COMMENTARY

After the Injury: PTSD in Kids

Flaura K. Winston, MD, PhD

Disclosures

February 27, 2012

Editorial Collaboration

Medscape &

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Hello. I'm Dr. Flaura Koplin Winston. I am an engineer and a general pediatrician, and I codirect the Center for Injury Research and Prevention at The Children's Hospital of Philadelphia. Along with studying ways to protect children and young adults from physical injury, we've studied the emotional impact of physical trauma on injured kids and their families.

Symptoms of traumatic stress from an accident or injury are much more common than people realize. It is important for clinicians to know how to recognize symptoms of postinjury traumatic stress in injured patients and their family members, and to know how to counsel patients about the resources available to them.

Let's put this in context. Each year in the United States, more than 1.5 million children will be in a car crash. One in 4 children and teens needs medical care for an injury. Seven million injured children are treated in an emergency department, and several hundred thousand injured children are admitted to the hospital. Each of these events can be a traumatic stress experience for children. Right now, hundreds of thousands of children across the country are recovering from an injury, and they rely on their parents and other caring adults to help them in this process.

Although it is important to tend to the physical wounds and rehabilitation, it is just as important for families to remember to look beyond the physical injuries. Our research shows that nearly all injured children and their parents can experience traumatic stress reactions in the days after a child's injury, and it's normal for these reactions to linger for up to a month.

As many as 1 in 8 children and their parents will have persistent traumatic stress reactions for months after the injury, and some will experience posttraumatic stress disorder (PTSD). These reactions can get in the way of full recovery and getting back to normal. The first step in helping a child recover is to learn what reactions to look for, what families can do to help, and what physicians can do to help parents respond in a healthy way.

In the first few days after an injury, nearly all children feel upset, jumpy, or worried at times. Parents and other family members can have similar reactions. Nearly everyone feels stress, headaches, tension, tense muscles, knots in their stomach, and sweaty palms at some point. These are all common physical manifestations of stress, and many people will report feeling that life is a bit out of control.

When an accident or injury causes overwhelming feelings of fear, helplessness, and horror, it can lead to more than just everyday stress reactions; it can lead to traumatic stress. There are 3 main types of traumatic stress reaction:

  • reexperiencing or reliving what happened;

  • avoidance -- staying away from reminders; and

  • hyperarousal -- feeling anxious or jumpy.

"Posttraumatic stress disorder" is the name given to stress reactions that are so severe that they get in the way of normal life and last for more than 1 month. Up to 1 in 10 people develop PTSD sometime in their lives. It's very common.

It is important to know whether your patient or someone else in your patient's family develops PTSD from the accident or injury because it can get in the way of the child's recovery, contribute to new medical problems, or make it harder to enjoy life.

The good news is that very good treatments for PTSD are available. Unfortunately, less than one half of the people with traumatic stress reactions talk to anyone about their problems or get professional help, even when their symptoms go on for a long time.

But without you, the families may not recognize the symptoms or their need for treatment. One of the most important things you, as their physician, can do is to remember how common injuries and crashes are, and to suggest treatment when necessary. It's very important to remember that the severity of the injury does not predict the severity of the reactions. For example, even children who witness a serious crash without sustaining an injury can present with symptoms.

You may not know that a child was in a car crash or bitten by a dog, but these events can have a lasting effect on children and their families. Be aware of the symptoms of traumatic stress. When you know that a child had an injury, probe for hyperarousal, reexperiencing, or avoidance symptoms.

For children who are having new challenges in school, with friends, or at home, probe for a history of injury or an exposure to a scary event that might be causing these abnormal reactions. For more information on how families can help their child recover from an injury, go to the After the Injury Website and share it with your families.

The site provides specific information and videos about traumatic stress and other concerns, an online tool for parents to rate their child's reactions, and specific ways that parents can help them recover. For more information on how you, the healthcare provider, can deliver trauma-informed care, go to our Health Care Toolbox.

Thank you very much.

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