Perinatal Trauma, Long-Term Consequences of

A rich literature, based on sound research, indicates that childhood traumatic experiences can result in lasting adverse consequences, including diagnoses such as posttraumatic stress syndrome. The history of our understanding of such phenomena, however, relates largely to children 2 years of age and older. The supposition usually enunciated is that for a seriously hurtful condition to have an enduring effect, the capacity for remembering and even the ability to recall the dreadful experience in words must be present. This reasoning suggests that if there is no cognitive representation of the earlier event encoded in the cerebral nervous system, there cannot be a condition of posttraumatic stress; it is as if the history never occurred in the life of the affected (or nonaffected) individual. However, our knowledge of memory processes, and especially of neuro-psychological retention of significant earlier events, has increased sharply in recent years and suggests that the transport of early memory traces of an early traumatic condition to an effect years later can no longer be considered impossible.

Thus, we must acknowledge that perinatal traumatic experiences, defined as hurtful assaults on very young children, even during the early days and months of life, and prenatally as well, may have lasting developmental consequences. Indeed, contemporary research on the effects of maternal and environmental toxicities, accidents, and surgical interventions to which the prenatal and newborn child might have been and may continue to be subjected demands closer scientific consideration than it has been given historically.

So embedded has been the assumption, in our social and medical cultures, of babies' insensitivity to painful experiences that until recently there has been little concern about carrying out surgical procedures, even for lung and heart anomalies of newborns without use of, or with very little, anesthesia. The defense of these practices with very young infants is usually that the anesthesia itself is hazardous. The additional footnote oft heard is that, in any case, the baby will not remember the surgical intervention. Indeed, no plausible or clearly verifiable report has occurred of an adult having direct memory of a circumcision in early infancy, despite the genuinely expressed beliefs by some individuals that they retained a detailed memory of the surrounding environment and the operation itself during circumcision as a newborn.