posttraumatic stress disorder

Followup studies have shown that a significant number of children injured in traffic accidents and other stressful events develop clear symptoms of posttraumatic stress disorder. While most emotional reactions after an injury are normal and transitory, prolonged symptoms that hinder return to normal activity should raise the possibility of PTSD.

These symptoms fall into four major categories:

Avoidance The child expends a lot of effort into blocking out memories of the event. He tries to avoid things that would remind him of it, and detaches himself from his emotions or from other people.

Reexperiencing The child cannot stop thinking about the event. Unwanted images come into his mind when he tries not to think of the event.

Increased physiologic arousal The child is irritable and hyperarroused. He startles abnormally easily. He cannot sleep peacefully, nor settle down and feel calm.

Dissociation The child feels as if what happens around him is not real, as if he is watching from a distance.

Children most at risk for PTSD are younger, more likely to be female, are more likely to have had previous emotional or behavioral problems, and may have had previous trauma. The severity of the injury sustained is not necessarily a good predictor of which child will develop PTSD. He is more likely to develop the disorder if he hears screams, sees the injury of family members, or if he thinks he is going to die (regardless of the injury he sustained).

A child whom you suspect is suffering from posttraumatic stress disorder can be helped best by

gently discouraging reliance on avoidance; do not push your child, but do not avoid direct discussion of the accident
talking understandingly with your child about his feelings, and reassure him that these feelings are normal and that you understand them
understanding that different aged children react differently to stress; very young children may be very clingy, but teens may want to withdraw into themselves
encouraging a return to normal activities as soon as possible, given any limitations caused by physical injuries
seeking professional help in dealing with these issues as a family

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