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 keeps having scary thoughts and memories of a past event. They find 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 long-term (chronic) problem.

PTSD may be accompanied by:

• Depression
• Substance abuse
• Anxiety

A traumatic 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 traumatic 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 and war
• Violent personal attacks, such as a mugging, rape, torture, or kidnapping
• Physical abuse
• Sexual assault
• Sexual abuse
• Emotional abuse or bullying
• Neglect

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 recover quickly from difficult things (resiliency)
• How well the child copes
• How supportive a child’s family and community are after the event
• How much ongoing community or neighborhood violence the child experiences

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 grouchy
• 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
• Reenact an event for seconds or hours or, in rare cases, 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

Not every child or teen who goes through a trauma gets PTSD. PTSD is diagnosed only if symptoms keep happening for more than 1 month and are negatively affecting the child’s life and how they function. 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. They will do a mental health evaluation.  

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

PTSD can be treated. Early diagnosis and treatment are 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 their 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's also affected by the level of family support. Parents play a vital role in treatment.

These measures may help prevent PTSD in children:

• Teach children that it's OK to say no to someone who tries to touch their body or make them feel uncomfortable.
• Encourage prevention programs in your community or local school system.
• Decrease the impact of unavoidable disasters, like earthquakes, by practicing disaster response drills in homes and schools

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

• Admit that the event happened. Pretending everything is normal won't help your child.
• Be supportive and get counseling for children and teens who have seen or gone through a traumatic event. A child or teen may at first not want counseling. But it may be needed months or even years after the traumatic event.
• Keep all appointments with your child's healthcare provider.
• Talk with your child’s healthcare provider about other providers who will be included 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 what your child needs and how serious the PTSD is.
• Tell others about your child’s PTSD. Work with your child’s healthcare provider and school to create 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. Get treatment now. Suicide is a health emergency.

Call your child's healthcare provider right away if your child:

• Feels extreme depression, fear, anxiety, or anger
• Expresses thoughts of self-harm
• 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 get help

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

Call 988 in a crisis

Call or text 988 if your child has thoughts or a plan to harm themselves and the means to carry out the plan. Don't leave your child alone, even for a moment. When you call or text 988, you will be connected to trained crisis counselors at the 988 Suicide & Crisis Lifeline. An online chat choice is also available at www.988lifeline.org. Lifeline is free and available 24/7.

If your child is older, make sure they have emergency numbers in their phone. These include parents, other trusted adults, their healthcare provider, and the 988 Suicide & Crisis Lifeline. Help your child understand that reaching out for help is the most courageous thing to do if they are thinking about self-harm.

• PTSD is a mental health problem. A child with PTSD may have constant, 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. They are at higher risk for other mental health problems such as depression, anxiety, and suicidal thoughts.
• Call or text 988 if your child has thoughts or plans to harm themselves or others and a means to carry out the plan.

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 healthcare provider after office hours. This is important if your child becomes ill and you have questions or need advice.