Posttraumatic Stress After Pediatric Injury: What Practitioners Should Know

October 15, 2013
FAST FACT:
19 percent of injured
children develop
significant PTS
symptoms, according
to a recent
meta-analysis
.

As a pediatric nurse, I know that the impact of injury for children and parents can sometimes go beyond the physical wound and that a full recovery can require more than the excellent medical care we now know how to provide.

According to a recent research review in JAMA: Pediatrics by my colleague, Nancy Kassam-Adams, PhD, a substantial body of research shows that posttraumatic stress (PTS) symptoms are common after pediatric injury and that these symptoms can affect a child’s physical and functional recovery. Although many children have a few traumatic stress reactions (such as re-experiencing, avoidance, or hyper-arousal) in the first few weeks after an injury, for most these reactions get better with time and with support from family and friends. Unfortunately, a significant sub-group (about 1 in 6 injured children) has more severe and persistent PTS symptoms, lasting more than a month and getting in the way of returning to normal functioning.  

Research is underway to refine prevention approaches, as well as the screening tools that can identify those at higher risk. Web-based approaches, and those that involve both parents and children, have shown promise. There is good news about treatment of severe and persistent PTS symptoms - research supports trauma-focused cognitive behavioral therapy as an effective intervention.

As pediatric health practitioners, we play a crucial role in recognizing and addressing PTS reactions in our injured patients.

What is trauma-informed pediatric care and how can you use it to prevent PTS in your patients? Here’s what you can do:

Consider PTS when you take care of injured children. Minimize potentially traumatic aspects of treatment – use child-friendly language to explain what is happening, support parents in being present during procedures, and be sure to optimize pain management. Recognize risk factors like a child’s preexisting trauma or a parent’s acute traumatic stress reactions. Identify children (and parents) who may need additional monitoring or referrals.

A good way to remember this is to think “D-E-F.” After taking care of the “ABCs” (airway, breathing, and circulation) and addressing other physical health needs:

  • address “D” (distress – pain, fear, worries)
  • promote “E” (emotional support for the child)
  • remember “F” (the family and how they are doing)

Ask children and parents about the symptoms of PTS. At follow-up appointments, be sure to ask how everyone is doing. Is anyone still having unwanted and intrusive thoughts about what happened, extreme avoidance of reminders of what happened, feeling edgy or vigilant, having difficulty sleeping, eating, or concentrating?

Share resources with families. AfterTheInjury.org, created by CIRP@CHOP, provides families with fact sheets, videos, and other resources to prevent PTS after a pediatric injury. HealthCareToolbox.org, created by the Center for Pediatric Traumatic Stress, has many free, downloadable tip sheets for children and parents.

Keep up-to-date on PTS related to injury and other types of child trauma. Good online resources are  HealthCareToolbox.org, NCTSN.org and http://learn.nctsn.org. Read this recent New York Times blog post from Perri Klass, MD about helping parents with traumatic stress long after a child's illness.