Center for Injury Research and Prevention

New Research Points to Factors Involved in Pediatric PTS

July 25, 2017

As much as parents try to protect their children, accidents will happen and may result in injury. Injuries are potentially traumatic events for children, and many children experience posttraumatic stress (PTS) symptoms in the immediate days and weeks following an injury. For the majority of children, these symptoms resolve on their own. However, approximately 10 to 30 percent of injured children experience persistent PTS symptoms, even posttraumatic stress disorder, which can interfere with their recovery and prevent them from being able to return to their typical activities (for example, school, riding in a car, playing sports). Why does this happen and can it be prevented?

Child with Cast

The answer is we still aren’t sure why some children are able to recover emotionally from injury on their own, while others need more help. Factors leading to persistent PTS symptoms in children are complex. A combination of biological, psychological, and environmental factors may influence the likelihood of a child developing PTS symptoms after an injury.

We recently conducted a study, published in Health Psychology which examined the relationships among several bio-psycho-social factors (heart rate following the child’s injury, global and trauma-specific threat appraisals, early coping, and trauma history) and PTS symptoms over time. Ninety-six children, aged 8 to 13 years, who were hospitalized for an injury, provided information three times: within two weeks of initial hospitalization, 6 weeks later, and 12 weeks later.

Although we did not find an association between either heart rate nor previous trauma in this study, we did find:

  • Children who experienced early PTS symptoms engaged in more coping strategies of various types.
  • Children with early global threat appraisals (thoughts that the world was a fearful place and/or that bad things always happen to them) and trauma-specific threat appraisals (interpreting the injury or injury event as fearful/life threatening) showed more severe initial PTS symptoms following their injury.
  • Children who used avoidant coping strategies (taking actions to so that they would not have to confront people, places or activities that reminded them of the injury or injury event) maintained more persistent PTS symptoms.

Toward the Future

What do these study findings mean for future research and for clinical practice? More research is needed to determine what kinds of strategies we can use to help support children and families following a child’s injury. The current study points out what NOT to do. Specifically, these findings suggest that children should not avoid their fears; it may be helpful for parents to encourage their children to safely approach their fears following injury.

Research findings from the current study also suggest that healthcare professionals may want to assess how the child experienced their injury (i.e., threat appraisals) and what the child is doing to cope with the injury to help determine current and future PTS risk. Healthcare professionals can also use preventive coping tools when working with children, such as the Cellie Coping Kit to promote adaptive coping strategies and to restructure avoidant ones following an injury.