Volume 7 Number 2

Child and Family health nurses and paediatric nurses have been charged with the responsibility of meeting the complex service needs of families with infants and young children at risk of becoming involved with the child protection system in Australia for over three decades. Since  the end of the 20th Century, Government policies in Australia have mandated that child protection become “everyone’s business”.¹  Nurses working with children and their families report that their role has been increasingly committed to caring for families experiencing complex challenges. These include family and domestic violence, alcohol and other drug problems, and the need for child protection along with lack of social support, poverty, parental mental illness.² Given the relationship between nurturing during the early years and impacts on child development, early intervention, frequent contact with families and engaging in supportive care is a critical element of the public health approach to reducing the risk of negative outcomes.³

An Australia-wide survey of Australian child and family nurses found that most respondents provided weekly support to families with young parents and with complex emotional and social needs.⁴ Support provided included developmental surveillance of infants and young children aged 0–5 years, health promotion and education around infant feeding, as well as giving parents guidance and support regarding their child’s care.⁴

For child and family health nurses and paediatric nurses working at the interface of child protection services and health, there is growing clinical and research interest in the use of  a trauma-informed approach to care.⁵ It is also recognised as an important underpinning framework for providing support for families with complex needs. Trauma-informed care focuses on recognising past and present traumatic experiences and responding appropriately.⁵

Trauma-informed care has been likened to a preventive, universal approach where the possibility of previous traumatic stress or experience is acknowledged.^6,7 It focusses on resilience rather than pathology and acknowledges that supportive and nurturing relationships are essential for healing.⁶ Trauma-informed care accepts that an individual’s experience and ways of being are viewed as adaptations to survive adversity.  And it can underpin the communication between nurses and children and families, supporting psychological safety and building the therapeutic relationship.^6,7 The Substance Abuse and Mental Health Services Administration (SAMHSA) refers to the four Rs of responding to trauma including (i) Realise, (ii) Recognise, (iii)Respond and (iv) Resist re-traumatisation.⁵

Realising the impacts of exposure to chronic or toxic stress and trauma on children and families including the neurological, physiological, psychological and social effects is the first step in providing trauma-informed care.⁶

Next, child and family health nurses and paediatric nurses need to recognise both physiological and behavioural symptoms arising from trauma.⁶  For example, physiological symptoms can range from sleep related difficulties, eating concerns, such as rapid eating, food hoarding, loss of appetite or eating disorders, and to toileting concerns including constipation, encopresis and enuresis.⁶ Behaviourally, trauma can manifest in a variety of ways including attachment concerns with primary caregivers, loss of previously achieved milestones, regression, irritability and inconsolability behaviours in infants and young children. In school aged children and adolescents there may be changes in academic performance, absenteeism, conduct issues, withdrawal from social activities, attention and focusing difficulties.⁶ Figure 1 provides a visual overview of the impacts of childhood trauma.

Figure 1. Impacts of childhood trauma, adapted from Goddard et al (2022)⁶ and Bartlett and Steber (2026)⁸

Responding to trauma in children and families involves both screening for adverse childhood events or trauma using a recognised and validated screening tool and then responding with trauma-informed health promotion and resilience strategies, as well as referral to specialist care if needed.⁶

Resisting re-traumatisation represents the final element of a trauma-informed care approach. All health professionals need to be aware that healthcare can inadvertently traumatise or re-traumatise those receiving care.⁹ Loss of privacy, fear concerning procedures or loss of control, removal of clothing, physical touch or perceived health professional or organisational bias or discrimination may all be traumatic for those with a history of trauma.⁹ Nurses can resist re-traumatisation by: building a supportive and respectful relationship with children, caregivers and families; seeking consent; promoting autonomy and choice; explaining steps during nursing care; and by seeking to understand and be aware of fears, concerns and potential triggers.⁹

Nurses practice across diverse settings and within a wide scope, with child and family health nurses and paediatric nurses playing a critical role in supporting children and families within a public health framework. Increasingly, nurses are called upon to address gaps in health and welfare systems.³ Differences in professional standards for these nursing roles are evident and contribute to differences in preparedness for roles that require managing the complexity and vulnerability experienced by families.⁴ The adoption of trauma-informed care offers a way forward in addressing the evolving scope of nursing practice for enhancing engagement with families with complex challenges. Nursing services can be intentionally structured to avoid reinforcing the distrust, powerlessness, and loss of control reported by survivors of childhood trauma.

Author(s)

Elizabeth M Forster*
RN BN MN GC (Higher Ed) GC (PosPsych) PhD FACCYPN
Associate Professor, School of Nursing and Midwifery, Griffith University, Brisbane, QLD 4101 Australia
Orcid: 0000-0002-1613-0024
Email e.forster@griffith.edu.au

Jennifer Fraser
RN PhD FACCYPN
Honorary Associate Professor Jennifer Fraser
Susan Wakil School of Nursing and Midwifery
Faculty of Medicine and Health
Level 8 East, Susan Wakil Health Building D18
The University of Sydney NSW 2006
Orcid: 0000-0003-0111-9137

*Corresponding author

References

1. Child Protection Procedures Manual (1995–2005). Policy and Practice Manual.
2. Child Protection Act 1999, s. 59, 122, Schedule 1.
3. Mawhinney B, Fraser JA. Engagement and retention of families in universal Australian nurse-home-visiting services: a mixed-methods study. Int J Environ Res Public Health. 2023;20(15):6472. doi: 10.3390/ijerph20156472
4. Rossiter C, Schmied V, Kemp L, Fowler C, Kruske S, Homer CSE. Responding to families with complex needs: a national survey of child and family health nurses. J Adv Nurs. 2017;73(2):386–398. doi: 10.1111/jan.13146
5. Wall L, Higgins D, Hunter C. Trauma-informed care in child/family welfare services. CFCA Paper No. 37. Child Family Community Australia (CFCA), Australian Institute of Family Studies; 2016.
6. Goddard A, Janicek E, Etcher L. Trauma-informed care for the pediatric nurse. J Pediatric Nurs. 2022;62:1–9. doi: 10.1016/j.pedn.2021.11.003
7. Isobel S. Trauma and violence informed care: a concept analysis and implications for mental health nursing practice. Int J Ment Health Nurs. 2025;34:e70202. doi:10.1111/inm.70202
8. Bartlett JD, Steber K. How to implement trauma-informed care to build resilience to childhood trauma: research brief. Child Trends; 2026. https://www.childtrends.org/publications/how-to-implement-trauma-informed-care-to-build-resilience-to-childhood-trauma