Question: My husband and I are new foster parents of a sweet 2-year-old girl. Our precious little one was subjected to neglect as well as severe scalding burns on her buttocks and genital areas (a "potty-training technique") by the birth-family. Unfortunately, we must continue visitation with the birth family three times a week until the court says otherwise.
She has been exhibiting varying symptoms of this trauma throughout her stay (disturbed sleep patterns, occasional aggressive behavior, nightmares, etc.).
Can you recommend some good reference materials on trauma in early childhood? Since she will continue to be exposed to the family, we would like to know how to prepare her for these experiences, as well as heal from the previous traumas. — No Name, via e-mail
Answer: You are a wonderful couple for taking on such a challenge. But you need more support from the child-protection team that made the foster placement than it sounds as if you are getting.
Your search for solutions is certainly admirable, and your request raises several questions. Are visitations with the child's birth parents supervised? From what you say, it sounds as if they should be. Will she have to go back to live with her birth parents anytime soon? Will she have to separate from you to be placed in a permanent adoptive home?
Both you and she deserve answers to such questions as soon as possible. Uncertainty in an already painful situation is bound to make things even harder for all of you. Preparing a young child for visitations would be influenced by answers to these questions. It would also be important to know how the child behaves as she anticipates a visit — and how she acts afterward.
The symptoms you describe seem predictable. A child who has been traumatized can be expected to have a number of reactions, some of which depend on her age and on the nature of the trauma. Nightmares, sleep disturbances and unwanted memories are common. So are "re-experiencing episodes," when a child seems to be reliving the horrible event in her head. At times like this a child can appear quite unreachable, but she needs quiet, gentle watching.
A child who has been traumatized may also be irritable, with frequent angry outbursts, and have difficulty soothing herself. Given the nature of the abuse you describe, she might also be fearful of undressing or using the bathroom.
Helping a child who has been badly traumatized is a big job. Foster parents will need the kind of support and information you are requesting. They, and the professionals helping the child, can all be overwhelmed at times by the intense feelings they must face about the child's suffering and the birth parents' unfathomable behavior.
Your child-protection team will need to provide support and information as well as treatment for the girl. Play therapy with a skilled therapist may help a child who has been abused. In her play, the child is likely to re-enact the trauma, relive her feelings and be helped to feel that she can master them.
Play gives a child a chance to be in control. This is important even at 2, though a child who is traumatized severely at such a young age may need to revisit this experience at older ages as she develops new ways of coping.
You and she deserve the help of an involved therapist who can help you handle her needs as well as the feelings that such a history stirs up in everyone who cares for a child.
Alicia Leiberman, a psychologist, has written beautiful books about 2-year-olds ("The Emotional Life of the Toddler," Free Press, 1995) and the loss of a parent at this age ("Losing a Parent to Death in the Early Years: Guidelines for the Treatment of Traumatic Bereavement in Infancy and Early Childhood," Zero to Three, 2003). But this child's situation is perhaps even more painful.
We do think the place to start is with information about how a child this age understands her world. Then you can begin to address the ways in which her experience has violated this. For example, any 2-year-old believes that most occurrences in her world happen because of her own feelings and actions. A physically abused toddler is bound to feel that the punishment inflicted on her was deserved.
This self-blaming can persist for many years and could seriously interfere with her ability to develop a full personality. You are absolutely right to want to help her now.
The following Web sites can provide more information: National Child Traumatic Stress Network www.nctsn.org; National Clearinghouse on Child Abuse and Neglect Information nccanch.acf.hhs.gov; Zero to Three www.zerotothree.org.
Questions or comments should be addressed to Dr. T. Berry Brazelton and Dr. Joshua Sparrow, care of The New York Times Syndication Sales Corp., 122 E. 42nd St., New York, N.Y. 10168. Questions may also be sent by e-mail to: nytsyn-families@nytimes.com. Questions of general interest will be answered in this column. Drs. Brazelton and Sparrow regret that unpublished letters cannot be answered individually. Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child's health or well-being, consult your child's health-care provider.