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Post-Traumatic Stress Disorder (PTSD)

What is post-traumatic stress disorder?

Post-traumatic stress disorder (PTSD) is a condition that can happen after your child sees or is involved in a very stressful event. The event usually involves a risk of injury or death. The stressful event may be:

  • Physical or sexual abuse
  • Violence, such as war, shootings, terrorist attacks, or robbery
  • A severe accident
  • The death of a loved one
  • A natural disaster, such as a flood, earthquake, hurricane, tornado, or fire

Most children and teens can get over PTSD with good treatment and family support. However, children have a greater risk for having PTSD later in life if they see or are involved in another stressful event.

What is the cause?

It is not known why one person will have PTSD after a trauma like a robbery, rape, battle, or severe car accident while another person may not. Things that increase the risk for PTSD after such an event include:

  • A family or personal history of mental illness
  • Long-term or repeated exposure to stressful events
  • The severity of the stressful event
  • Lack of family and social support after the event
  • The brain makes chemicals that affect thoughts, emotions, and actions. Without the right balance of these chemicals, there may be problems with the way you think, feel, or act. People with this disorder may have too little or too much of some of these chemicals.
  • People with this disorder may have physical changes in their brain.

PTSD can start at any age.

What are the symptoms?

Symptoms may start right after the stressful event or may start 3 or more months later. When stressful events, such as abuse, keep happening, the symptoms may come on slowly and get worse over time.

There are 3 types of PTSD symptoms.

  1. Your child acts or feels like the event is happening again (flashbacks). Your child may:
    • Daydream or have repeated thoughts, emotions, and images of the event
    • Have nightmares about the event
    • Have panic attacks when things happen that remind your child of the stressful event
    • Repeat the event over and over when they play. For example, if your child was in a car accident, he may constantly replay the accident with toy cars.
  2. Your child avoids things related to the stressful event. Your child may:
    • Avoid conversations, thoughts, or places that remind your child of the event
    • Forget parts of the event
    • Feel and act very distant and detached from others
    • Show fewer emotions, or show more sudden and extreme emotional reactions, such as anxiety, panic, anger, or guilt
    • Feel hopeless about the future
  3. Your child is physically alert all or most of the time. Your child may:
    • Have a lot of trouble falling or staying asleep
    • Be very irritable or have angry outbursts
    • Have trouble concentrating or staying focused
    • Be startled or jump at sudden or loud noises
    • Feel very suspicious and be on guard all the time

Your child may also:

  • Avoid people or get scared around people or things that remind them of the event. For example, your child might become unhappy and withdrawn when around an adult who has sexually or physically abused him.
  • Have trouble with bedwetting after successful toilet training
  • Not talking as much as before the event
  • Being very clingy with parents or trusted adults
  • Have physical symptoms, such as headaches or stomachaches, when reminded of the event
  • Talk about death and suicide, such as saying "I wish I were dead"

Your child may also feel very fearful, helpless, angry, or sad. Your child may feel guilty, thinking that they somehow caused the event or could have prevented it. Your child may deny what happened. Anniversaries of the event can often cause a flood of emotions and bad memories.

Some of these symptoms are normal after a stressful event. For most children, these symptoms stop within a month after the stressful event. If your child keeps having these symptoms, it’s called PTSD.

How is it diagnosed?

Your child’s healthcare provider or therapist will ask about your child’s symptoms, medical and family history, and any medicines your child is taking. Your provider will make sure your child does not have a medical illness or drug or alcohol problem that could cause the symptoms. Your child may be referred to a mental health professional who specializes in working with children and teens.

How is it treated?

PTSD can be successfully treated with therapy, medicine, or both.

Therapy is usually the first treatment for children. Several types of therapy may help your child:

  • Play therapy uses toys, games, and drama to help children learn to deal with their feelings. Play therapy helps children express their feelings without words.
  • Cognitive behavioral therapy (CBT) is a way to help your child identify and change views he has of himself, the world, and the future. CBT can make your child aware of unhealthy ways of thinking. It can also help your child learn new ways to think and act.
  • Eye movement desensitization and reprocessing (EMDR) helps your child cope with feelings and thoughts about distressing past events. Your child moves his eyes back and forth, usually following the therapist's hand or pen, while he recalls the event. Over time, your child becomes less upset about the event.
  • Exposure and response prevention therapy helps your child confront his fears by gradually increasing your child’s exposure to them. This process also involves learning ways to relax, such as breathing exercises. With help from the therapist, your child learns to overcome his anxiety.
  • Family therapy is often very helpful. Family therapy treats all members of the family rather than working with one person alone. It helps the whole family to make changes.

Medicine

Several types of medicines can help. Your healthcare provider will work with you to select the best one for your child. Your child may need to take more than one type of medicine.

What can I do to help my child?

  • Let your child make simple decisions when appropriate. Because PTSD often makes children feel powerless, you can help by showing them that they have control over certain parts of their lives. For example, let your child decide what to have for dinner or how to spend the day.
  • Check for books written for children who have been exposed to stressful events. Books are available for children of different ages and for different kinds of stressful events. Read and discuss the books with your child.
  • Support your child. Encourage children to talk about whatever they want to talk about. Be a good listener. This helps your child know that their feelings and thoughts really do matter, that you truly care about them, and that you never stop caring. If your child shuts you out, be sure to let your child know that you are there for him whenever he needs you. Remind your child of this over and over again.
  • Stay in touch with teachers, babysitters, and other people who care for your child to share information about symptoms your child may be having.
  • Be consistent. Understand that you are not responsible for your child's anxiety, even if something such as a car accident may have triggered it. Be firm and consistent with rules and consequences. Your child needs to know that the rules still apply to him. It does not help to teach children that they can avoid consequences if they’re anxious or if they act out.
  • Help your child learn ways to manage stress. Teach your child to practice deep breathing or other relaxation techniques when feeling stressed. Help your child find ways to relax--for example, by taking up a hobby, listening to music, watching movies, or taking walks.
  • Take care of your child’s physical health. Make sure your child eats a healthy diet and gets enough sleep and exercise every day. Teach your child to avoid alcohol, caffeine, nicotine, and drugs.
  • Check your child’s medicines. To help prevent problems, tell your healthcare provider and pharmacist about all of the medicines, natural remedies, vitamins, and other supplements that your child takes. Make sure your child takes all medicines as directed by your provider or therapist. It’s very important for your child to take medicine even when feeling and thinking well. Without the medicine, your child’s symptoms may not improve or may get worse. Talk to your provider if your child has problems taking the medicine or if the medicine doesn't seem to be working.
  • Contact your healthcare provider or therapist if you have any questions or your child’s symptoms seem to be getting worse.
  • Get emergency care if your child has serious thoughts of suicide or self-harm, violence, or harming others.
  • You can get more information from:
Developed by RelayHealth.
Pediatric Advisor 2015.2 published by RelayHealth.
Last modified: 2014-02-13
Last reviewed: 2014-01-27
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Copyright ©1986-2015 McKesson Corporation and/or one of its subsidiaries. All rights reserved.
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