Nancy Kassam-Adams, PhD, the associate director for Behavioral Research at the Center for Injury Research and Prevention at CHOP and director of the Center for Pediatric Traumatic Stress, talks about how pediatric health practitioners play a crucial role in recognizing and addressing PTS reactions in our injured patients.

Thomas came to the Emergency Department by ambulance after being struck by a car while riding his bike with friends. The 9-year-old was treated for a forearm fracture and sent home with a cast. Thomas was quiet and well-behaved as long as his grandmother (and legal guardian) Mrs. G was in the room. When she was not present, he appeared agitated and was less cooperative with nursing care. At a primary care appointment two weeks later, Mrs. G reported that Thomas jumped whenever he heard screeching brakes, experienced nightmares, and refused to play with friends in the park near his home, formerly his favorite activity. She felt “jumpy” herself and anxious for Thomas’ safety when he wasn’t at home.

What Thomas and Mrs. G experienced is all too common. The impact of injury for children and parents can go beyond the physical wound to psychological distress that impedes full recovery. In the first few weeks, many children have a few post-traumatic stress (PTS) reactions (intrusive thoughts, avoiding reminders of what happened, or hyperarousal symptoms like exaggerated startle response). For most, these reactions get better with time and family support. Unfortunately, about 1 in 6 injured children has more severe and persistent PTS symptoms, lasting more than a month and getting in the way of returning to normal.

Pediatric health practitioners play a crucial role in recognizing and addressing PTS reactions in our injured patients. Think “D-E-F” when seeing an injured child. After first taking care of the basics (the “ABCs”) of physical health, address “D” (distress – pain, fear, worries), promote “E” (emotional support for the child), and remember “F” (family responses). At follow-up appointments, be sure to ask how everyone is doing. Is anyone feeling edgy or overvigilant? Having difficulty sleeping? Connect parents with evidence-based resources for families, such as Key tips for parents: Help your child go back to normal routines, take time to care for yourself, remember that your child’s responses may differ from yours.

By getting the help they needed, Thomas’ and Mrs. G’s symptoms improved over time. One month later Thomas still jumped when he heard tires squealing but no longer had nightmares. Six months later he was riding his bike in the park. Mrs. G was still a little anxious for her grandson’s safety but was talking with a close friend for support. They had found a “new normal,” with the help of their pediatrician.