Posttraumatic Stress Disorder (PTSD) in Children

What is posttraumatic stress disorder (PTSD) in children?

Posttraumatic stress disorder (PTSD) is a mental health problem. It can affect people of all ages. A child with PTSD has persistent, scary thoughts and memories of a past event. He or she finds the event terrifying, either physically or emotionally.

The symptoms of PTSD may start soon after a stressful event. Or they may not happen for 6 months or longer. Some children with PTSD have long-term effects. They may feel emotionally numb for a very long time. PTSD in children often becomes a chronic problem.

PTSD may be accompanied by:

• Depression
• Substance abuse
• Anxiety

What causes PTSD in a child?

An event that triggers PTSD may be:

• Something that happened to the child
• Something that happened to someone close to the child
• Something the child saw

A child or teen may suffer from PTSD after one of these events:

• Bad accidents, such as car or train wrecks
• Invasive medical procedures, especially for children younger than age 6
• Animal bites
• Natural disasters, such as floods or earthquakes
• Manmade tragedies, such as bombings
• Violent personal attacks, such as a mugging, rape, torture, or kidnapping
• Physical abuse
• Sexual assault
• Sexual abuse
• Emotional abuse or bullying
• Neglect

Which children are at risk for PTSD?

A child’s risk for PTSD is often affected by:

• How close the child was to the traumatic event
• How bad the event was
• How long the event lasted
• If the event happened more than once
• How well the child is able to bounce back, or recover quickly from difficult things (resiliency)
• How well the child copes
• How supportive a child’s family and community are after the event

What are the symptoms of PTSD in a child?

Children and teens with PTSD feel a lot of emotional and physical distress when exposed to situations that remind them of the traumatic event. Some may relive the trauma over and over again. They may have nightmares and disturbing memories during the day. They may also:

• Have problems sleeping
• Feel depressed or irritable
• Feel nervous, jittery, or alert and watchful (on guard)
• Lose interest in things they used to enjoy. They may seem detached or numb and are not responsive.
• Have trouble feeling affectionate
• Be more aggressive than before, even violent
• Stay away from certain places or situations that bring back memories
• Have flashbacks. These can be images, sounds, smells, or feelings. The child may believe the event is happening again.
• Lose touch with reality
• Re-enact an event for seconds or hours or, very rarely, days
• Have problems in school
• Have trouble focusing
• Worry about dying at a young age
• Act younger than their age, such as thumb-sucking or bedwetting
• Have physical symptoms, such as headaches or stomachaches

How is PTSD diagnosed in a child?

Not every child or teen who goes through a trauma develops PTSD. PTSD is diagnosed only if symptoms keep happening for more than 1 month and are negatively affecting the child’s life and how he or she functions. For those with PTSD, symptoms most often start within 3 months after the traumatic event. But they can also start months or years later.

A child psychiatrist or mental health expert can diagnose PTSD. He or she will do a mental health evaluation.  

How is PTSD treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.

PTSD can be treated. Early diagnosis and treatment is very important. It can ease symptoms and enhance your child’s normal development. It can also improve your child’s quality of life.

Treatment may include:

• Cognitive behavioral therapy. A child learns skills to handle his or her anxiety and to master the situation that led to the PTSD.
• Medicines for depression or anxiety. These may help some children feel calmer.

Recovery from PTSD varies. Some children recover within 6 months. Others have symptoms that last much longer. Recovery depends on the child’s inner strengths, coping skills, and ability to bounce back. It is also affected by the level of family support. Parents play a vital role in treatment.

How can I help prevent PTSD in my child?

These measures may help prevent PTSD in children:

• Teach children that it is OK to say no to someone who tries to touch his or her body or make him or her feel uncomfortable.
• Encourage prevention programs within your community or local school system.

How can I help my child live with PTSD?

As a parent, you play a key role in your child’s treatment. Here are things you can do to help:

• Be supportive and seek counseling for children and teens who have seen or gone through a traumatic event.
• Keep all appointments with your teen’s healthcare provider.
• Talk with your child’s healthcare provider about other providers who will be involved in your child’s care. Your child may get care from a team that may include counselors, therapists, social workers, psychologists, and psychiatrists. Your child’s care team will depend on his or her needs and how serious the PTSD is.
• Tell others about your child’s PTSD. Work with your child’s healthcare provider and school to develop a treatment plan.
• Reach out for support from local community services. Being in touch with other parents who have a child with PTSD may be helpful.
• Take all symptoms of depression and suicide very seriously. Seek treatment right away. Suicide is a health emergency.

When should I call my child’s healthcare provider?

Call your healthcare provider right away if your child:

• Feels extreme depression, fear, anxiety, or anger toward him or herself or others
• Feels out of control
• Hears voices that others don’t hear
• Sees things that others don’t see
• Can’t sleep or eat for 3 days in a row
• Shows behavior that concerns friends, family, or teachers, and others express concern about this behavior and ask you to seek help

PTSD increases risk for other mental health disorders, including depression and suicidal thinking.

Call 911 if your child has suicidal thoughts, a suicide plan, and the means to carry out the plan.

Key points about posttraumatic stress disorder in children

• PTSD is a mental health problem. A child with PTSD has persistent, scary thoughts and memories of a past event.
• A traumatic event, such as a car crash, natural disaster, or physical abuse, can cause PTSD.
• Children with PTSD may relive the trauma over and over again. They may have nightmares or flashbacks.
• PTSD is diagnosed only if symptoms keep occurring for more than 1 month and are negatively affecting the child’s life.
• A child with PTSD may need therapy and medicine. Extra support and reassurance are important for children with PTSD.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.