Pediatric Traumatic Stress

What is pediatric traumatic stress?

Pediatric traumatic stress is a set of psychological and physiological responses children and their families have to:

  • Pain
  • Injury
  • Serious illness
  • Medical procedures
  • Invasive or frightening treatment experiences in medical settings

These responses may include symptoms of arousal, re-experiencing and avoidance. Symptoms can vary in intensity and are often related to the patient's or family member's subjective experience.


Interventions should be based on a family's situation and their ability to adapt to stress. Families exposed to traumatic stress from a healthcare experience typically fall into two groups:

  • Resilient families: It is quite common for pediatric patients and family members to initially experience some traumatic stress symptoms during medical events. Most affected patients and families are resilient and able to adapt with some support.

  • Families who struggle: A smaller number of children and families have multiple risk factors or experience significant distress as a result of medically-related events and situations. These reactions can become disruptive to the child's and family's functioning and to the child's medical treatment. They can also be exacerbated by other life stressors, circumstances and traumatic experiences.

Framework for intervention

To provide optimal care for ill or injured children and their families, medical and mental health professionals should be aware of traumatic stress reactions that may interfere with the patients' health and functioning. CPTS' Pediatric Psychosocial Preventative Health Model© provides a three-tiered approach to addressing medical traumatic stress in pediatric patients and their families. Our model is adapted from the National Institute of Mental Health (NIMH) prevention framework, and provides recommendations for assessing and treating medical traumatic stress at three levels: universal, targeted, and clinical/treatment. It is an easy model for healthcare professionals to incorporate into their routine clinical encounters.


Most children and families facing challenging medical events are understandably distressed, but are resilient and have good coping resources.

Recommendation: Help these families help themselves by:

  • Providing general support for social and emotional functioning
  • Focusing on natural coping systems and strengths
  • Providing information regarding common reactions
  • Screening or asking about indicators of higher risk.


Some children and families present with significant acute stress reactions, or have multiple risk factors, (e.g., history of prior trauma, extremely frightened, experiencing pain or painful procedures, parent / child separation, concurrent financial or familial stressors, experience of loss, and feeling isolated or lacking in social support.)

Recommendation: Help these families by:

  • Providing increased support
  • Helping the children and family to anticipate challenges and strengthen coping skills
  • Implementing brief preventive interventions
  • Monitoring ongoing distress


A significant minority of children and families experience continued or increasing distress, which impairs their ability to make decisions, adhere to treatment, or decreases quality of care.

Recommendation: Help these families by:

  • Arranging for evaluation or treatment by a mental health professional
  • Helping them seek out more extensive psychosocial support

Assessment and intervention development

CPTS assessment and intervention development is founded on a well-established program of clinical research in pediatric traumatic stress at CHOP. We have a number of current assessments and interventions in development and evaluation that address children's and families' traumatic stress symptoms, perceptions, worries and coping skills. These brief assessments and interventions can be implemented by medical providers or by medical-psychosocial provider teams. They include:


  • STEPP – Screening Tool for Early Predictors of Post-Traumatic Stress Disorder (PTSD) (Emergency Medicine / Pediatric Injury)
  • ASC-Kids - Acute Stress Checklist for Children (Pediatric Injury / Acute Medical Event)
  • PAT 2.0 – Psychosocial Assessment Tool (Oncology / Pediatric Illness)


  • SPC – Stepped Preventive Care (Injury)
  • SCCIP-ND – Surviving Cancer Competently Intervention Program for Parents of Children Newly Diagnosed with Cancer (Illness)
  • SCCIP – Surviving Cancer Competently Intervention Program for Adolescent Survivors of Pediatric Cancer and their Families (Illness)

Assessment and intervention resources for mental health providers »