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Post-Traumatic Stress Disorder in Children

What is post-traumatic stress disorder?

Post-traumatic stress disorder (PTSD) is a debilitating condition. It occurs after an event that the person finds terrifying, either physically or emotionally. With PTSD, the person has persistent, frightening thoughts and memories (flashbacks) of the event. Sometimes these effects don’t occur for 6 months or longer after the event. But when PTSD occurs soon after an event, the condition generally improves after 3 months. Some people with PTSD have long-term effects and often feel chronically, emotionally numb. PTSD in children usually becomes a chronic disorder.

What causes post-traumatic stress disorder?

The event that triggers PTSD may be:

  • Something that happened to the child

  • Something that happened to someone close to the child

  • Something the child saw

A child's risk for developing PTSD is often affected by:

  • The child's proximity and relationship to the trauma

  • The severity of the trauma

  • The duration of the traumatic event

  • The recurrence of the traumatic event

  • How well the child is able to “bounce back” from difficult things (resiliency)

  • The child’s coping skills

  • The support resources available to the child from the family and community after the event

The following are examples of events where there is a threat of injury or death. These events may cause PTSD if experienced or seen by a child or teen:

  • Serious accidents (such as car or train wrecks)

  • Invasive medical procedures for young children (under the age of 6)

  • Animal bites (such as dog bites) 

  • Natural disasters (such as floods or earthquakes)

  • Manmade tragedies (such as bombings)

  • Violent personal attacks (such as a mugging, rape, torture, being held captive, or kidnapping)

  • Physical abuse

  • Sexual assault

  • Sexual molestation

  • Emotional abuse, bullying

  • Neglect

Who is affected by post-traumatic stress disorder?

About 4% of children under age 18 are exposed to some form of trauma in their lifetime that leads to PTSD. Of those children and teens who have experienced trauma, about 7% of girls and 2% of boys are diagnosed with PTSD.

What are the symptoms of post-traumatic stress disorder?

Children and teens with PTSD feel extreme emotional, mental, and physical distress when exposed to situations that remind them of the traumatic event. Some may relive the trauma over and over again in the form of nightmares and disturbing memories during the day. They may also have any of the following:

  • Problems sleeping

  • Depression

  • Feeling jittery or “on guard”

  • Being easily startled

  • Loss of interest in things they used to enjoy (the child seems detached or numb, and is not  responsive)

  • Trouble feeling affectionate

  • Irritability, more aggressive than before, or even violent

  • Avoiding certain places or situations that bring back memories

  • Flashbacks (These can be images, sounds, smells, or feelings. The child may believe the traumatic event is happening all over again.)

  • Losing touch with reality

  • Reenactment of an event for a period of seconds or hours or, very rarely, days

  • Problems in school

  • Trouble focusing

  • Worries about dying at a young age

  • Acting younger than their age (thumb-sucking, bedwetting, and other regressive behaviors)

  • Physical symptoms (such as headaches or stomachaches)

How is post-traumatic stress disorder diagnosed?

Not every child or teen who experiences a trauma develops PTSD. PTSD is diagnosed only if symptoms keep happening for more than 1 month and are negatively affecting the child's life and level of functioning. For those with PTSD, symptoms usually begin within 3 months after the trauma. But they can also start months or years later.

PTSD can occur at any age, including childhood. It may be accompanied by:

  • Depression

  • Substance abuse

  • Anxiety

The length of the condition varies. Some people recover within 6 months, others have symptoms that last much longer.

A child psychiatrist or other qualified mental health professional usually diagnoses PTSD in children or teens following a full psychiatric evaluation. Parents who note symptoms of PTSD in their child or teen can help by seeking an evaluation early. Early treatment can decrease future problems.

Treatment for post-traumatic stress disorder

Your child's healthcare provider will figure out the best treatment plan for your child based on:

  • Your child’s age, overall health, and medical history

  • Extent of your child's symptoms

  • How well your child handles certain medicines, treatments, or therapies

  • If your child’s condition is expected to get worse

  • The opinion of the healthcare providers involved in your child's care

  • Your opinion and preference

PTSD can be treated. Early detection and intervention is very important. It can reduce the severity of symptoms, enhance the child's normal growth and development, and improve his or her quality of life. Treatment should always be based on a full evaluation of the child and family. Treatment recommendations may include:

  • Cognitive behavioral therapy. The focus is on helping the child learn skills to manage his or her anxiety, and to master the situation that led to the PTSD.

  • Antidepressant or antianxiety medicine. This may help some children to feel calmer.

Recovery from PTSD varies. It depends on the child or teen’s inner strengths, coping skills, and ability to "bounce back.” Recovery is also affected by the support available within the family. Parents play a vital supportive role in any treatment process.

Prevention of post-traumatic stress disorder

Preventive measures include the following:

  • Teach children that it is OK to say no to someone who tries to touch his or her body or make him or her feel uncomfortable.

  • Provide appropriate support or counseling for children and teens who have seen or experienced a traumatic event.

  • Encourage prevention programs within your community or local school system.

Medical Reviewers:

  • Ballas, Paul, DO
  • Nelson, Gail A., MS, APRN, BC