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PACEs in Pediatrics

Book review: "Once I was very, very scared," a book on childhood trauma


The past few years have brought a wealth of evidence for the impact of childhood trauma on lifelong health. The AAP has recognized the importance of childhood trauma with conferences (2015 Violence, Abuse and Toxic Stress: An Update on Trauma-informed Care in Children and Youth) and resources (AAP Trauma Toolbox for Primary Care.) Like many pediatricians, I have been grateful for the attention to and evidence base for an area of pediatrics I see on a daily basis but for which I have felt inadequately trained.

For those of us practicing in community primary care clinics, the challenge has been what to do once we have screened for and heard about our patients’ exposure to trauma. As a pediatrician with San Mateo County Clinics, I feel fortunate that my patients have more access to trauma informed mental health services than in many “safety net” systems. In practice, however, it is still sometimes difficult to connect patients with appropriate therapy. At the same time, I have found that referral is not necessary in as many cases as I might have thought. Many families have found basic education on current medical understanding of trauma and resilience to be very useful.

What has been missing, until now, has been a highly accessible way for families and others to talk with young children about trauma and resilience. Once I Was Very Very Scared by Chandra Ghosh Ippen, Ph.D. and Erich Ippen, Jr. fills that need. A picture story book, Once I Was Very Very Scared tells the story of several young animals who were scared by acute or chronic trauma and show reactions ranging from aggressive barking (dog) to hiding (turtle) or feeling ashamed (elephant). Guided by a wise porcupine, the animals learn how to talk about what they have been through, how to understand their feelings and how to find ways to feel better. Families in my clinic who have read Once I Was Very Very Scared with their children have found the book to be enjoyable and useful. The book is available in English, Spanish, Arabic and Turkish. Free pdf versions in English and Spanish are available at

Also available on the website are worksheets in English and Spanish for helping children understand their own feelings and choose healing activities. The worksheets ask, for example, “How are you like turtle?” and “What can help turtle?”

About the authors: “Chandra Ghosh Ippen, Ph.D. is Associate Director of the Child Trauma Research Program at UCSF and the Director of Dissemination and Implementation for Child- Parent Psychotherapy (CPP). She has co-authored over 20 publications related to trauma and diversity-informed practice including the book Don't Hit My Mommy, which is the manual for Child-Parent Psychotherapy. She has over 15 years of experience conducting trainings nationally and internationally. Her husband Erich Ippen, Jr., a digital artist and technical director at Industrial Light and Magic, has created visual effects for movies like Rango, Harry Potter, The Avengers and Star Wars and many others. Together they have created an invaluable tool for anyone who cares for children whose lives have been affected by trauma or adversity.”

 To learn more about how people around the world are using Once I Was Very Very Scared to help children, visit


This book review by Elizabeth Grady, MD, FAAP, San Mateo County, first appeared on the AAP-California website. 

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