Children in kinship care arrangements (being raised by grandparents or other relative caregivers) display more frequent and severe emotional and behavioral problems when compared to U.S. children overall.[1]  The reasons for this can frequently be attributed to the circumstances that brought the child into their grandparent’s household to begin with: prenatal drug exposure, child abuse or neglect, domestic violence, parental substance abuse, illness, divorce, incarceration or death.[2]

The National Child Traumatic Stress Network (NCTSN) recommends the following steps that grandparents and other relative caregivers can take to help their grandchildren, nieces, nephews, etc. who have been exposed to trauma during their childhood:[3]

  • Answer children’s questions using simple words
  • Teach children to recognize their “feelings” and name them
  • Encourage their attempts to make sense out of the story of their life
  • Teach safety skills
  • Balance stimulating activities and relaxation time
  • Identify and honor positive family traditions
  • Establish routines and schedules (predictability is key!)
  • Provide consistent connection, love and affection

However, even with the best support systems in place, children who have experienced trauma (and especially complex trauma) may need professional help.  Not all therapy is equally effective in treating children for the mental health complications that result from trauma.  It’s important to select an evidence-based therapeutic modality that is age-appropriate for your grandchild.  Diagnostic tools and assessments developed for children over age 5 do not produce accurate results when used on younger children.[4]   One of the most common and effective methods of addressing trauma in young children is trauma-focused cognitive behavioral therapy (TF-CBT).[5]

Without clear child custody orders, grandparents and other relatives raising children may lack ability to authorize medical or psychiatric treatment.  Doctors, psychologists and therapists will generally want releases and authorizations for treatment to be signed by either a natural parent or an individual who has a child custody order that clearly gives them decision making authority.  These orders will often be issued in connection with a case requesting child custody (allocation of parental responsibilities) or to be named a child’s legal guardian.  In addition, adoption of a grandchild or family member always gives the adoptive parent the same rights to authorize medical and therapeutic treatment that a natural parent would have.

[1] Smith & Palmieri (2007). Risk of Psychological Difficulties Among Children Raised by Custodial Grandparents. Psychiatric Services, 58(10), 1303-1310.

[2] Pinson-Milburn NM, Fabian ES, Schlossberg NK, et al. (1996). Grandparents raising grandchildren. Journal of Counseling and Development. 548–554.

[3] NCTSN,

[4] Scheeringa & Haslett (2010). The reliability and criterion validity of the diagnostic infant and preschool assessment: A new diagnostic instrument for young children. Child Psychiatry & Human Development, 41, 299– 312.

[5] Buss, Warren & Horton (2015).  Trauma & Treatment in Early Childhood: A Review of the Historical and Emerging Literature for Counselors.  The Professional Counselor, 5(2), 225-237.