Acute Stress Disorder Is Common Among Children and Parents Following
Pediatric Traffic Injury, According to Researchers at The Children's
Hospital Of Philadelphia
PHILADELPHIA, June
3 /PRNewswire/ -- In 90 percent of families with children injured in
a traffic crash, the child or a parent will suffer at least one significant
acute stress symptom, according to a study at The Children's Hospital
of Philadelphia. And 25 percent of children and parents experience more
pervasive symptoms that warrant clinical attention. Nancy Kassam-Adams,
Ph.D. and Flaura K. Winston, M.D., Ph.D., co-authors of the study in
the June 2002 issue of Pediatrics, offer guidelines for assessing acute
stress symptoms in children and parents.
"The study
investigated the range of acute stress symptoms in children and their
parents to enable pediatricians to better identify and address the psychological
impact of injury," said Dr. Kassam-Adams, associate director of
behavioral research, TraumaLink at Children's Hospital. "Evidence
about the prevalence of these symptoms in injured children can help
physicians distinguish between normal reactions to trauma and reactions
that require further care and follow-up."
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The study population
included 97 children who were admitted to The Children's Hospital of
Philadelphia for traffic related injuries between July 1999 and May
2000. The children had been injured in a traffic crash in which the
child was a passenger, a pedestrian, or a bicyclist.
"A key component
to assessing acute stress is that pediatricians understand how both
parents and children respond to a child's injury," states Dr. Winston,
director of TraumaLink. "It is normal for parents to be very distressed
in the aftermath of a child's injury, yet parents' own acute stress
symptoms may influence a child's response to the traumatic event."
Acute stress disorder
is a group of symptoms and reactions that may occur within the first
month after a traumatic experience. ASD symptoms include re-experiencing
the trauma (unwanted and upsetting thoughts or memories), avoiding reminders
of the trauma, hyperarousal (jumpiness), and dissociation (numbing,
feelings of unreality).
Post-traumatic stress
disorder (PTSD) is diagnosed when these symptoms persist for a long
time (at least one month) and begin to impair the individual's everyday
functioning. Prior research indicates that even children with minor
injuries from a traffic crash are at risk for developing PTSD, say Dr.
Kassam-Adams and Dr. Winston. For adults, ASD symptoms soon after a
traumatic event are a warning sign for developing PTSD. However, there
has been little research available for pediatricians about ASD symptoms
and later PTSD in injured children.
The Children's Hospital
researches found that acute stress symptoms were common within the first
month after injury. Among injured children and their parents, more than
four-fifths experienced at least one significant acute stress symptom.
About one quarter of children and parents experienced broad acute distress,
reporting symptoms of dissociation, re-experiencing, avoidance, and
hyper-arousal. Forty percent of the families were affected by these
more pervasive acute stress symptoms, with the injured child, the parent,
or both reporting broad distress. Symptoms did not always co-occur in
both parent and child.
"We need to
identify effective ways for health care providers to support distressed
parents, so that parents in turn can most effectively help their child
to cope with a traumatic injury," stated Dr. Kassam-Adams.
The research outlined
in the Pediatrics article has immediate implications for clinical practice,
particularly regarding parent education and supportive care for families.
The researchers offer these recommendations for pediatricians and other
primary care providers treating a child who is injured in a traffic
crash:
Routinely call
the family several days and one to two weeks following the injury
to ask about behavioral symptoms and family function.
Make use of the
ongoing physician-patient relationship to explore acute stress symptoms
and any functional impairment in the injured child. A brief office
visit with the child and parents could serve this purpose.
Explore the effect
of the child's injury on the family. Remember that parents can experience
acute stress symptoms following pediatric traffic injuries and these
symptoms may limit the parent's ability to support the child.
Provide supportive
care and encourage families to discuss the crash and their current
feelings.
Provide a referral
for further assessment and psychological care when a child's (or parent's)
acute stress symptoms last for more than one month or impair everyday
functioning.
The study, funded by the Maternal and Child Health Bureau, is part of
the Child and Adolescent Reactions to Injury and Trauma Research Program
at TraumaLink, an interdisciplinary pediatric trauma research center
at The Children's Hospital of Philadelphia.
Founded in 1855
as the nation's first pediatric hospital, The Children's Hospital is
recognized today as one of the leading treatment and research facilities
for children in the world. Through its longstanding commitment to providing
exceptional patient care, training new generations of pediatric healthcare
professionals and pioneering major research initiatives, Children's
Hospital has fostered medical discoveries, innovations and breakthroughs
that have benefited children worldwide.
