mother by an intimate partner showed symptoms of trauma afterward, such as increased arousal, increased aggression or an interference with normal infant development. Infants and young children (under age 4) can develop post-traumatic stress disorders after events, according to a <a href="https://pubmed.ncbi.nlm.nih.gov/7896652/" target=_blank>study</a> in the Journal of the American Academy of Child &amp; Adolescent Psychiatry.

Kathleen Mulrooney, a counselor who is also program director for the Infant and Early Childhood Mental Health Program for Zero to Three, a nonprofit organization dedicated to improving the lives of babies and toddlers, said it’s important to note that not every infant who experiences a trauma will be traumatized. As with adults, it depends on the infant, “because what is traumatic for one person is not for someone else,” Mulrooney says.

“To be traumatized, one must be severely frightened,” says <a href="https://medicine.tulane.edu/departments/psychiatry-child-adolescent-pediatrics-infant-institute-psychiatry/all-faculty/charles-h">Charles Zeanah</a>, a psychiatrist and the executive director of the Institute of <a href="https://medicine.tulane.edu/infant-institute">Infant and Early Childhood Mental Health at Tulane University School of Medicine</a>. Infants under 12 months may not always be aware that a particular situation is actually dangerous, which can potentially protect them from trauma, he says.

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In this context, caregivers can be key in buffering small children from the effects of trauma by how they react. “The ability of parents or key caregivers to provide protection, to have a co-regulating role when it comes to the stress response is critical,” Mulrooney said in an email.

If a child has a significant trauma before age 2 but following the trauma “the baby has the powerful protective factors of consistent safety, love and security; there is a decreased likelihood of having mental health problems,” Chesher says in an email. “That doesn’t mean the baby didn’t suffer or that their body doesn’t remember that trauma, it means that there were protective factors around to mitigate the effects of the trauma.”

Regina Sullivan, a developmental behavioral neuroscientist and professor of psychiatry at NYU Grossman School of Medicine, says that while a primary caregiver cannot“buffer a small child from trauma in the environment — it’s called social buffering because the child’s fear response and stress hormone response is reduced — more recently, we have shown that the caregiver is actually blocking neural activity in the amygdala, the brain area responsible for fear.”

Trauma  in infancy can <a href="https://pubmed.ncbi.nlm.nih.gov/29088514/">physically alter the developing architecture of the brain</a>, according to the American Academy of Pediatrics. <a href="https://developingchild.harvard.edu/science/key-concepts/toxic-stress/" target="_blank">Toxic stress</a>  — strong, frequent or prolonged adversity —  has been shown in various studies to harm <a href="https://publications.aap.org/pediatrics/article/129/1/e232/31628/The-Lifelong-Effects-of-Early-Childhood-Adversity">learning capabilities, memory and executive functioning</a>.

“Many brain areas in infants and small children are physically altered and the ability of those brain areas to talk to one another is also modified by trauma,” said Sullivan.

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Yet trauma in infancy can be difficult to recognize given that infants are not yet verbal and rely on their caregivers to respond to their needs, which means a caregiver would have to be attuned to symptoms and seek help.

“A baby can’t just go up to you and say, ‘Hey this happened yesterday, I’m scared,’ Chesher says. “And so really learning the language of the babies is important and then educating people on how to read that language. And so, if we don’t know the red flags, then we are not identifying trauma and we can have longer term effects on the brain.”

Experts say some red flags of trauma for babies younger than 12 months are: feeding or sleep problems and not being able to be comforted by their caregiver. A toddler (between ages 1 and 3) can express themselves more verbally and physically than a baby. Some red flags of trauma in that age group can involve repeating traumatic events in their play or becoming aggressive, Chesher says.

“One of the issues is how that child expresses trauma might be through disruptive sleep or being a bit fussier,” Sullivan says, “things that occur in normal children for a host of many reasons, which makes it difficult to identify which child is going to respond to the trauma in a way that will be long lasting and damaging.”

If a parent or other caregiver is concerned, based on a child’s behavior and experiences, they should “ask to be referred to an infant and early childhood mental health specialist,” Chesher says.

Experts will look at a variety of factors,  with the most critical being the relationship between the baby and their primary caregiver. In addition to observing that interaction,  mental health experts may also look at “pregnancy history, birth history, medical history, development history, safety screeners, perinatal depression screener [for both parents], how the infant eats and how the infant sleeps,” Chesher says.

Depending on a child’s age, different interventions are available, including child-parent psychotherapy.

“It is essential that the parents or  … their caregivers … are involved in a major way in the treatment because it is really through relationships with caregiving adults that infants thrive and do well,” Zeanah says.

To recover, an infant needs a caregiver in their life who can accurately read their cues and respond in a nurturing, patient manner, Wotherspoon says. “One of the most powerful therapeutic tools that we have is the relationship a child has with a nurturing caregiver and they only need one and it doesn’t have to be perfect. … An infant who gets that fairly early on can recover beautifully from trauma,” Wotherspoon says.

Increasing awareness about infant and early childhood mental health among both parents and medical practitioners is critical, experts say. But it’s also important for parents to understand what trauma is — and is not. A child “getting distressed is different than being traumatized,” Zeanah says.

“It’s important to distinguish from everyday events that might scare the child and are important in the child learning how to regulate their emotions and physiology versus trauma from horrible events such as a tornado or a parent who is repeatedly traumatizing the child unnecessarily through verbal or physical assaults,” Sullivan says.

“We want parents to enjoy this time in their life and not be fearful that they are going to traumatize their child by making them eat vegetables or get vaccinated,” she adds. “Those are normal experiences in life that the child needs to experience as part of [the] current world.”