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Developmental trauma causes prolonged and repeated activation of the sympathetic nervous system and therefore ongoing and repeated stress to the body (Ranabir & Reetu, 2011). Due to this physiological response, trauma is often said to 'live in the body' and can have the consequence of seriously damaging our physical health.

Developmental Trauma 

Trauma occurs when an individual experiences a chronically-activated stress response for any reason. Developmental trauma can occur when a child perceives or experiences a threat to their physiological safety, mental wellbeing, or caregiver relationships. Childhood trauma can be caused by one or more Adverse Childhood Experiences (ACEs), such as neglect, abuse (physical or mental), homelessness, food insecurity, unstable relationships, or witnessing crime. (Childhood trauma can also come from sensory processing challenges – for example hypersensitivity to sensory input – which, over time, result in an activated stress response (Barthel, 2019).) Not all ACEs cause trauma, and there is no “one size fits all” approach to diagnosing and treating developmental trauma.*   

The Impact of Trauma 

Developmental trauma impacts a child’s emotional and physical wellbeing during a crucial period in life when their brains and bodies are still maturing and developing. Trauma, therefore, contributes to many short- and long-term effects. In the short term, external stressors activate the autonomic nervous system, a part of the peripheral nervous system that controls vital functions, such as our breathing, heart rate, and digestion. The autonomic nervous system has two equally important components – the sympathetic and parasympathetic nervous systems – that work together to keep the body in a state of equilibrium (i.e., functioning well and feeling good).  

The parasympathetic nervous system is often known as the “rest and digest” branch. This branch prepares the body for targeted activities like sleep and processing food and is a slower-acting system. Activities like breathwork and hanging upside down can elicit parasympathetic response (Barthel, 2021).  

The sympathetic nervous system is activated when there is an environmental stressor or threat, and the body responds to protect us. This system is known as the “fight or flight” response and is fast-acting, with multiple generalized body responses to prepare our body to flee or face the threat. Activation of this system produces increased heart rate, blood pressure, blood flow to skeletal muscles, sweat production (regulating body temperature), and the secretion of stress hormones (such as cortisol) from the adrenal glands.** 

“Trauma Lives in the Body” 

Developmental trauma causes prolonged and repeated activation of the sympathetic nervous system and therefore ongoing and repeated stress to the body (Ranabir & Reetu, 2011). Due to this physiological response, trauma is often said to “live in the body” and can have the consequence of seriously damaging our physical health. Prolonged stress impacts physical health in several ways, such as creating a weakened immune system and memory deficits. In the long-term, studies prove that developmental trauma can lead to several negative outcomes – both emotional and physical – that can last for years after the trauma is experienced (Adverse Childhood Experiences, 2021). For example, children who undergo trauma are more likely in adulthood to struggle with addiction and alcoholism, as well as experience a lower socioeconomic status (SES), a higher mortality rate, and higher rates of illness (Felitti, 2002). 

Signs of Trauma 

“How people move tells you their story.” – Kim Barthel, OTR 

Here are some potential signs and outcomes of developmental trauma: 

  • Need for Control
    • A child may have difficulty with transitions or rigidity and inflexibility in play and daily routines. 
  • Difficulty Accepting Boundaries
    • A child may have a meltdown when they hear the word “no,” or they may test limits.  
  • Attachment Differences
    • A child might display an insecure attachment style with their caregiver(s), where they have difficulty separating, fear their caregiver will not return, or difficulty self-soothing without a caregiver’s support.  
    • Or the child may display an avoidant attachment style with their caregiver(s), where they appear not to care if their caregiver is in the room or may seem entirely disconnected. 
  • Difficulty Regulating Emotions and Arousal  
    • A child might: 
      • Have frequent outbursts or mood swings. 
      • Show a low tolerance for frustration, such as having big reactions to seemingly small problems or easily giving up when a task is hard. 
      • Demonstrate a physical response pattern (e.g., hitting, kicking, pushing, biting, or scratching) when upset. 
      • Be “movement seeking” (i.e., appear to be in a constant state of motion, such as running, climbing, falling, or throwing their body into others or objects). 
      • Have high arousal. They might appear to be in that state of “fight or flight” and have high energy and difficulty calming down. They might also have a loud voice or racing heart. On the other hand, they might show low arousal. They could appear tired or sluggish, avoid tasks, or shut down completely and appear unresponsive. 
  • Unsafe Movement Patterns   
    • A child might:  
      • Jump or crash into things without regard for their safety. 
      • Have poor body or spatial awareness such as frequent trips/falls, clumsiness or pacing of the room.  
  • Postural Differences  
    • A child might have a collapsed posture (i.e., have shoulders that are slumped forward and a downward gaze) or be hypervigilant (i.e., have wide-open eyes, tensed muscles, or a stance that suggests they are ready for a fight).  

How to Address Trauma 

As mentioned above, there is no “one size fits all” approach when it comes to trauma, but early intervention is KEY to shifting the negative trajectory of ACEs and developmental trauma. A knowledgeable, multidisciplinary team might include mental health therapists, occupational therapists, social workers, case managers, and in-home support (like respite care or family therapy) for families to reduce burnout. These teams could suggest interventions such as: 

  • Having caregivers share space with children in relationship-based play. This includes caregivers joining children in child-directed play, getting down on their level, and providing a calm and safe space for them to explore and express themselves. It also means being present, validating their thoughts and emotions, and being supportive. A support team might also provide parent coaching to nurture and develop a secure relationship.  
  • Co-regulation. This is the art of an adult using their own calm body to shift the emotional and regulatory state of the child’s. For example, instead of saying, “Take a deep breath,” a caregiver would take a deep breath themself. The child will likely start to mimic the caregiver’s breathing pattern. In co-regulation, caregivers need to be aware of how they are presenting. For example, are they a calm and grounding presence, or are they feeling anxious and triggered?  
  • Attunement. Attunement is about making children feel seen, heard, and understood. Attunement occurs when children feel their caregivers are in sync with them, physically and mentally. It may include the caregiver narrating what they are doing in play with the child: “Wow, I see how you are rolling down the ramp. It looks like you are having a lot of fun. I want to roll down the ramp with you!”  
  • Interventions for the body. A skilled occupational therapist will investigate how trauma is showing up in a child’s body and contributing to difficulties in daily activities and routines. Specific interventions may include addressing sensory and motor skills including, but not limited to:  
    • Sound (e.g., creating a grounding rhythm). 
    • Touch (e.g., using deep pressure touch to produce serotonin) (Field, 2019 as cited in Kim Barthel, 2021). 
    • Building body awareness and safe exploration of physical space. 
    • Addressing regulation and coping skills. 

Next Steps 

If you are worried your child experienced or is currently experiencing trauma, please reach out for help. The good news is that there are many resources and actions you can take to help develop resiliency in your child. 

You may find it helpful to write notes on the following information:  

  • Have any ACEs occurred in your child’s lifetime? What were they, and when did they occur? 
  • What behaviors or “warning signs” are you worried about? When do they typically occur; how frequently; what do they look like; how long do the behaviors last; and what helps? 

This type of data can be very helpful in identifying patterns and potential causes of stress in your household. Reaching out to your primary healthcare provider can be a good start in identifying what resources may be best for your family.  

Here are some helpful websites for additional information and resources:  

Resources on Trauma for Caregivers and Families – Child Welfare Information Gateway 

NIMH » Coping With Traumatic Events ( 

All NCTSN Resources | The National Child Traumatic Stress Network 

Fast Facts: Preventing Adverse Childhood Experiences |Violence Prevention|Injury Center|CDC 

St. David’s Center for Child and Family Development is also here to support you and your family system. Our staff provide trauma-informed care across a variety of programs that operate on-site, in-home, and via telehealth. Please reach out to the CORE team to learn more via email at or phone (952) 939-0396. 


*For a more extensive list of ACEs, please visit Adverse Childhood Experiences (  

**There is a new proposal for a third pathway – the Dorsal vagal pathway – which produces the “freeze” or shut-down response pattern and is known as the Polyvagal theory (Porges, 2009). This theory also includes a “social and emotional response” component, whereby stress can be mitigated and resiliency developed by supportive factors such as a well-regulated caregiver. Many interventions are grounded in this theory; however, it is still being researched. 



Adverse childhood experiences. (2021, August 12). Retrieved May 9, 2022, from,explore%20two%20critical%20components%20of%20a%20child%E2%80%99s%20development. 

Barthel, Kim (2021, November 12). Psychosensory interventions, and (2019, February 8). Psycho-Sensory Processing Intervention  

Felitti, V. J. (2002). The relation between adverse childhood experiences and adult health: Turning gold into lead. The Permanente journal. Retrieved May 9, 2022, from 

Peter Bull Art Studio. (2019, November 13). Parasympathetic and sympathetic nerves: Bull Art, medical illustration, history infographic. Pinterest. Retrieved May 9, 2022, from 

Porges S. W. (2009). The polyvagal theory: new insights into adaptive reactions of the autonomic nervous system. Cleveland Clinic journal of medicine, 76 Suppl 2(Suppl 2), S86–S90. 

Ranabir, S., & Reetu, K. (2011, January). Stress and hormones. Indian journal of endocrinology and metabolism. Retrieved May 9, 2022, from 


Elizabeth Kallas is a registered occupational therapist (OT) with over four years of experience working in outpatient pediatrics. At St. David’s Center, she provides services in the Autism Day Treatment program, outpatient therapy, and feeding therapy. She also works part-time as an OT in adult inpatient mental health and previously worked for three years as an adult rehabilitative mental health practitioner. Elizabeth loves combining her passion for pediatric occupational therapy and mental health services and plans to return to graduate school this summer for her doctorate in OT.

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