Trauma and Pain

Post-traumatic Stress Disorder in Infancy and Early Childhood

Infants and young children who have experienced severe traumas show many symptoms of impairment, similar to post-traumatic symptoms in older children and adults. The alternative criteria were more reliable and more valid for diagnosing PTSD in infancy than DSM-IV criteria.


Clinicians ought to be aware that infants and young children can develop posttraumatic disorders after traumatic events. Criteria for diagnosing these disorders in standard nosologies may need revision for use with children younger than 48 months of age. 

© 1995 The American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.


Circumcision Study Halted Due to Trauma

Researchers found circumcision so traumatic that they ended the study early rather than subject any more infants to the operation without anesthesia. Those infants circumcised without anesthesia experienced not only severe pain, but also an increased risk of choking and difficulty breathing. The findings were published in the Journal of the American Medical Association. Up to 96% of infants in some areas of the United States receive no anesthesia during circumcision. No anesthetic currently in use for circumcisions is effective during the most painful parts of the procedure.

Lander, J. et al., “Comparison of Ring Block, Dorsal Penile Nerve Block, and Topical Anesthesia for Neonatal Circumcision,” JAMA 278 (1997): 2157–2162.

“In the case of circumcision, relational resources are unavailable to the neonate. The next level of fight-flight-freeze also does not serve him since he is easily trapped and overpowered by those performing the procedure. All he has left, therefore is the level of shock defense, which consists of central nervous system flooding by terror, rage, and finally numbing, paralysis, and dissociation; this his his last chance to control the high level of central nervous system activation, which might otherwise result in death. Watchinig videotapes of neonates being circumcised portrays this clearly to the aware eye. The so-called “quiet” after circumcision is more likely a state of dissociation in response to the overwhelming pain and terror than it is a state of peaceful relaxation.”

John Rhinehart

Researchers Demonstrate Traumatic Effects of Circumcision

A team of Canadian researchers produced new evidence that circumcision has long-lasting traumatic effects. An article published in the international medical journal The Lancet reported the effect of infant circumcision on pain response during subsequent routine vaccination. The researchers tested 87 infants at 4 months or 6 months of age. The boys who had been circumcised were more sensitive to pain than the uncircumcised boys. Differences between groups were significant regarding facial action, crying time, and assessments of pain.

The authors believe that “neonatal circumcision may induce long-lasting changes in infant pain behavior because of alterations in the infant’s central neural processing of painful stimuli.” They also write that “the long-term consequences of surgery done without anaesthesia are likely to include post-traumatic stress as well as pain. It is therefore possible that the greater vaccination response in the infants circumcised without anaesthesia may represent an infant analogue of a post-traumatic stress disorder triggered by a traumatic and painful event and re-experienced under similar circumstances of pain during vaccination.”

Taddio, A. et al., “Effect of Neonatal Circumcision on Pain Response during Subsequent Routine Vaccination,” The Lancet 349 (1997): 599–603.