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This article describes recent developments in theory and clinical practice with traumatized children in the birth to five age range. It revisits the treatment of an abused two-year-old girl and her mother from the perspective of the child's reappearance in the clinic twenty years later to ask about her past. The early treatment of the child and the mother is re-examined from the perspective of the advances in theory and practice about early childhood trauma in the intervening decades. These advances are contrasted with the persistent gap between the urgent needs of maltreated children and their families and the availability of services designed to support their mental health.

There is a great need to better understand the impact of traumatic events very early in life on the course of children's future development. This report focuses on the intriguing case of a girl who witnessed the murder of her mother by her father at the age of 19 months and seemed to have no recollection of this incident until the age of 11, when she began to exhibit severe symptoms of posttraumatic stress disorder (PTSD) in response to a traumatic reminder. The case presentation serves as the basis for a discussion regarding pertinent issues involved in early childhood trauma. This case and accompanying discussion were originally presented at the 19th Annual Meeting of the International Society for Traumatic Stress Studies and were transcribed and revised for use in this article. Specific topics include early childhood memory and trauma, learning and the appraisal of danger, and PTSD and traumatic grief in early childhood. Clinical and public health implications are also discussed. This case illustrates the dramatic impact that "preverbal" traumatic memories can have on children's later functioning and speaks to the importance of assisting very young children in the immediate aftermath of traumatic events.