Post-Traumatic Stress Disorder, Pediatric

Post-traumatic stress disorder (PTSD) is a mental health condition. It can occur in children who go through a life-changing event or trauma. It can also happen in children who hear about or see a traumatic event.

It is normal for a child to show signs of stress after a traumatic event. If symptoms last for more than a month, your child may have PTSD. Symptoms often improve over time. Some children may have symptoms for years if they do not get help.

What are the causes?

• Situations where your child's life was in danger, such as in motor vehicle accidents or plane crashes.
• Physical assault.
• Disasters caused by nature or humans, such as fires or floods.
• Violent crimes, such as kidnappings or school shootings.
• Sexual assault.

• In your child's community.
• At home (domestic violence).
• During war.

What increases the risk?

• Children who have gone through a traumatic event, such as:
  • A disaster.
  • An accident or serious illness.
  • The death of a parent.
• Children with other mental health conditions.
• Children who have a parent with a mental health condition.

What are the signs or symptoms?

In children aged 6 or younger

• Repeat traumatic events through play.
• React as if the trauma were occurring in the present.
• Stay away from people, places, or things that remind them of the trauma.
• Have changes in mood or how they react to situations. Your child may:
  • Become violent or have temper tantrums.
  • Startle easily.
  • Have problems sleeping.
• Not talk or have trouble talking.
• Have a change in eating habits.
• Wet the bed after having been trained to use the toilet.

In children older than age 6

• Believe that they notice warning signs to avoid trauma in the future (omen forming).
• Recall an event in a different order than how it happened (time skew).
• Act out some of the trauma during play.
• Have trouble focusing.
• Feel guilty or ashamed.

In teenagers

• Relive the trauma through:
  • Memories that cause them distress.
  • Dreams.
  • Intense feelings when something reminds them of the trauma.
  • Physical reactions. These can include a fast heart rate, shortness of breath, sweating, and shaking.
  • Flashbacks. This is when your child feels like the past event is happening in the present.
• Avoid anything that reminds them of the trauma. Your child may:
  • Lose interest or not take part in daily activities.
  • Feel cut off from or stay away from other people.
• Have physical or emotional symptoms (increased arousal symptoms). Your child may:
  • Be easily startled or nervous.
  • Behave in a careless or self-destructive way.
  • Have trouble focusing.
  • Yell at or hit other people or objects.
  • Have trouble sleeping.
• Have negative moods and thoughts. Your child may:
  • Not be able to remember certain parts of the traumatic event.
  • Be unable to feel positive emotions, such as happiness or love.

How is this diagnosed?

PTSD is diagnosed through an assessment by a mental health professional. You or your child may be asked to describe the trauma. You may be asked if you have noticed any changes in your child's behavior.

How is this treated?

• Medicines to reduce PTSD symptoms.
• Therapy. This is done with therapists who are experts in the treatment of PTSD. It may include:
  • Counseling (cognitive behavioral therapy, or CBT).
  • Exposure therapy.
  • Eye movement desensitization and reprocessing (EMDR) therapy.
  • Play therapy.

Some children with PTSD may need both medicines and therapy.

Follow these instructions at home:

Managing stress and anxiety

• Help your child find ways to manage stress and anxiety. These may include:
  • Breathing exercises.
  • Meditation or yoga.
  • Listening to music.
  • Organized exercise and play.
  • Spending time with people who make your child feel safe.
  • Finding a support group or family counselor.
• Reduce things that cause stress (triggers), such as family fights, moving to a new home, or changing schools.
• Try not to let your child see disturbing images in the media.

Activity

• Help your child find activities that are healthy for their mind and body.
• Plan activities that let your child relax and have fun.
• Create and follow schedules and routines.

Talking to your child

• Be loving and show affection.
• Give your child time to accept what has happened.
• Use simple words to answer your child's questions.
• Listen to your child about their feelings.

General instructions

• Give your child over-the-counter and prescription medicines only as told by the health care provider.
• Follow your child's treatment plan carefully.

Where to find more information

• Centers for Disease Control and Prevention: cdc.gov
• The National Institute of Mental Health: nimh.nih.gov
• National Center for PTSD: ptsd.va.gov

Contact a health care provider if:

• Your child's symptoms do not get better or get worse.
• Your child has new symptoms.
• Your child talks a lot about death.
• Your child has trouble sleeping or a change in appetite.

Get help right away if:

• Your child has thoughts of suicide.
• Your child has thoughts of harming others.

• Call 911.
• Call the National Suicide Prevention Lifeline at 1-800-273-8255 or 988. This is open 24 hours a day.
• Text the Crisis Text Line at 741741.

Summary

• It is normal for a child to show signs of stress after a traumatic event. If these symptoms last for more than a month, your child may have post-traumatic stress disorder (PTSD).
• PTSD is diagnosed through an assessment by a mental health professional.
• Treatment may include medicines and therapy.
• Help your child find ways to deal with stress and anxiety. Contact your health care provider if your child's PTSD does not get better.