Supporting Caregivers with Trauma Histories

February 19, 2025 by Ameena Ahmed, PsyD & Ankita Khandai, MD

As pediatricians, our primary focus is often on the health and well-being of the children in our care. But to truly support a child’s development and overall well-being, we must also consider the environment they come from—especially the caregivers who play such a crucial role in their lives. For many caregivers, past trauma can deeply influence how they interact with their children, manage stress, and access healthcare services. Understanding the impact of trauma on caregivers and adopting trauma-informed approaches in our practices is essential not only for supporting these adults but also for fostering healthier, more resilient families. In this post, we’ll explore practical strategies for pediatricians to engage with and support caregivers who have experienced trauma, creating an environment where both children and their caregivers can thrive.

Why Does This Matter?

Traumatic or stressful events during a child’s life, also called adverse childhood events (ACEs), have well documented effects on long term health outcomes for children.

When children face multiple ACEs, their stress response systems can become chronically activated, leading to toxic stress. Unlike mild or moderate stress, which can be protective and help a child develop coping skills, toxic stress overwhelms the child’s ability to manage the situation and can lead to harmful physiological and emotional changes. The ongoing exposure to this kind of stress—without the buffering effect of supportive, nurturing relationships—can disrupt normal development and contribute to long-term health problems.

Parental adversities, including maternal depression, substance use, and a history of ACEs themselves, heighten the risk of toxic stress in children– in fact, a 2023 review found the children of parents who experienced ACEs were more likely to have premature birth, developmental delay, learning difficulties, obesity, autism, externalizing behavior or socioemotional development problems. In fact, the higher the number of ACEs a parent is exposed to, the more at risk the child is of negative health and well-being outcomes. Research also indicates that these parental struggles can reduce responsive caregiving, impeding the foundational exchanges between caregivers and their children that promote healthy development. This intergenerational impact means that parents’ stress, trauma, or health issues directly influence the stability of the caregiving environment, intensifying stress responses in children.

One way to help mitigate the effects of caregiver ACEs and trauma is to practice trauma-informed care (TIC). The goal of trauma-informed care is to create a safe, supportive environment that empowers patients by acknowledging and assessing the role that trauma plays in their physical, emotional, and psychological health, while actively avoiding practices that could re-traumatize them. Trauma-informed care, much like handwashing before each interaction, serves as a universal precaution that should be used with all patients to ensure they feel safe and supported. Understanding the impact of trauma on caregivers and utilizing trauma-informed assessments and interventions in our practices is essential not only for supporting these adults but also for fostering healthier, more resilient families.

Caregiver Assessment

Caregivers may be hesitant to share their own trauma due to fear of judgment, concerns about child protective services, or distrust in the healthcare system. Providers can normalize these discussions by explaining, “Many caregivers face challenges that impact their and their child’s well-being. We ask these questions to better understand how to support you and your family.” Addressing concerns with sensitivity builds trust and creates the foundation for trauma-informed assessments. Caregivers with trauma histories bring unique challenges and strengths to pediatric care, and understanding these experiences is key to providing effective support. Trauma-informed assessments ensure privacy, explain the purpose of the questions, and seek consent. Providers should clearly explain how the information will be used and involve caregivers in the process. Caregivers can also opt out of questions they find uncomfortable.

Providers can use both formal tools, like the Adverse Childhood Experiences (ACEs) questionnaire, and informal strategies to assess trauma histories (such as open-ended questions and observations during visits). However, it should be noted that formal screening measures often outperform clinical judgment and should include reliable and valid caregiver-focused tools, such as postpartum depression screenings or assessments for social determinants of health. Screenings should be conducted in safe environments and presented as standard care for all families to reduce stigma and promote equity. Resilience screeners can also help identify strengths that buffer stress, offering a nuanced view of caregiver challenges and well-being. These tools enable providers to promote resilience and support strategies like strengthening social connections or managing stress.

However, routine screening is effective only when paired with intervention to address identified needs. Recognizing trauma is just the first step. Tailored interventions in response to these assessments will then help caregivers manage stress, emotional challenges, and practical barriers that impact parenting. These efforts foster resilience and empower caregivers to create supportive, nurturing environments for their children.

Subsequent Intervention

Once trauma histories are identified, interventions should focus on supporting the caregiver’s well-being and strengthening their capacity to care for their child. These interventions can be adapted to the realities of busy pediatric settings. However, advocacy is also crucial to ensure providers have the time and resources to offer this support effectively.

Psychoeducation is a key intervention. Caregivers benefit from understanding trauma and its effects on parenting and health. Key messages include that trauma responses are normal, stress affects parenting, and healing is possible with the right supports in place. Simple resources, such as handouts or reputable websites, empower caregivers to understand their situation. Emotional support is equally vital. Providing caregivers with validation, nonjudgmental listening, and encouragement for self-care benefits the entire family. Behavioral health specialists or social workers on the care team can offer additional support as needed.

Caregivers with significant trauma histories may need referrals to specialized services like trauma-focused cognitive-behavioral therapy (CBT), support groups, or parenting programs. Warm handoffs—introducing caregivers to specialists or making referral calls—increase the likelihood of follow-through. Pediatric providers also connect families to broader supports, like safe recreational spaces, libraries, and neighborhood programs. Advocacy for access to services such as legal aid, childcare, and early education reduces systemic barriers and external pressures. Providers can assist with healthcare navigation and connect families to resources for food, housing, or financial aid.

Caregiver support requires ongoing effort. Providers must check in regularly to adjust plans and offer encouragement. This commitment strengthens the caregiver-provider relationship and demonstrates long-term investment in the family’s well-being.

Call to Action

To truly support caregivers, pediatric providers must integrate regular caregiver assessments into their practices while addressing critical barriers like gaps in training, time constraints, and limited access to resources. Healthcare systems must allocate resources, space, and time to ensure that providers can deliver equitable and effective interventions after assessment. By overcoming these challenges, we can build a healthcare framework that uplifts both caregivers and their children, creating pathways for resilience and well-being for families.