If the 0-3 years are the first few chapters of a child’s life, then the prenatal period is the prologue, foreshadowing what may come. Toxic stress can alter the brain’s development even before birth, shaping the way a child responds to the world. The amazing thing about the brain, however, is that it’s adaptable, flourishing with care or withering with neglect. In other words, the ending of the story hasn’t been written yet.
As providers who come into contact regularly with children and families, our opportunity to intervene may come after the early years have passed, as the true impact of toxic stress and trauma on the brain often reveals itself as children grow and are faced with higher expectations and demands at home and school. Understanding the impact of in utero and early childhood trauma on the developing brain and the possible long-term consequences provides a fuller picture of who our clients are and gives us a guide toward effective intervention and planning for the future.
In Utero Trauma and its Impact on Brain Development
Clients become involved with systems of care for a variety of reasons – abuse and neglect, mental illness, interpersonal violence, substance/alcohol use, and other socioeconomic risk factors that impact their well-being. When a person becomes pregnant while exposed to these conditions, their baby is impacted as well. Continued exposure to elevated levels of stress hormones produced by the birthing person’s body, in response to the external toxic environment, creates a toxic intrauterine environment for an unborn child, disrupting typical development of the brain.
The brain is constantly ‘under construction’ during the prenatal period and develops in carefully timed stages, and disruptions during these stages – such as exposure to stress hormones – can impact how well it functions later in life. There’s the potential for issues to present immediately at birth – low APGAR scores, feeding issues, difficulty regulating temperature, withdrawal symptoms – and then later, typically around the time children begin attending pre-K/Kindergarten and the impact of in utero and preverbal trauma becomes observable through learning challenges and behavioral issues.
Pre-Verbal Trauma and Long-Term Developmental Outcomes
Preverbal trauma, the experience of trauma before language skills and explicit memory develop, is challenging for this very reason, as children have no cognitive memories about their experiences. Without context, becoming flooded with stress hormones and feeling like you have no control over your body when triggered is confusing and scary and I’ve observed this is often the final push before as children cross from regulated to dysregulated. Adults often remind kids to “use your words” when they need help but when you’re five or six years old and struggling, there are no words. The result is an epic breakdown of communication, with children and adults speaking two very different languages.
Children who’ve experienced in utero and pre-verbal trauma move through their world anticipating risk or actively seeking out risk. Their body’s alarm system, the sympathetic nervous system, adapted in utero to engage in a fight/flight/freeze response quickly and their brain continues to adapt in response to continued exposure after birth and beyond. When children are in this heightened state, they are so focused on anticipating risk to maintain safety that they can’t focus on academics or social skills. The brain requires the right chain of events occurring at the right time in order to develop and so too, does learning. When children are hypervigilant or frequently triggered from a young age, foundational pre-learning skills, such as sitting, listening, working in a group, may be more challenging, creating a shaky foundation from which higher learning builds.
Tools like Casebook are vital in supporting us as we piece together our assessment and plan for intervention with children who’ve experienced in utero and preverbal trauma. With the right tools and trauma-informed care, we can offer children a path to healing and resilience. Casebook empowers professionals to track progress, understand behaviors, and ensure that no child slips through the cracks.
