The earliest period of childhood is often called infancy. ‘Infancy’ comes the Latin word ‘infantia’ meaning early childhood or literally ‘the inability to speak’. Infants and young children can be the subject of legal proceedings including where physical and/or psychological harm has occurred and yet, it can be difficult for impact to be assessed especially when the ability to speak is absent.
There was also once a school of thought that the baby is born as a ‘tabula rasa’ or blank sheet, however our knowledge has significantly progressed and we know now that the infant at birth has already accumulated experiences from its antenatal world which may have long-term impacts.
The first 1001 days, from conception to age two is considered a highly sensitive period of life when the brain is acutely influenced by both genetic and environmental factors and 90% of brain development happens by age 5, highlighting how experiences in this time may impact across time and the developing brain.
When trauma occurs early in life there is potentially significant risk to the baby and young child’s developmental trajectory. There can be a dose effect of the timing and chronicity of an event, but we also know that the presence of a stable and loving caregiver during times of stress exposure can help attenuate impact.
Understanding the Difference Between Stress and Trauma
It should be noted that stress reactions are common and typically reflect developmentally normal responses to everyday challenges. Irritability, clinginess, brief regression, or temporary changes in sleep and appetite often appear during these moments. Crucially, these reactions settle once the stressor passes and the young child receives appropriate co‑regulation from caregivers. Their underlying sense of safety remains intact, and their physiological arousal returns to baseline.
A trauma response differs in both intensity and impact. Trauma arises when an event is experienced as frightening, threatening, or beyond the child’s capacity to manage. In these circumstances, the stress-response system becomes persistently activated, and the child struggles to return to baseline even with supportive caregiving. Both stress and trauma can occur due to an incident, such as a road traffic collision, but the distinction lies in how the child’s nervous system interprets and responds to the event.
Road traffic collisions often evoke images of physical injury—broken bones, head trauma, emergency treatment, and survival. Yet this focus can obscure the fact that babies and young children may be traumatised even when they appear physically unharmed. Developmental trauma frameworks emphasise that trauma is defined not only by the event itself but by its impact on neurobiological regulation, felt safety, and the child’s ability to engage in typical developmental processes.
Babies Can Remember Without Words
A persistent misconception is that babies are too young to remember traumatic experiences, but babies and young children retain far more than we assume. The challenge lies in how these memories are stored, accessed and communicated.
Although babies and young children may not verbalise fear, they can communicate distress through changes in sleep, feeding, behaviour, attachment, and emotional regulation. The absence of words should never be mistaken for the absence of traumatic experience. Infants remember safety and danger in ways that are developmentally appropriate to them, often expressed through physiological and behavioural patterns rather than language.
A road traffic collision, for example, can be frightening for all involved. For babies and young children, the sudden noise, violent movement, flashing lights, unfamiliar strangers, and visible distress of parents create an environment of alarm and uncertainty. When there is no significant physical injury, it is easy to assume the child has escaped unscathed. Yet infants experience the world through relationships, sensations, and emotional connection. A terrified parent, an invasive medical procedure, or separation from caregivers can leave a lasting imprint.
When Medical Care Becomes Part of the Trauma
Paediatric Medical Traumatic Stress (PMTS) and Infant Medical Trauma (IMT) are relevant here. They recognise that trauma may arise not only from an incident or injury but also from the medical care that follows. Hospitalisation, painful procedures, intensive care admissions, repeated examinations, and separation from parents can all contribute to traumatic stress. For babies, who cannot understand why these events are happening, healthcare can feel like an ongoing threat rather than a source of help.
PMTS reframes how we think about recovery after road traffic collisions. A baby or young child may be discharged from a hospital stay physically well yet continue to experience sleep disturbance, feeding difficulties, heightened distress, clinginess, or developmental regression. Similar behaviours can be seen in young children who appear unharmed post RTC. Families may notice increased startle responses, difficulty separating from caregivers, or a general loss of settled behaviour. If these changes continue after the stressor has ceased the noted change may reflect trauma rather than the aftermath of injury, illness or a stressor, such as an RTC.
The Role of Parents and Caregivers in Recovery
Parents and caregivers play a central role in recovery. Infants regulate their emotions through relationships and rely on adults to help them feel safe and protected. Following a road traffic collision, parents are often traumatised themselves—managing injuries, guilt, fear, or symptoms of post‑traumatic stress. When caregivers are struggling, their capacity to provide the emotional regulation infants depend upon may be compromised.
Public understanding of early years trauma needs to expand. Because babies cannot articulate their distress, their trauma can remain invisible. Yet their inability to describe the impact does not mean they were unaffected. Infants communicate through behaviour, relationships, sleep, feeding, play, and emotional regulation. When we learn to interpret these forms of communication, it becomes clear that many infants carry the imprint of traumatic experiences long after the event.
Clinical Psychologists and Psychiatrists assess these domains to determine whether changes have occurred since a significant stressful incident and how long they have persisted. This helps build a formulation of the child’s experience and the potential impact of a stressful incident.
Looking Beyond the Physical Effects of an RTC
In the case of RTCs they should be understood as not solely physical events. They are psychological, relational, and developmental events in a child’s life. Understanding babies’ and young children’s recovery from such events requires more than a physical lens; it requires attention to safety, attachment, family functioning, and emotional wellbeing. In the case of RTCs trauma can begin at the moment of the impact, continue at the roadside, and intensify in the emergency department or hospital ward. Its effects may remain long after visible injuries have healed.
The absence of words should never be mistaken for the absence of memory. Babies and young children can remember, even when they cannot tell us.
Professor Nicola Doherty
Lead Psychologist, Associate at Psychological Pathways
