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Trauma Informed Pediatric Care

"A-B-C" orients providers to the crucial first steps to save a life (Airway, Breathing, Circulation). "D-E-F" can help providers remember the key initial steps for children's emotional recovery from illness or injury.

Health care providers are experts in treating illness, restoring functioning, and saving lives. After attending to the basics of children's physical health (the A-B-C's), providers can promote their patients' health and recovery by paying attention to the next steps of trauma informed pediatric care - "D-E-F".


E-Emotional Support


The D-E-F protocol is designed as a practical tool to guide health care providers in implementing trauma-informed pediatric care by helping providers identify what they can do, as they take care of ill or injured children, to address and prevent traumatic stress responses.

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

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

DEF Protocol for Trauma-Informed Pediatric Care

Trauma Informed Pediatric Care: Addressing DISTRESS


  • Actively assess and treat pain.

Fear and anxiety

  • Minimize traumatic aspects of treatment / procedures.
  • Provide information and choices.
  • Listen carefully and clarify misconceptions.
  • Ask about fears and worries.
  • Provide reassurance and realistic hope.

Grief or loss

  • Ask about losses associated with this illness or injury.
  • Did patient witness / learn of injury or death of friends / family?
  • Consider need for bereavement support.

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Trauma Informed Pediatric Care: Addressing EMOTIONAL SUPPORT

Current emotional support: Who and what does patient need now?

  • Help child and parents identify support needs & effective coping strategies.
  • Empower parents to comfort and help their child.
  • Encourage child to stay in touch with friends.

Barriers to mobilizing existing supports?

  • Are parents able to be with child for procedures?
  • Are parents able to help calm and soothe child?
  • Do parents understand child's condition & treatment plan?
  • Are others in the child's / family's support system aware of current situation and able to help?

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Trauma Informed Pediatric Care: Addressing FAMILY

Assess family members' distress

  • Ask parents, siblings, other family members how they're doing.
  • Are any family members having an especially difficult time?

Gauge family stressors and resources

  • Help family identify strengths and coping resources.
  • Encourage parents to use their support systems.

Address other needs (beyond medical)

  • Ask about other current stressors that hamper family's ability to cope with child's illness / injury / hospital stay.
  • Connect family with appropriate support services.

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