Posttraumatic Stress Following Pediatric Injury

Abstract

After pediatric injury, transient traumatic stress reactions are common, and about 1 in 6 children and their parents develop persistent posttraumatic stress (PTS) symptoms that are linked to poorer physical and functional recovery. Meta-analytic studies identify risk factors for persistent PTS, including preinjury psychological problems, peritrauma fear and perceived life threat, and posttrauma factors such as low social support, maladaptive coping strategies, and parent PTS symptoms. There is growing prospective data indicating that children's subjective appraisals of the injury and its aftermath influence PTS development. Secondary prevention of injury-related PTS often involves parents and focuses on promoting adaptive child appraisals and coping strategies. Web-based psychoeducation and targeted brief early intervention for injured children and their parents have shown a modest effect, but additional research is needed to refine preventive approaches. There is a strong evidence base for effective psychological treatment of severe and persistent PTS via trauma-focused cognitive behavioral therapy; evidence is lacking for psychopharmacological treatment. Pediatric clinicians play a key role in preventing injury-related PTS by providing "trauma-informed" pediatric care (ie, recognizing preexisting trauma, addressing acute traumatic stress reactions associated with the injury event, minimizing potentially traumatic aspects of treatment, and identifying children who need additional monitoring or referral).

Nurses' Views and Current Practice of Trauma-Informed Pediatric Nursing Care

“…Background WHILE THE VAST majority of injured children experience full physical recovery post-injury, a significant subset experience negative psychological sequelae (Gold, Kant, & Kim, 2008;Kassam-Adams, Marsac, Hildenbrand, & Winston, 2013). In a meta-analysis, the proportion of injured children experiencing significant symptoms of posttraumatic stress (PTS) was 19% (Kahana, Feeny, Youngstrom, & Drotar, 2006).…”

“…Research consistently shows that objective injury severity does not predict PTS symptoms, but that a child's subjective sense of life threat is a risk factor for PTS symptom development. (See a recent review for a comprehensive summary of the research literature to date (Kassam-Adams et al, 2013)). PTS symptoms include re-experiencing a psychologically traumatic event via intrusive thoughts or images, avoidance of reminders of the event, cognitive and emotional changes, and hyperarousal symptoms such as an exaggerated startle response or hyper-vigilance for danger (American Psychiatric Association, 2014).…”

“…1 Trauma-informed care shares many of the goals of family-centered care (Committee on Hospital Care, 2003;O'Malley, Brown, & Krug, 2008) and "atraumatic care" (Hockenberry et al, 2013), but incorporates specific practices to reduce the impact of potentially traumatic medical events and treatment and the risk of ongoing PTS symptoms following these events (Stuber, Schneider, Kassam-Adams, Kazak, & Saxe, 2006). Research on the etiology of PTS symptoms indicates a number of risk factors in the peri-trauma period: the child's level of acute pain, more severe emotional distress, separation from parents, poor social support for the child, child coping strategies of avoidance or social withdrawal, and parental emotional distress (Kassam-Adams et al, 2013). Thus, grounded in this empirical literature, key elements of trauma-informed pediatric care include: 1) minimizing potentially traumatic aspects of medical care and procedures; 2) providing the child and family with basic support and information; 3) addressing immediate child distress (pain, fear, loss); 4) promoting emotional support (helping parents and family help their child); 5) remembering family needs (and identifying family strengths); 6) screening to determine which children and families might need more support; and 7) providing anticipatory guidance to those targeted children about adaptive ways of coping.…”

Racial Disparities in Outpatient Mental Health Service Use Among Children Hospitalized for Traumatic Brain Injury

“…An estimated 1 in 6 children develop persistent posttraumatic stress symptoms after any injury, which often lead to poor physical and functional recovery. 18 Disparities in a range of outcomes occur for children in low-income families, ethnic minority families, and those living in families with low education. 19–22 …”

Knowledge and training in paediatric medical traumatic stress and trauma-informed care among emergency medical professionals in low- and middle-income countries

“…Childhood injuries can have profound and lifelong psychological effects, with approximately one in six injured children experiencing psychological sequelae, including paediatric medical traumatic stress (Kassam-Adams, Marsac, Hildenbrand, & Winston, 2013; Price, Kassam-Adams, Alderfer, Christofferson, & Kazak, 2015). Paediatric medical traumatic stress is defined as ‘a set of psychological and physiological responses of children and their families to pain, injury, serious illness, medical procedures and invasive or frightening treatment experiences’ (National Child Traumatic Stress Network, 2003).…”