Skip to main content
Home
Pediatric Medical Traumatic Stress
  • Home
  • Trauma-informed pediatric care

    What is Pediatric Medical Traumatic Stress?

    • The basics
    • Prevalence & course
    • Traumatic stress symptoms
    • Risk factors
    • Understanding the family's experience
    • Key research findings

    How to Provide Trauma-Informed Care

    • The basics
    • D-E-F framework
    • Levels of risk and trauma-informed care
    • Timeline for trauma-informed care
    • Referral to mental health care
    • Addressing health disparities
    • Developmental considerations
    • Cultural considerations

    Self Care & Secondary Trauma

    • The basics
    • Self care tips
    • Organizational support
  • Find information for..
    • The healthcare team
    • Physicians-PAs-NPs
    • Nurses
    • Pre-hospital providers
    • Medical interpreters
    • Mental health professionals
    • Child welfare professionals
    • Child Life Professionals
  • Professional Education
    • Take a Free Online Course
    • Other education resources
  • TICKET
  • Find Tools and Resources

    Patient Education

    Patient Education

    • For parents & caregivers
    • For children & teens

    Screening & Assessment

    Screening & Assessment

    • The basics
    • Find screening & assessment tools
    • Screening after pediatric injury
    • Psychosocial Assessment Tool (PAT)
    • Acute Stress Checklist (ASC-Kids)
    • Family Illness Beliefs Inventory (FIBI)

    Intervention

    Intervention

    • The basics
    • Surviving Cancer Competently (SCCIP)
    • Cellie Coping Kit

    Trauma-Informed Care

    Trauma-Informed Care

    • The basics
    • TIC Provider Survey
    • Observation Checklist - Pediatric Resuscitation

    COVID-19

    COVID-19

    • COVID-19
    • Resources for healthcare staff
    • COVID-19 Exposure and Family Impact Scales (CEFIS)
    • Helping my child cope

    Resources

    Resources

    • More resources
    • More resources
  • For Patients and Families
    • Coping with injury or illness
    • Sleep
    • Pain
    • Behavior
    • Worries & fears
    • Quiet or withdrawn
    • School
    • Siblings
    • Parents
    • Need more help?
    • Family voices

Traumatic stress symptoms - what to look for

Most health care providers are familiar with ways that children and family members may show stress. Traumatic stress reactions go beyond usual stress reactions. At times, these reactions are triggered by reminders or thoughts of the traumatic experience. Sometimes the trigger is not so obvious, such as a sight, smell, or sound that the person is not even aware is a reminder.

There are four main types of traumatic stress symptoms: re-experiencing, avoidance, changes in cognition (thinking) and mood, and hyper-arousal.

Re-experiencing

What to look for
  • Thinking a lot about the illness, injury, or procedure (unwanted, intrusive thoughts)
  • Feeling distressed at thoughts or reminders of it
  • Having nightmares and "flashbacks"
Examples of re-experiencing symptoms
  • Intrusive thoughts / memories: "The image of my son getting a spinal tap frequently pops into my mind."
  • Feeling the event is recurring: "At least once a day, I have a flashback to the accident. It's like it's happening all over again."
  • Distress at reminders: "To this day, I still can't stand the antiseptic smell of hospitals" OR "My heart races every time I hear a siren."
  • Distressing dreams: "The other day I dreamed that I was in the woods lost, and the doctors and nurses were hiding behind some trees."

Avoidance

What to look for
  • Avoiding thoughts or feelings about the illness, injury, or hospital experience, or things associated with it
  • Avoiding places or activities that are reminders of the illness/ injury/ hospital experience
Examples of avoidance symptoms
  • Avoidance thinking: "I block it out, try not to think about when I was in the hospital."
  • Avoidance of places/activities: "I try to stay away from things that remind me of the time I was sick."

Changes in cognition (thinking) and mood

What to look for
  • Exaggerated negative thoughts about self, others, the world
  • Pervasive negative emotions: fear, anger, guilt, shame
  • Numbness or detachment from emotions, especially positive emotions
Examples of changes in cognition and mood
  • Exaggerated negative thoughts: "I will never get over this." "The world is a totally dangerous place."
  • Numbness / detachment: "Since this happened, I just don't feel anything anymore."

Hyper-arousal

What to look for
  • Increased irritability
  • Trouble concentrating or sleeping
  • Exaggerated startle response
  • "Hypervigilance" - always expecting danger
Examples of hyper-arousal symptoms
  • Hypervigilance: "I know the doctors say we are in the clear, but I take my daughter's temperature every day. I am always afraid something bad will happen."
  • Exaggerated Startle: "I jump at any loud noise."
  • Difficulty Sleeping / Concentrating: "Most nights, I toss and turn and just can't get to sleep." "It's just impossible to keep my mind on things."
field_image
Quick links
  • About Us
  • Ethics & Compliance
  • Privacy Policy
  • Terms of Use
Quick Contact
  • cpts@chop.edu
  • 3401 Civic Center Blvd.
    Philadelphia, PA 19104

Subscribe to Health Care Toolbox

CHOP Nemours Logo UK Healthcare Logo NCTSN Logo Award 2012

© 2021 Children's Hospital of Philadelphia. All Rights Reserved.