Child trauma occurs more than you think. More than two thirds of children reported at least 1 traumatic event by age 16. Potentially traumatic events include:

• Psychological, physical, or sexual abuse
• Community or school violence
• Witnessing or experiencing domestic violence
• National disasters or terrorism
• Commercial sexual exploitation
• Sudden or violent loss of a loved one
• Refugee or war experiences
• Military family-related stressors (e.g., deployment, parental loss or injury)
• Physical or sexual assault
• Neglect
• Serious accidents or life-threatening illness

Fast Facts

At least 1 in 7 children have experienced child abuse and/or neglect in the past year, and this is likely an underestimate. In 2019, 1,840 children died of abuse and neglect in the United States.

Each day, more than 1,000 youth are treated in emergency departments for physical assault-related injuries.

In 2019, about 1 in 5 high school students reported being bullied on school property in the last year.

8% of high school students had been in a physical fight on school property one or more times during the 12 months before the survey.

Each day, about 14 youth die from homicide, and more than 1,300 are treated in emergency departments for violence-related injuries.

It’s important to recognize the signs of traumatic stress and its short- and long-term impact.

The signs of traumatic stress may be different in each child. Young children may react differently than older children.

Preschool Children

• Fear being separated from their parent/caregiver
• Cry or scream a lot
• Eat poorly or lose weight
• Have nightmares

Elementary School Children

• Become anxious or fearful
• Feel guilt or shame
• Have a hard time concentrating
• Have difficulty sleeping

Middle and High School Children

• Feel depressed or alone
• Develop eating disorders or self-harming behaviors
• Begin abusing alcohol or drugs
• Become involved in risky sexual behavior

The Body's Alarm System

Everyone has an alarm system in their body that is designed to keep them safe from harm. When activated, this tool prepares the body to fight or run away. The alarm can be activated at any perceived sign of trouble and leave kids feeling scared, angry, irritable, or even withdrawn.

Healthy Steps Kids Can Take to Respond to the Alarm

• Recognize what activates the alarm and how their body reacts
• Decide whether there is real trouble and seek help from a trusted adult
• Practice deep breathing and other relaxation methods

Impact of Trauma

The impact of child traumatic stress can last well beyond childhood. In fact, research has shown that child trauma survivors may experience:

• Learning problems, including lower grades and more suspensions and expulsions
• Increased use of health and mental health services
• Increase involvement with the child welfare and juvenile justice systems
• Long-term health problems (e.g., diabetes and heart disease)

Trauma is a risk factor for nearly all behavioral health and substance use disorders.

There is hope. Children can and do recover from traumatic events, and you can play an important role in their recovery.

A critical part of children's recovery is having a supportive caregiving system, access to effective treatments, and service systems that are trauma informed.

Not all children experience child traumatic stress after experiencing a traumatic event. With support, many children are able to recover and thrive.

As a caring adult and/or family member, you play an important role.

Remember To:

• Assure the child that he or she is safe.
• Explain that he or she is not responsible. Children often blame themselves for events that are completely out of their control.
• Be patient. Some children will recover quickly while others recover more slowly. Reassure them that they do not need to feel guilty or bad about any feelings or thoughts.
• Seek the help of a trained professional. When needed, a mental health professional trained in evidence-based trauma treatment can help children and families cope and move toward recovery. Ask your pediatrician, family physician, school counselor, or clergy member for a referral.

Childhood traumatic stress occurs when violent or dangerous events overwhelm a child’s or adolescent’s ability to cope.

Traumatic events may include:

• Neglect and psychological, physical, or sexual abuse
• Natural disasters, terrorism, and community and school violence
• Witnessing or experiencing intimate partner violence
• Commercial sexual exploitation
• Serious accidents, life-threatening illness, or sudden or violent loss of a loved one
• Refugee and war experiences
• Military family-related stressors, such as parental deployment, loss, or injury

In one nationally representative sample of young people ages 12 to 17:

• 8% reported a lifetime prevalence of sexual assault
• 17% reported physical assault
• 39% reported witnessing violence

Also, many reported experiencing multiple and repeated traumatic events.

It is important to learn how traumatic events affect children. The more you know, the more you will understand the reasons for certain behaviors and emotions and be better prepared to help children and their families cope. Learn more about the types of trauma and violence and types of disasters.

Community violence includes many events. It might be a stranger using physical threat or direct violence to take something or hurt someone. It can also be violence between family members, close partners, or peers. These events may include cruel acts such as being shot, raped, stabbed, or beaten.

Most of the attention from media and research is on community violence that involves adults. However, many children and teens face violence in their neighborhoods and schools. Such violence can have effects on children.

How Much Community Violence Do Children Face?

Many people think that community violence only happens in gangs and inner cities. It is true that people who are poor, non-White, and living in crowded inner-city areas deal with a lot of violence. Community violence also occurs, though, in White, middle-class areas, both suburban and rural. All kinds of youth are at risk for community violence.

Over one-third of girls and boys across the country ages 10 to 16 years are victims of direct violence. Direct violence includes attempted kidnapping, physical and sexual assault. Even more children have faced indirect community violence. That is, they have seen violence or they know a victim of community violence.

In one study, over three-quarters of children in a high-violence urban area reported coming into contact with community violence. Of note, more than half of the parents said that their children had not been exposed to violence in the community.

Who Is at Risk?

Sadly, there is no way to make sure your child does not face community violence. However, we do know some of the factors that add to a child's risk for coming into contact with community violence:

• Living in poor, inner-city areas.
• Being non-White.
• Being in a gang or using alcohol or drugs.
• Living in a home with domestic (family) violence.
• Males see more community violence than do females and are at more risk for physical attacks.
• Females are at more risk for sexual assault.

What Are the Effects of Community Violence?

If hurt by violence, a child may have to cope with physical or medical problems. A child may also have mental health problems, including PTSD. Some people think that young children are not harmed by community violence because they are too young to understand or remember. However, studies have found signs of PTSD in babies and young children.

A child's exposure to community violence affects the whole family. Parents are often very worried about their child's health and well-being. If resources and help are limited, parents can become angry. As a parent, you might blame yourself for not being able to keep your child safe. You may even become too protective. Parents sometimes use harsh discipline when the child acts out, even though the child's behavior is related to a trauma. Relations among family members can become strained. Parents are trying to comfort their child while at the same time trying to handle their own fears. This is hard, even more so if they live in an area where violence is common.

What Can We Do?

Children can be helped. The best thing for a child is a caring adult. If a child is touched by violence, spend time with the child. Be sure the child understands that you are there to listen. Help the child talk about the trauma, but do not make him or her talk. Answer questions honestly using words that your child understands.

Try to understand that children may have new problem behaviors as a result of the trauma. These behaviors need your patience and understanding. Ask for help from friends, family, and medical and mental health experts for you and your child.

Prevention programs are also important to keep community violence from happening. This involves gang prevention. Also, programs can help children and teens at risk for violence learn how to peacefully solve problems. These programs work better if they happen before age 6 years. They are also better if they are taught in the children's homes and schools. Programs should also try to prevent high-risk behaviors such as alcohol and drug use and carrying weapons.

School shootings can erode the sense of safety and security people usually feel. This is true at both an individual and community level. These sudden, tragic events challenge our need to see the world as orderly and controllable. People in the affected communities are forced to adapt to extreme loss or disruptions to their lives. Even those who live far away may find themselves feeling fear, anger and loss.

There are elements that research tells us are related to people doing better through adverse situations. With these 5 elements, you can choose the actions that can help you and your family better cope after a school shooting:

• Increase sense of safety
• Increase calming
• Connect with each other
• Build personal and family competence
• Foster hope

How to Apply the 5 Elements

You can modify these elements based on many factors, including the level of disruption in your life and the age of children in the home. Using them as a guide can help you create your own ways to help your family cope.

Pick some of the following ideas within each of these 5 elements or develop your own. Using them can help your family work through the challenges you are facing. If anyone is having a very hard time and needs more help, know that there are resources available to support recovery.

Increase sense of safety

When families don't feel safe it can feel overwhelming. School shootings can result in an ongoing sense of being threatened, so it is important to increase your sense of safety. It is helpful to give consistent safety messages to your family, such as:

• "We will get through this together."
• "No matter what happens, we will do what we need to do to take care of each other."

Some people feel safer by becoming involved in change efforts, activism or community programs that increase safety. For others, it may be more important to focus on what is in their capacity to control, even if those things seem like small actions.

Increase calming

School shootings can cause anxiety. People may have trouble thinking clearly or sleeping soundly. It is important to help yourself and your family find ways to take breaks and calm down, even momentarily.

• Offer simple calming strategies such as slowed, even breathing, talking through concerns, finding distractions (with books, videos or anything that can take your mind off what is happening), and taking short breaks.
• Try noticing and naming your feelings. Ground your attention by focusing on what you can see, feel and hear in the current moment.
• Understand that feelings such as sadness, anxiety and fear are common and that it's okay to talk about them.
• Think about limiting activities that trigger anxiety—such as checking the news—even if you think they are helpful.

Do your best to let family know that their well-being is one of your priorities. Keep to a routine. Structure helps younger children know what to expect and can be calming. Consider scheduling into your day shared activities that have meaning for your family.

Connect with each other

Be dedicated about connecting with loved ones within and outside the immediate family. Include family members who don't live in your home to make the circle wider.

Build personal and family competence

There are many ways to build competence and develop skills that can help you get through your current challenges. For instance, involve the family in a problem-solving approach to challenges, where you talk through problems; break them down into smaller chunks; brainstorm creative solutions together; negotiate the solutions that will work best for everyone; and take small, steady steps towards your goals.

Role-model competence. Demonstrating patience with yourself will show your children how to do the same. Just being your best self—whatever that best self is in that moment given the circumstances—will inspire others. As you strive to do your best remember to keep your expectations realistic. A crisis can make it hard to keep up our usual standards in what we think, feel, or do. You may need to adapt your expectations of what a good day is, and of what you demand from yourself.

Foster hope

It is natural that families may be scared, in shock, angry, sorrowful or discouraged following school shootings. This is particularly true for those in the communities where the violence took place. Focusing on the ways you and your family are safe or strong can help to foster hope. You can also discuss positive things that you see others doing, ways you believe that the situation will become better with time, or ways in which you are grateful. Ask others in your life to share how they have maintained hope or seen things from a more hopeful perspective. Highlight that many people are working hard to keep schools safe and help people recover.

Many people turn to their values or beliefs as a way to make meaning or raise hope in a difficult time. For some, that might mean helping others or engaging in protest and activism. Others who have faith in a higher power spend more time in activities that foster those beliefs, like prayer, meditation, reading or reflection. Researchers have found that resilient families share open communication about feelings, engage in group problem-solving, make meaning in the face of adversity, share their hopes in overcoming challenges, encourage each other, and work to tolerate uncertainty. They also find ways to transform adversity through beliefs, positive growth, spirituality or religion.

Summary

The strategies you choose can make a difference in maintaining hope, ability to endure, connectedness, ability to remain calm, and sense of safety. As you practice these actions, adapt them to your current circumstances. Do your best from moment to moment and remember that you don't need to be perfect or steady at all times. Try to be kind to yourself and remember that anything you do to role model these strategies will help your children grow and be able to help others as friends or caregivers themselves.

People who are more directly affected by the shooting or those with previous histories of trauma or prior mental health conditions may need to get more tailored or individual support. Meeting with others who have faced similar challenges can help, however, mental health treatment may also be needed. If you feel very distressed or unable to function, contact a medical or mental health provider. There are effective treatments for acute stress disorder, PTSD, and complicated grief—all problems that can develop after a trauma. The sooner you get help, the sooner you will start to feel better.

Child sexual abuse includes a wide range of sexual behaviors that take place between a child and an older person. These behaviors are meant to arouse the older person in a sexual way. In general, no thought is given to what effect the behavior may have on the child. For the most part, the abuser does not care about the reactions or choices of the child.

Child sexual abuse often involves body contact. This could include sexual kissing, touching, and oral, anal, or vaginal sex. Not all sexual abuse involves body contact, though. Showing private parts ("flashing"), forcing children to watch pornography, verbal pressure for sex, and exploiting children as prostitutes or for pornography can be sexual abuse as well. Researchers estimate that in our country about one out of six boys and one out of four girls are sexually abused.

Under the child sexual abuse laws, the abuser must be older than the victim in most cases. Some states require the abuser to be at least five years older.

Who Commits Child Sexual Abuse?

• Most often, sexual abusers know the child they abuse, but are not family. For example, the abuser might be a friend of the family, babysitter, or neighbor. About 6 out of 10 abusers fall into that group.
• About 3 out of 10 of those who sexually abuse children are family members of the child. This includes fathers, uncles, or cousins.
• The abuser is a stranger in only about 1 out of 10 child sexual abuse cases.
• Abusers are men in most cases, whether the victim is a boy or a girl.
• Women are the abusers in about 14% of cases reported against boys and about 6% of cases reported against girls.
• Child pornographers and other abusers who are strangers may make contact with children using the Internet.

What Are the Effects of Childhood Sexual Abuse?

It is not always easy to tell whether a child has been sexually abused. Sexual abuse often occurs in secret, and there is not always physical proof of the abuse. For these reasons, child sexual abuse can be hard to detect.

Some child sexual abuse survivors may show symptoms of PTSD. They may behave in a nervous, upset way. Survivors may have bad dreams. They may act out aspects of the abuse in their play. They might show other fears and worries. Young children may lose skills they once learned and act younger than they are. For example, an abused child might start wetting the bed or sucking his or her thumb. Some sexual abuse survivors show out-of-place sexual behaviors that are not expected in a child. They may act seductive or they may not maintain safe limits with others. Children, especially boys, might "act out" with behavior problems. This could include being cruel to others and running away. Other children "act in" by becoming depressed. They may withdraw from friends or family. Older children or teens might try to hurt or even kill themselves.

Sexual abuse can be very confusing for children. For a child, it often involves being used or hurt by a trusted adult. The child might learn that the only way to get attention or love is to give something sexual or give up their self-respect. Some children believe the abuse is their fault somehow. They may think the abuser chose them because they must have wanted it or because there is something wrong with them. If the abuser was of the same sex, children (and parents) might wonder if that means they are "gay."

Almost every child sexual abuse victim describes the abuse as negative. Most children know it is wrong. They usually have feelings of fear, shock, anger, and disgust. A small number of abused children might not realize it is wrong, though. These children tend to be very young or have mental delays. Also some victims might enjoy the attention, closeness, or physical contact with the abuser. This is more likely if these basic needs are not met by a caregiver. All told, these reactions make the abuse very hard and confusing for children.

If childhood sexual abuse is not treated, long-term symptoms can go on through adulthood. These may include:

• PTSD and anxiety.
• Depression and thoughts of suicide.
• Sexual anxiety and disorders, including having too many or unsafe sexual partners.
• Difficulty setting safe limits with others (e.g., saying no to people) and relationship problems.
• Poor body image and low self-esteem.
• Unhealthy behaviors, such as alcohol, drugs, self-harm, or eating problems. These behaviors are often used to try to hide painful emotions related to the abuse.

If you were sexually abused as a child and have some of these symptoms, it is important for you to get help.

What Can Caregivers Do to Help Keep Children Safe?

Although caregivers cannot protect their children 100% of the time, it is important to get to know the people that come around your child.

Most importantly, provide a safe, caring setting so children feel able to talk to you about sexual abuse. Other tips to keep your children safe include:

• Talk to others who know the people with whom your child comes in contact.
• Talk to your children about the difference between safe touching and unsafe touching.
• Tell the child that if someone tries to touch his or her body in their private areas or do things that make the child feel unsafe, he should say NO to the person. He needs to tell you or a trusted adult about it right away.
• Let children know that their bodies are private and that they have the right not to allow others to touch their bodies in an unsafe way.
• Let them know that they do not have to do EVERYTHING the babysitter, family member, or group leader tells them to do.
• Alert your children that abusers may use the Internet. Watch over your child on the Internet.

What Should You Do if You Think Your Child Has Been Sexually Abused?

If a child says she or he has been abused, try to stay calm. Reassure the child that what happened is not her fault, that you believe her, that you are proud of her for telling you (or another person), and that you are there to keep her safe. Take your child to a mental health and medical professional right away. Many cities have child advocacy centers where a child and her family can get help. These centers interview children and family members in a sensitive, warm place. They can help you report the abuse to legal authorities. They can help you find a medical examiner and therapist skilled in child sexual abuse.

Children can recover from sexual abuse and go on to live good lives. The best predictor of recovery is support and love from their main caregiver. As a caregiver, you might also consider getting help for yourself. It is often very hard to accept that a child has been sexually abused. You will not be supporting your child, though, if you respond in certain unhelpful ways. For example, you will not be able to provide support if you are overwhelmed with your own emotions. Don't downplay the abuse ("it wasn't that bad"), but also try not to have extreme fears related to the abuse ("my child will never be safe again"). It will not help children if you force them to talk, or if you blame the child. Getting therapy for yourself can help you deal with your own feelings about the abuse. Then you might be better able to provide support to your child.

Children may learn about a terrorist attack in a number of different ways. They may see or go through the event themselves. They may see or hear about it on TV, from other people at school, or from adults talking about the event. For example, both the September 11, 2001, attacks and the Oklahoma City bombing got a lot of attention in the media and the public. So, many children heard about and saw the events.

How should we speak to children about these events when they occur? Should we try to keep them from knowing about what happened? Or should we talk openly about the events? How can we help children make sense of a tragedy that we do not understand? How will children react? How can we help children feel better? Luckily, there have been relatively few terrorist attacks in the United States.

How Do Children Respond?

Children can be strongly affected by terrorist effects. After the September 11th attacks, 35% of parents reported that their children had at least one stress symptom. Almost half reported that their children were worried about their own safety or the safety of a loved one. Two years after the Oklahoma City bombing, 16% of children who lived near Oklahoma City had PTSD. This finding is noteworthy because these youths were not directly exposed to the bombing, nor were they related to people who had been killed or hurt.

Children show all kinds of reactions after a terrorist attack. Many symptoms are similar to those that happen after any traumatic event. For information about how children of different ages may respond to trauma, please see PTSD in Children and Adolescents. You will also find information about rates of PTSD in children exposed to other types of trauma.

What Puts Children at Higher Risk?

Findings from a study following the Oklahoma City bombing found that two factors related to increased stress symptoms in children:

• More exposure to television coverage
• Higher parental distress

When a parent is upset, this rubs off on their children. The children become upset too. Other factors that increase the risk that a child will have stress symptoms include being female, as well as knowing someone hurt or killed by the attack. Research also shows that continued arousal and fear several weeks out from the bombing puts a child at higher risk for PTSD.

How You Can Help Children Cope

Create a safe environment

Make your children feel safe. If possible, children should stay in a place they are used to and with people to whom they feel close. Keep their routine as regular as possible. Children find comfort in having things be consistent and familiar. Try to limit adult talk about the event when around the child.

Provide children with reassurance and extra emotional support

Adults need to make children feel safe enough to ask questions, express their feelings, or just be alone. Let children know they can ask questions. Ask children what they have heard and how they feel about it. Reassure the child that they are safe and that you will not leave them.

Be honest with children about what happened

Provide true information, but make sure you speak at a level that the child can understand. Very young children (age 0 to 2 years) may not need to hear about the terrorist attack. School-aged children may need help understanding what has happened. You might want to tell them that there has been a sad accident and that many people have been hurt or killed. Teens will have a better idea of what happened. You may want to watch certain news coverage with your teen and then talk about it.

Don't let children watch too much television about the event

After terrorism or disaster, try not to expose your child to reminders of the event. This could include scary TV programs or news programs. For more about how media coverage affects children, see Media Coverage of Traumatic Events.

Tell children what the government is doing

Reassure children that the state and federal government, police, firefighters, and hospitals are doing everything possible. Explain that people from all over the country and from other countries help out in times of need.

Be aware that children are often anxious if the adults around them are anxious

It is hard to know when to share your own feelings with your children. You want to talk to them about the events, but you do not want to make them feel more scared. This may mean hiding some of your own fears. For example, after the September 11th attack, many parents were scared of another attack. Others were angry and wanted revenge. Parents must deal with their own feelings before they can help children understand and label their feelings. Parents who are scared should talk about how to cope with such feelings and how family members can help each other.

Try to put the event in perspective

Although you may be scared, children need to know that attacks are rare events. Children also need to know that the world is generally a safe place.

Children are often the most vulnerable of those impacted during and after a disaster. According to the National Child Traumatic Stress Network, a growing body of research has established that children as young as infancy may be affected by events that threaten their safety or the safety of their parents or caregivers.

Disasters are unfamiliar events that are not easily understood by children, who can find them emotionally confusing and frightening. During the time of turmoil, they may be left with a person unfamiliar to them and provided with limited information. Some warning signs of distress in children ages 6 to 11 include:

• Withdrawing from playgroups and friends
• Competing more for the attention of parents and teachers
• Being unwilling to leave home
• Being less interested in schoolwork
• Becoming aggressive
• Having added conflict with peers or parents
• Having difficulty concentrating

For teens, the impact of disasters varies depending on how much of a disruption the disaster causes their family or community. Teens ages 12 to 18 are likely to have physical complaints when under stress or be less interested in schoolwork, chores, or other responsibilities.

Although some teens may compete vigorously for attention from parents and teachers after a disaster, they also may:

• Become withdrawn
• Resist authority
• Become disruptive or aggressive at home or in the classroom
• Experiment with high-risk behaviors such as underage drinking or prescription drug misuse and abuse

Children and teens most at risk for emotional distress include those who:

• Survived a previous disaster
• Experienced temporary living arrangements, loss of personal property, and parental unemployment in a disaster
• Lost a loved one or friend involved in a disaster

Most young people simply need additional time to experience their world as a secure place again and receive some emotional support to recover from their distress. The reactions of children and teens to a disaster are strongly influenced by how parents, relatives, teachers, and caregivers respond to the event. They often turn to these individuals for comfort and help. Teachers and other mentors play an especially important role after a disaster or other crisis by reinforcing normal routines to the extent possible, especially if new routines have to be established.

The signs of traumatic stress are different in each child. Young children react differently than older children.

Preschool Children

• Fearing separation from parents or caregivers
• Crying and/or screaming a lot
• Eating poorly and losing weight
• Having nightmares

Elementary School Children

• Becoming anxious or fearful
• Feeling guilt or shame
• Having a hard time concentrating
• Having difficulty sleeping

Middle and High School Children

• Feeling depressed or alone
• Developing eating disorders and self-harming behaviors
• Beginning to abuse alcohol or drugs
• Becoming sexually active

For some children, these reactions can interfere with daily life and their ability to function and interact with others.

The impact of child traumatic stress can last well beyond childhood. In fact, research shows that child trauma survivors are more likely to have:

• Learning problems, including lower grades and more suspensions and expulsions
• Increased use of health services, including mental health services
• Increased involvement with the child welfare and juvenile justice systems
• Long term health problems, such as diabetes and heart disease

Trauma is a risk factor for nearly all behavioral health and substance use disorders.

Even with the support of family members and others, some children do not recover on their own. When needed, a mental health professional trained in evidence-based trauma treatment can help children and families cope with the impact of traumatic events and move toward recovery.

Effective treatments like trauma-focused cognitive behavioral therapies are available. There are a number of evidence-based and promising practices to address child traumatic stress.

Each child’s treatment depends on the nature, timing, and amount of exposure to a trauma.

Families and caregivers should ask their pediatrician, family physician, school counselor, or clergy member for a referral to a mental health professional and discuss available treatment options.

All children may experience very stressful events that affect how they think and feel. Most of the time, children recover quickly and well. However, sometimes children who experience severe stress, such as from an injury, from the death or threatened death of a close family member or friend, or from violence, will be affected long-term. The child could experience this trauma directly or could witness it happening to someone else. When children develop long term symptoms (longer than one month) from such stress, which are upsetting or interfere with their relationships and activities, they may be diagnosed with post-traumatic stress disorder (PTSD).

Examples of PTSD symptoms include

• Reliving the event over and over in thought or in play
• Nightmares and sleep problems
• Becoming very upset when something causes memories of the event
• Lack of positive emotions
• Intense ongoing fear or sadness
• Irritability and angry outbursts
• Constantly looking for possible threats, being easily startled
• Acting helpless, hopeless or withdrawn
• Denying that the event happened or feeling numb
• Avoiding places or people associated with the event

Because children who have experienced traumatic stress may seem restless, fidgety, or have trouble paying attention and staying organized, the symptoms of traumatic stress can be confused with symptoms of attention-deficit/hyperactivity disorder (ADHD).

Examples of events that could cause PTSD include

• Physical, sexual, or emotional maltreatment
• Being a victim or witness to violence or crime
• Serious illness or death of a close family member or friend
• Natural or manmade disasters
• Severe car accidents

Treatment for PTSD

The first step to treatment is to talk with a healthcare provider to arrange an evaluation. For a PTSD diagnosis, a specific event must have triggered the symptoms. Because the event was distressing, children may not want to talk about the event, so a health provider who is highly skilled in talking with children and families may be needed. Once the diagnosis is made, the first step is to make the child feel safe by getting support from parents, friends, and school, and by minimizing the chance of another traumatic event to the extent possible. Psychotherapy in which the child can speak, draw, play, or write about the stressful event can be done with the child, the family, or a group. Behavior therapy, specifically cognitive-behavioral therapy, helps children learn to change thoughts and feelings by first changing behavior in order to reduce the fear or worry. Medication may also be used to decrease symptoms.

Prevention of PTSD

It is not known exactly why some children develop PTSD after experiencing stressful and traumatic events, and others do not. Many factors may play a role, including biology and temperament. But preventing risks for trauma, like maltreatment, violence, or injuries, or lessening the impact of unavoidable disasters on children, can help protect a child from PTSD.

Not all children experience child traumatic stress after experiencing a traumatic event, but those who do can recover. With proper support, many children are able to adapt to and overcome such experiences.

As a family member or other caring adult, you can play an important role. Remember to:

• Assure the child that he or she is safe. Talk about the measures you are taking to get the child help and keep him or her safe at home and school.
• Explain to the child that he or she is not responsible for what happened. Children often blame themselves for events, even those events that are completely out of their control.
• Be patient. There is no correct timetable for healing. Some children will recover quickly. Others recover more slowly. Try to be supportive and reassure the child that he or she does not need to feel guilty or bad about any feelings or thoughts.