By: Brooks Keeshin, MD, FAAP
PTSD was once seen as something that only combat veterans and war refugees might struggle with. But new research shows that people of all ages can experience PTSD, even young children.
Kids may develop PTSD in response to any one-time or repeated traumas that threaten their sense of safety and security. This could be a single traumatic event like a car crash or sexual assault, or a long series of traumas. Many kids develop PTSD in response to ongoing
violence or conflict.
PTSD can also develop when children witness traumatic events or situations, even though they were not injured or directly involved in what happened. For example, a child who witness a shooting may show symptoms of PTSD.
Here's what parents and caregivers need to know about PTSD, and what to do if you believe your child is suffering from it.
Understanding what PTSD is (and isn't)
People sometimes joke about "having PTSD" when they're feeling frustrated by a problem that keeps cropping up in their lives. But in reality, PTSD is a serious, life-changing condition that requires medical treatment.
Children who live with PTSD may struggle with the everyday rhythms of school, sports, friends, family and community. But signs and symptoms may vary, depending on the child's age.
A primary type of symptom children and adolescents may experience are memories, flashbacks or nightmares after the event. They may also become distressed emotionally and physically when they're reminded of they scary event. Kids and teens between 7 and 18 may also have flashbacks and other
adult symptoms of PTSD.
Younger children may not describe their memories, but instead might reenact trauma during playtime. For example, they may be more likely to play with fake guns after witnessing a shooting or crash their toy cars after surviving a scary accident. Of course, the way a child plays with toys does not always confirm that they have PTSD, but this is one potential sign of the disorder.
What other signs suggest a child may have PTSD?
Children and teens living with PTSD may suffer from several symptoms at once, including:
Disrupted sleep, often with
nightmares or night terrors
Agitation, confusion, anger or irritability
Sudden or extreme emotional reactions
Difficulty concentrating and thinking clearly
Loss of interest in things they once loved
Return to behaviors from an earlier life stage (thumb-sucking, clinging to parents and caregivers, or needing extra help with simple tasks)
Kids with PTSD often become
hypervigilant, constantly scanning their surroundings for possible dangers. Teens may be especially prone to risky behaviors such as
substance use or
What kinds of trauma can cause PTSD in children?
Children and teens can develop PTSD in the wake of experiences such as:
Serious car, train or plane accidents
bitten or attacked by a dog or other animal
Being diagnosed with a life-threatening health condition
Invasive medical procedures, especially in children 6 and younger
Natural disasters such as floods, hurricanes or wildfires
Man-made disasters such as
war, bombings or terrorist acts
Violent personal attacks, including shootings, kidnapping or being held captive
Physical or emotional abuse at home, school or in the community
Rape, sexual assault or
Bullying or emotional abuse
Getting trapped or locked in a small space
Being separated from parents or caregivers without knowing what will happen next
Why do some traumatized children develop PTSD and others don't?
A child's risk of developing PTSD depends on several factors, including:
The perceived seriousness of the trauma. Children who develop PTSD after being bitten by a dog may recover more quickly than those who have been kidnapped or sexually abused. That said, each child's experience is unique, and their reactions will vary.
The frequency of the trauma. Children who have been traumatized over and over again may react very differently from those who experienced a single terrifying event.
The child's proximity to the trauma. Did bad things happen at home? Next door? At school? Or much farther away?
Relationship with the victim. Kids who are direct victims of trauma may face much higher risks of developing PTSD than those who only witness traumatic events. However, children who see or hear painful things may feel ashamed that they couldn't do anything to stop them or help the victims. Blame, shame and guilt will be a greater burden for kids who have
witnessed violence or abuse of a parent, sibling or close
Can childhood PTSD show up long after a traumatic event?
Yes. In fact, children may react to trauma 6 months or more after it happens—or, in the case of ongoing trauma, even years after the fact. This may reflect the brain’s effort to manage or suppress overwhelming memories and the emotions associated with them.
As they grow and develop, children may think differently about earlier experiences. For example, a 7-year-old who suffers sexual abuse but shares this with a responsible adult and receives treatment may appear to recover fully at the time. But later, as a teenager, they may recall the abuse and feel troubled in new ways—a sign that more trauma-focused therapy is needed to help them cope with new or increased trauma symptoms.
Is there a good way to explain PTSD to a very young child?
Your pediatrician can help you talk with your child about their symptoms and treatment. What matters most is reassuring your child that they haven't done anything wrong. Something bad happened to them, and their brain is trying to make sense of it.
Your child may feel comforted to know that their brain is working hard to help them cope. You might say, "Our brains are really good at keeping us safe when we are in danger. But later on, when we're safe again, our minds might not fully realize that. Feeling like we're always in danger is really uncomfortable, but there are ways to help the brain work the way it did before the bad thing(s) happened."
How can I get treatment for a child who has PTSD?
The first step is to speak with your child's pediatrician, who can link you with a trauma-informed mental health specialist in your area. Seeking a referral is important, since not all therapists specialize in treating trauma. Your child will need to be evaluated to determine if PTSD is causing their symptoms, and whether there are other issues that should be addressed.
We are learning a great deal about the value of
trauma-informed care. Trauma-informed care begins with a close look at the difficult experiences a child has endured, and the way those experiences are affecting them. This helps determine the right care
team to provide treatment and support for the child and family.
PTSD is often treated with a blend of talk therapy and social support. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is one of the best studied and most widely available PTSD treatments for children and adolescents. In rare circumstances, medications might be prescribed, usually to help with PTSD-related sleep problems that therapy does not seem to resolve.
Are there other ways to help my child recover from PTSD?
The love and care you show your child while they work their way through treatment will make a healing difference. Here are a few tips to follow and share with other adults in your child's life.
Be patient. Keep in mind that your child will not feel better right away. The brain is an incredibly complex system that requires time to recover and redirect itself after a painful event. Even more time and treatment may be needed if your child endured a long series of traumatic experiences. It's natural to want quick relief, but remind yourself that healing must happen on its own schedule.
Be extra supportive. Your child needs warmth and constant reassurance that you love them, trust them and will support them. Let them know you will do everything possible to help them feel safe and secure.
Validate their feelings. Avoid downplaying the trauma or suggesting that your child will "get over it" soon. Accept the emotional truth of their feelings and reactions. Kids need to know you won't judge them or resent the extra time and care they need from you right now.
Advocate for them. Ask friends, family members, teachers, coaches and neighbors to provide non-judgmental support. If someone is saying unkind things, don't be afraid to issue a gentle challenge: "I know this can be confusing, but my child has been through a lot. I am asking you to show compassion, because I know you care about them."
Respect their need for privacy. Older children and teens with PTSD may feel even more reluctant to talk about their feelings than younger children. They may worry that others will see them as "weird," "creepy" or "crazy." Allow them the extra space they may need right now, while making sure they know your door is always open. If you sense your child is feeling embarrassment or shame, learn more about ways to cope with
self-stigma and, as appropriate, share these strategies with your child.
Offer helpful information to others. Many of the people in your child's life may struggle to grasp what's going on. Sharing this article may help you explain how PTSD works. This can build a broader base of support for your child, so don't be afraid to offer resources to grandparents, aunties and uncles, close friends and others who are close to your child.
4 facts to remember about PTSD
PTSD is a sign that the brain is struggling to recover from a deeply disturbing event. Like all serious health conditions, it will take time to heal.
There is no shame in having PTSD. This is a serious health condition that can affect anyone who has endured trauma. Remind yourself that this is an organic brain condition, not something you have to hide from others. This will help you seek out the treatment your child needs.
Children can and do recover. We have effective ways to treat PTSD and more helpful knowledge is being revealed all the time. There is hope that your child will recover and thrive.
Your pediatrician is ready to help. So don't wait to get the resources you and your child need. Make the call today.
About Dr. Keeshin
Brooks Keeshin, MD, FAAP is a child abuse pediatrician and child psychiatrist at the University of Utah. He provides care for children who have experienced trauma at Primary Children’s Center for Safe and Healthy Families. He also directs Pediatric Integrated Post-trauma Services, a Category II Center of the Nation Child Traumatic Stress Network. Within the American Academy of Pediatrics, Dr. Keeshin is a Council on Child Abuse and Neglect member and currently serves on the Executive Committee of Council on Healthy Mental and Emotional Development.