||What are the long term effects of traumatic
What is 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
What are the signs
of traumatic stress?
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
- start bedwetting and thumb-sucking again;
- become preoccupied with thoughts and memories of the
- be unable to concentrate;
- be irritable and disobedient;
- complain of physical symptoms such as headaches and
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
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
- '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
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.
What can help?
When should I seek help?
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
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
Ask for help if:
- the child's upset feelings and behaviour seem to be getting
- the signs of extreme stress last for longer than about one
- 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
Where can I get help?
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
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
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
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
Rutter, M. & Taylor, E.
(eds) (2002) 'Child and Adolescent Psychiatry' (4th edn).
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
© Royal College of Psychiatrists March 2017
Due for review March 2020