Thomas: Pediatric Trauma Flashcards
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
trauma
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
T/F: In 2007, Estimated 1,760 child died from abuse/neglect
True
T/F: Children who experience ACE’s have a worse prognosis overall.
True
i.e. these kids are:
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 resilience factors that aid kids who have experienced adverse life events?
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
What are some barriers to mental health care for foster children?
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”)
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
PTSD is not the only possible psychiatric sequelae of trauma. What else can occur as a result?
Depression Anxiety Substance abuse Subsyndromal PTSD Acute Stress Reaction Eating Disorders Conduct Disorder
What are some developmental aspects to consider in trauma cases?
regulation of affect and behavior
effect on core identity
social skills
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
Signs of trauma in elementary school children
Become anxious and tearful Worry about their own or others’ safety Become clingy with a teacher or parent Feel guilt/shame Tell others about the event again and again Become upset if they get a small bump or bruise Have a hard time concentrating Experience numbness Have fears that the event will happen again Have difficulty sleeping Show changes in school performance Become easily startled
Signs of trauma in middle & high school children
Feel depressed and alone
Discuss the traumatic events in detail
Develop eating disorders and self-harming behaviors
Start using or abusing alcohol or drugs
Become sexually active
Feel like they are going crazy
Take too many risks
Have sleep disturbances
Don’t want to go places that remind them of the event
Say that they have no feeling about the event
Show changes in behavior
What is the mainstay of treatment for PTSD?
psychotherapy
**meds can be used as an adjuvant
What is the medication treatment of choice for children with PTSD?
antidepressants - SSRIs
**alpha-adrenergic agents (clonidine & guanfacine) can reduce autonomic nervous system arousal
What are some components of trauma-focused CBT?
Psychoeducation - teaches kids what’s happening to them
Symptom monitoring - anxiety
Relaxation techniques
Exposure - kids write down trauma narrative
Cognitive re-structuring
Parent training
