Trauma Informed Pediatric Care

Health care professionals are experts in treating illness and injury, restoring functioning, and saving lives. But they may be less comfortable addressing the emotional and psychological impact of illness, injury, and medical treatment, or feel out of their depth when considering the impact of prior traumatic experiences on a child’s current medical care.


DEF Protocol for Trauma-Informed Pediatric Care


 Important reminders about children’s responses to medical events:

  • Many parts of the experience of illness, injury, and medical treatment have the potential to be traumatic for children of all ages.
  • Children’s traumatic stress responses to illness and injury can become persistent and problematic. Children may have upsetting thoughts they cannot stop, may try to avoid things that remind them of difficult parts of their experience, and may be irritable or have trouble sleeping. These responses can impact adherence to medical care, health outcomes, and quality of life.
  • Parents and siblings can also be affected. Some parents become hypervigilant for signs and symptoms the illness has returned or over their child’s safety. Siblings may worry in private about their brother or sister.
  • Culture can impact each child’s and family’s response to illness, injury, and medical treatment, as well as their response to adversity and trauma.
  • For pediatric patients, the risk of ongoing traumatic stress reactions is related to perception of life threat, pain, acute emotional distress in the child or parents, and by prior traumatic exposure (i.e. before this medical event).
  • Many of these risk factors can be modified or influenced during the process of pediatric care.

Providing trauma-informed pediatric care means that healthcare professionals bring a basic understanding of these key points about traumatic stress into their encounters with children and families. Trauma-informed practice can promote optimal health outcomes and reduce problematic psychological sequelae.


Why “D-E-F”?

"A-B-C" orients us to the crucial first steps to save a life (Airway, Breathing, Circulation).

After attending to the basics of physical health (the A-B-C's), use "D-E-F" as a reminder to address Distress, Emotional support, and Family needs as key elements of trauma-informed pediatric care.

D-E-F: Distress, Emotional Support, and Family Needs

The D-E-F protocol is a practical tool to guide trauma-informed pediatric care. The D-E-F framework helps health care professionals identify what they can do, within their own scope of practice, to address and prevent traumatic stress responses.

Click to explore how-to tips and case examples for:

D-E-F tools you can use

To implement trauma informed care with the D-E-F Protocol in your location, download the D-E-F cards, accompanying Nursing Assessment Form and User Guide:

D-E-F Pocket Cards with quick screening and intervention recommendations.

D-E-F Nursing Assessment Form

D-E-F Users Guide

D-E-F Poster

A D-E-F Users Guide, D-E-F cards, D-E-F Nursing Assessment, and D-E-F posters are available to order through the Center for Pediatric Traumatic Stress.



D-E-F and Trauma Informed Care: Learn More

Each and every doctor, nurse, or other healthcare professional a child and family comes in contact with has the opportunity to prevent, assess, and intervene in ways that can promote emotional recovery and resilience.

To build specific skills to implement the D-E-F Protocol at the bedside with your pediatric patients, register for free online continuing education courses available on this site.