Pediatric Trauma Flashcards
What is trauma?
Not any stress, but a serious threat or assault on bodily integrity, one that may involve the threat of death.
Includes sexual assault even without the risk of death (assault on body integrity)
The threat can be towards a loved one (parent or sibling) rather than the child himself/herself.
Can involve either witnessing or learning about it.
The degree of trauma is determined by how the individual interprets the trauma.
Give some examples of childhood trauma.
Physical abuse Sexual abuse Natural disasters Building collapse Transportation accidents Invasive medical procedures Community violence Domestic Violence Physical assault Bullying Terrorism War
Approx how many children die from abuse & neglect each year?
1,760 children die/year from abuse or neglect
What happens to the brain with early trauma?
Neuroendocrine studies indicate an association between early adversity and atypical development of the HPA axis stress response, which can predispose to psychiatric illness.
structural differences in the hippocampus and corpus callosum, and decreased activity of the prefrontal cortex.
WHat’s the deal with MAO-A gene?
if you are abused & have this gene–more likely to develop antisocial personality disorder
Give a summary of the things associated with ACE.
More likely to initiate drinking alcohol at a younger age.
More likely to use alcohol as a means of coping with stress.
More likely to smoke, use drugs, become obese and engage in promiscuity.
Higher risk of school failure, gang membership, unemployment, homelessness, violent crime, incarceration and becoming single parents.
High risk adults who become parents are unlikely to provide stable, supportive parenting (intergenerational cycle).
Poor health-related quality of life and increased risk for diseases such as COPD and liver disease.
What are some individual resilience factors?
Easy temperament Secure attachment Basic trust Problem solving abilities An internal locus of control An active coping style Enlisting people to help Making friends Acquiring language and reading well Realistic self-esteem Sense of harmony Desire to contribute to others Faith that one’s life matters
T/F Majority of foster care children are not receiving mental health treatment.
True.
What are some of the barriers preventing foster children from receiving mental health support?
Lack of trained providers in the community
Difficulties in ensuring continuity of care across settings as children transition.
Lack of integrated care (eg, care being provided in “silos”)
What are some risk factors that increase likelihood of trauma?
Intensity of trauma exposure and proximity
High media exposure
History of previous trauma, abandonment or attachment problems
History of anxiety, depression, low resilience,high reactivity
Parents’ level of stress
Aside from PTSD, what are some other conditions that can arise from childhood trauma?
Depression Anxiety Substance abuse Subsyndromal PTSD Acute Stress Reaction Eating Disorders Conduct Disorder
What is the DSM5 criteria for a PTSD diagnosis?
Criterion A: Exposure to actual or threatened death, serious injury or sexual violence
Criterion B: Reexperiencing Cluster: at least one symptom (trauma play, nightmares, trauma-specific re-enactment)
Criterion C: Avoidance
Criterion D: Negative alterations in mood/cognition (need two): inability to remember, negative beliefs, blame, decreased interest, detachment, inability to experience positive emotions
Criterion E: Alterations in arousal and reactivity (need two): irritable, aggressive, reckless, hypervigilance, exaggerated startle response, decreased concentration, sleep disturbance
What is traumatic play?
not imaginative or fun, but replaying bad memories
Chowchilla pretending to be a bus driver
Barbies having sex
What are some signs of trauma?
***Regulation of affect and behavior
Deterioration of ability to inhibit aggression
Conversely, fear of agression may promote excessive inhibition and lack of assertion.
Substance abuse to manage painful emotions
**can have a neg. effect on core identity–powerlessness, guilt, less empathy
**withdrawal from normal social activities
What are signs of trauma in preschool children?
Feel helpless and uncertain Fear of being separated from their parent/caregiver Cry and/or scream a lot Eat poorly and lose weight Return to bedwetting Return to using baby talk Develop new fears Have nightmares Recreate trauma through play Are not developing to the next growth stage Have changes in behavior Ask questions about death
