Traumatic stress

Children, like adults, sometimes experience or witness something extremely frightening and dangerous, such as a road accident, a serious injury or a crime.

This can cause a traumatic stress reaction, which affects the way the child thinks, feels and behaves. Children can be as severely affected as adults. If you recognise it, you will be better able to help your child to recover, and also to know when to seek professional help.

Individual children react in different ways to traumatic events. How they react may also depend on their age. Immediately after the traumatic event, children may find it hard to sleep and have bad dreams and nightmares. Sometimes, the effects may not appear for days or weeks. Children may, however:

• become fearful, clingy and anxious about being separated from their parents;
• start bedwetting and thumb-sucking again;
• become preoccupied with thoughts and memories of the event;
• be unable to concentrate;
• be irritable and disobedient;
• complain of physical symptoms such as headaches and stomach-aches.

All these are normal reactions to an extremely frightening event. With help and support from the people close to them, children begin to get over the shock in a few days, and usually recover after a few weeks.

Sometimes a child has feelings of depression and anxiety that go on for several weeks and may get worse. If they go on for a long period of time, it is likely that the child may need some help to feel better.

If the traumatic experience was so bad that the child was in danger of being killed or seriously injured, they may have felt terrified, horrified and helpless. Post-traumatic stress disorder (PTSD) might follow a dreadful experience of this sort. It is difficult, however, to make a diagnosis in a child under the age of 7 years.

Some of the typical signs of PTSD are:

• 'Flashbacks’ of the event. For a few moments, it seems as though they are re-living the experience in your mind, like watching an action-replay, which can be distressing and frightening - particularly for children.
• Deliberately avoiding thoughts or feelings about it. If they have been in a car crash, you may avoid roads, or even TV programmes about cars because it reminds them of the accident.
• Sleeping badly.
• Being easily startled and appearing frightened at the slightest noise.

These reactions can go on for months, and can interfere considerably with a child's daily living. They may be unable to enjoy playing or find it difficult to concentrate on their school work. Occasionally, these problems can continue as the child grows into adulthood.

The best approach, immediately after a traumatic event, is to accept that a child will be distressed - this is normal. At this stage, parents can help greatly by letting their child talk about the event if they want to, or helping them to relive it in games and drawings.

Leaving children alone ‘to forget things’ does not help. Talking can help children to adjust. It helps them to make sense of what has happened, to feel less alone with their worries and to regain a sense of control. However, forcing someone to talk about it, when they don't want to, does not seem to be helpful.

If you have been involved in the traumatic event, you may also be distressed. It is usually better to admit to your children that you are feeling sad and upset. At the same time, you need to make it clear that you don't expect them to look after your feelings. If you recognise that you have symptoms of PTSD then get help. Your child will manage their feelings and emotions better if you are not feeling fearful or anxious yourself.

Sometimes, children find it easier to talk to other adults rather than their parents. Professional help may be needed to help get them get back to normal more quickly, and to prevent or reduce the harmful effects of prolonged stress reactions.

Ask for help if:

• the child's upset feelings and behaviour seem to be getting worse
• the signs of extreme stress last for longer than about one month
• worries prevent you, your child or your family getting on with normal, everyday life
• the child has symptoms of PTSD that go on for longer than a month.

If you are concerned about your child at any time following a traumatic event, consult your GP who will be able to offer you help and support. If problems continue, the doctor may suggest extra help from the local child and adolescent mental health service (CAMHS).

If you have been involved directly in a community disaster, special support services may be arranged. Do not hesitate to make contact with them if you want to talk over your worries.

We had a car crash 3 months ago. This other car was on the wrong side of the road and ran into us. Luckily, we were ok, but the man in the other car was hurt really badly.

At first, I was still myself afterwards. But after a few weeks, I stopped sleeping properly. I’d have really bad dreams about the crash; I’d see the other car all mashed up and the man inside covered in blood. Sometimes, I’d see the same thing but while I was awake. I couldn’t sleep on my own anymore and had to go into Mum and Dad’s bed ‘cos I was so scared; I hadn’t done that since I was tiny.

I became really frightened, especially about cars and roads. I couldn’t go anywhere in the car, even if it was Mum or Dad driving, and then even walking on the pavements felt scary. It meant it was really difficult to get to school and I missed a lot of my lessons.

Mum spoke to Miss Reilly, my Head of Year, and took me to see the doctor. The doctor said she thought I’d become really frightened because of the crash and that talking to someone might help. She sent me to see Clare; Mum says she’s a psychologist. I’ve seen Clare 6 times now, I go every week.

Sometimes Mum and Dad come too. We talk and also do stuff outside, practical stuff Clare says will help me be less frightened about cars and roads. I do get scared when we go out of her office and onto the pavement, but she talks me through it and we stay outside until I feel ok again.

I’ve not been in a car yet – that feels too scary at the moment, but I am doing better than I was, so it might not be too long. Miss Reilly has given me work to do at home and I’m planning to try to go back to school after half term, maybe just a few hours each day at first. Clare says it’s better to do things like that step by step.

• CRUSE Bereavement Care - helpline 0870 167 1677; for young people freephone 0808 808 1677.
• Samaritans - provide a 24-hour service offering confidential emotional support to anyone who is in crisis. Call 116 123 or email: jo@samaritans.org
• Victim Support - helping people to cope with crime. Supportline 0845 303 0900

References

Rutter, M. & Taylor, E. (eds) (2002) 'Child and Adolescent Psychiatry' (4th edn). London: Blackwell.

Credits

Revised by the Royal College of Psychiatrists’ Child and Family Public Engagement Editorial Board (CAFPEB).

With grateful thanks to Dr Margaret Bamforth., Dr Virginia Davies, Dr Vasu Balaguru, and Thomas Kennedy.

This resource reflects the best possible evidence at the time of writing.