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Helping Traumatized Children effects of childhood trauma may also include cardiovascular issues, chronic back pain, fibromyalgia, gut problems, irritable bowel syndrome, and many forms of arthritis in adulthood. With appropriate, safe, and effective interventions, we can provide children with compassion, nurturing, and tools to ease the effects of trauma. your current scope of practice, you should respectfully refer the client to a more qualified practitioner. Providing touch therapy for children who have experienced trauma requires an ability to adapt the work to each child's specific emotional and physical needs (see Connecting with Young Clients, page 61). Specific concerns associated with young clients may include fear of massage administered by a stranger and general apprehensions about touch. Working with children who have experienced trauma requires more sensitivity to the child's comfort level, physical cues, and gestures, as well as a much slower, more intentional pace. "The child may not be comfortable with touch right away and may need songs, stories, or the parent's gentle voice to relax them," Benson says. "Or a child may be so hungry for attention or touch they want to sit in your lap when you first meet them. Both are extremes and require the child to learn the appropriate and healthy way to touch others." When working with children who have experienced any trauma, it is best to let them control the session. Always ask for their permission to perform massage therapy, no matter how young or how incapacitated they may be. Explain the massage in terms children will understand, and give phrases or code words for "yes," "no," and "stop." Many children who have experienced abuse have a history of knowing they cannot say "no" to anything, and this gives them permission to control the session without using potential trigger words. W Working with Children When using massage therapy for children who have experienced trauma, the work does not need to be aggressive to achieve its maximum potential. Professionals wishing to work with this population should have specialized training to provide effective support. Some of the many benefits we hope to achieve through the use of nurturing touch include decreased tactile aversion, decreased production of stress hormones, improvements in social interaction, increased feelings of self-worth, improved ability to selfregulate and self-soothe, increased feelings of calm and relaxation, improved growth and development, and better sleeping habits. Pediatric massage may be used as a supportive therapy by specially trained massage therapists, or by caregivers who have learned massage techniques from a skilled, educated massage therapist. The role of hands-on practitioners is never to diagnose trauma, but rather to support all clients with compassion. Practitioners should be particularly sensitive to the reactions of children who are more likely than others to be at risk for developing problems. If you do not feel comfortable working with this population under Do your best to learn a few personal characteristics about the child before the session—not just physical or emotional issues, but general likes and dislikes—and try to incorporate or exclude these preferences in the session. "For younger children, I like to find out their favorite color and main interest in advance and make an effort to include this in the session in some way," says Shannon Doher, LMT, and cofounder of Touch Institute Los Angeles Inc. "For older kids and teens, I encourage them to bring in their favorite music for the session. If the child does not want to participate in the session or wants to end it at any time, for any reason, I immediately comply." Provide safe positioning to help empower the child. Try beginning with the child sitting up; lying supine or prone may feel very vulnerable to your pediatric client. Giving choices is important, but do not give an overwhelming amount of choices. Also, while you want to let these children know they are in charge, as they have likely never felt in charge of anything, it is advisable that you do not give a choice of removing clothing at the first session. Having a parent or caregiver in the room during the massage is typically standard when the child is under 18. When providing pediatric touch therapy, use slow transitions and be consistent, predictable, and repetitive. Always try to interact with children based on emotional age, and use soothing, nonverbal interaction, such as gentle stroking of the hand or demonstrating healing touch on a stuffed animal. "When I was lying in my [hospital] bed, everyone made me do something that hurt. Tina gave me a 64 massage & bodywork september/october 2013