Children and young people may find it difficult to feel good again after having been involved in serious events such as escape or abuse. Children may have severe anxiety, distressing memories or nightmares. With support and treatment, children have good chances to be free of their symptoms.

In post-traumatic stress syndrome, the symptoms for children differ in part from the symptoms of adults. Investigation and treatment can also be different for adults and children. You can also read about post-traumatic stress syndrome at UMO  or You.

Post-traumatic stress syndrome is also called PTSD, which is an abbreviation of English’s “post-traumatic stress disorder”.

In this article, the word child is used for children and young people up to 18 years. This article is for those who are custodians or close relatives of a child with symptoms that may be PTSD.

What is PTSD?

A child who has been involved in scary, abusive or shocking events can have mental or physical problems. There may be individual events that affect the child, such as accidents or serious illness of a relative.

It can also be events that the child has difficulty getting out of since the events often last for a long time. Examples of such events are physical or sexual abuse, escape, lack of care at home or close relatives who find it difficult to accommodate the child.

Especially situations where the child has been subjected to violence or abuse can evoke strong feelings of fear or fear. The child may also feel bad if they have witnessed unpleasant events.

The reactions are different

Some scary ones can be uncomfortable after scary events. But then it is important that you as a custodian or close relative keep an eye on the child so that you can detect any complaints in a good time. Other children may feel mentally ill after an event but get rid of their symptoms of post-traumatic stress syndrome which sometimes disappear by themselves.

Some children may have psychological trauma. This means that the child retains his symptoms and that they need treatment to feel good again.

It is good if the child can continue with what they feel good about, such as going to preschool or school. Then it can be easier to recover.

Symptoms of post-traumatic stress syndrome

The symptoms of severe events can vary widely and are affected by several circumstances. The risk of serious symptoms increases if, for example, the child has experienced frightening events at a very young age or if they have been exposed to such events several times. On the other hand, the safety and support of close relatives or other adults in the child’s environment can protect the child, lead to minor symptoms or help the child to get rid of problems more quickly.

Children under six years may have symptoms other than older children

It can be difficult for you as a parent or guardian to interpret the problems of younger children. This is because younger children do not yet have the ability to express their thoughts and feelings.

Younger children may have the following symptoms:

  • The child shows concern, anxiety and fear of darkness.
  • The child has difficulty separating from his or her relatives.
  • The child has nightmares, has difficulty sleeping and may not want to sleep anymore.
  • The child may start to pee during the day or in the bed at night after previously being dry.
  • What the child relives may prove to be in play. The game can be less imaginative and have elements of coercion.
  • The child may cry often. They can be sad, angry or defiant.
  • The child’s development is suddenly delayed without having been late in their development. The child may find it more difficult to be alone, for example playing alone.
  • The child will have problems such as stomach or head pain. The child may also have less appetite.

The symptoms of post-traumatic stress syndrome in the list may partly also be common behaviors or reactions in young children. The child, on the other hand, may have received PTSD if the difficulties are very extensive. It is the health center or child and adolescent psychiatry that assesses whether a child has received PTSD.

Children over six years with symptoms of PTSD

Children over six years may partly have symptoms other than younger children. The trouble may be one or more of the following:

  • The child relives the difficult things that have happened through painful memories. These memories are also called flashbacks. The memories can be triggered by sensations or events that are reminiscent of serious experiences.
  • The child may have nightmares at night.
  • The child experiences severe anxiety, fear and sometimes physical symptoms such as palpitations as they relive the difficult events.
  • The child tries to avoid situations that can be linked to what happened. She doesn’t want to talk about it and think about what happened.

Depending on what the child has experienced, there are sometimes feelings of guilt and shame. The child may also find it difficult to trust other people.

Other signs of PTSD among children over six years may be any of the following:

  • The child has an outgoing and angry behavior that can be perceived as aggressive.
  • The child cuts or scratches on the body.
  • The child is depressed and withdrawn with less desire to do such things as he previously appreciated.
  • The child has difficulties with concentration and learning.
  • The child has sleep disorders.
  • The child may start to pee during the day or in bed at night.
  • The child is easily frightened or excessively vigilant and can snatch even without noticeable reason.
  • The child shows strong anxiety or anxiety when to be separated from his or her relatives.
  • The child has physical problems such as fatigue, stomach ache or headache.

For some children who feel ill, the symptoms eventually disappear by themselves. Others have their problems and need treatment. The child may have had PTSD if the symptoms are long-lasting and if they have difficulty coping with everyday life. Some children get only a few symptoms, but these can be difficult and need treatment.

What can increase the risk of getting symptoms?

What the child’s life situation looks like can increase the risk of having symptoms after experiencing something serious or scary.

Here are some situations that may make the child easier to get symptoms:

  • The child has inadequate support from adults.
  • The child has previous experiences of difficult events such as sexual abuse or domestic violence or outside.
  • The child has some form of disability.
  • The child has or has had other mental disorders.
  • The child has parents who are mentally ill or who have been subjected to difficult events themselves.
  • The child lives in an exposed environment and experiences stress. The cause may be, for example, bullying, poverty or being an asylum seeker and living with great uncertainty.

Severe events can lead to other conditions

Scary experiences don’t always lead to PTSD. They can also cause other forms of mental illness later in life. For example, it can be depression or anxiety. The experiences can also lead to abuse when the child is older or adult. Sometimes a child may have different diagnoses at the same time.

When and where should the child and I seek care?

Contact your child care center or child care center if your child develops symptoms after experiencing one or more scary events. You can also contact a pediatrician or student health.

You can contact many receptions by logging in.

The doctor at the health center can write a referral to the child and adolescent psychiatry, BUP if the child needs psychiatric care. You can also contact one of  BUP’s local receptions yourself.

Seek emergency care immediately if there is a danger to the child’s life

Immediately contact a psychiatric emergency room or nearest emergency room if the child is mentally ill and unable to cope.

You who are a custodian or close relatives and have been involved in serious events yourself may also need support to feel good again and be able to help your child. If you are feeling mentally ill, contact a health center or psychiatric clinic.

Investigation

Depending on the child’s age, there are different ways to check if the child has experienced severe events. One way is that the therapist asks direct questions to the child during one or more conversations where you as the custodian are present. Another is that the therapist interviews both you and the child when you meet the therapist together.

It may also happen that the therapist wants to talk to you individually to get as clear information as possible. This requires that the child is able to be alone with the therapist and that the child wants to talk to the therapist. It is common for the therapist to hear with you if it feels good for you to have an individual conversation with the child.

The therapist also uses questionnaires to assess a child’s mental health. Older children and young people can fill in certain questionnaires themselves. Sometimes the therapist may choose to use toys to make it easier for the child to tell what has happened.

It is important for the therapist to know how the child is feeling and how the situation is at home, at school, and at leisure. The therapist may also ask to speak with the teacher or other adults in the child’s environment.

Tell us about what works well in the child’s life

Tell the therapist what works well in the child’s life. It can often be an asset to the treatment. The therapist can then better strengthen the child who needs to get through a difficult time.

It is important that the therapist knows as much as possible about the child’s background and symptoms and that they get to know the child. This makes it easier for the therapist to assess what treatment the child needs.

The child may also have other illnesses

In order to exclude other illnesses, the child also needs to be examined for any other mental illness or for physical disorders. Mental illness that occurs concurrently with PTSD can be, for example, depression or anxiety disorder. If the child has several different diagnoses at the same time, it is important that they receive treatment for their illnesses in addition to PTSD.

Care can help you if your child is subjected to violence

Caregivers in child and adolescent psychiatry need to ask whether the child has been subjected to or witnessed violence. It is important to be able to find out if there is a threat that causes the child to need help and protection. The care needs to contact the social services in your municipality if the child is exposed to violence in close relationships. The social services can offer various forms of support and, among other things, help with sheltered housing if necessary.

There is also help for perpetrators of violence who are prepared to receive support to change their lives. It is the county council or the home municipality that has information about which local organizations offer support in your area.

Treatment of Post-traumatic stress syndrome

Treatment for PTSD cannot erase the memory of what has happened. But it can help the child process a serious experience so that a terrible memory can eventually be transformed into normal memory. It is a memory that belongs to the past and that no longer disturbs everyday life.

Increasing the security of the relationship between the child and you as the custodian can also be a goal of treatment. In connection with this, it may sometimes be necessary that you as a custodian need to learn how to safely take care of the child.

An initial effort is often that the therapist together with the child and you plan what the treatment of post-traumatic stress syndrome should mean. Feel free to ask if there is something you do not understand. It is important that the child and you feel safe and know how the treatment is organized and what the goal is.

Initial support should provide security

The treatment of children with PTSD usually starts with increasing security and making everyday life work again. It can be about good routines for sleep, meals, strengthening relationships with relatives and providing support for organized schooling.

The child can also learn relaxation exercises to reduce mental and physical stress. It is important that the child continues with activities that he feels good about. It can be a physical activity or artistic interest such as pictures, music or dance. You who are the custodian may gladly encourage the child to move, for example. It is even better if you are physically active together.

It is important to increase security so that the child will eventually be able to process the scary that has happened. A calm and safe environment, together with a good relationship with the therapist, are important prerequisites for treating PTSD.

The initial support is also called stabilization. It is especially important to begin treatment with stabilization if the child has been subjected to sexual or physical violence.

You can get an education about PTSD

In some county councils, the receiving reception can offer training on PTSD. The education can give you who is the custodian and the child, for example, knowledge of what happens in the brain and in the body when someone is exposed to serious events. You can also learn how difficult experiences can manifest as mental symptoms.

The training can also help you and your child understand that symptoms of PTSD are common reactions to serious events. Most people react the same way if they are exposed to something very unpleasant. It is especially important that you who have custody of younger children participate in education.

There are various therapies that can help children with PTSD

Toddlers themselves cannot usually process what has happened. Therefore, as a custodian, you often need to participate in the treatment of the youngest children.

The therapy is more directly focused on the seriousness that has happened if the child is about two years and older. The therapist then tries to understand what has happened by, for example, playing or drawing pictures with the child. It will help to approach the nasty events and will arouse the desire to play with the child again.

Child-Parent Psychotherapy, CPP

Child-Parent Psychotherapy, CPP, is a treatment for children between 0 and 6 years. It is an important part of therapy to improve the relationship and interaction between the child and you as custodian or close relatives. The treatment also includes creating a common story of the scary that has happened.

You as an adult will learn more about how the experiences affect the child. You will also receive support on how to deal with and manage the child’s difficulties.

Other therapies can also help the child

Older children usually meet the therapist on their own. However, you who are custodians or close relatives still often need to be involved in the therapy. In addition to CPP, there are various other treatments for children, including Cognitive Behavioral Therapy, KBT, and Eye Movement Desensitization and Reprocessing, EMDR.

In EMDR, eye movements are used in connection with the activation of painful memories. This means that the therapist asks the child to think about the scary that has happened. At the same time, the child is allowed to make a series of movements with the eyes. The eye movements seem to help the brain process trauma memories and in this way reduce symptoms.

It is important that you as a custodian or close relative ensure that the child continues to attend school. Ask student health for help if you find that your child needs support to manage the school.

Drug

It is uncommon to treat PTSD in children and adolescents with drugs. On the other hand, it may be necessary to provide medication to relieve individual symptoms such as difficulty sleeping.

Being related to children with PTSD

Children with PTSD need a safe, predictable and functioning environment to feel good again. Relatives and other adults in the child’s environment can help here. A stable relationship with you and other important adults makes it easier for the child to recover.

It is good to take the time, listen and ask questions when children with PTSD feel ill. Show that you care and support the child when they want to tell about the scary that has happened. Be patient if the story is repeated several times.

Children who have experienced one or more serious events can easily become angry or annoyed by small things and show strong feelings. Be as calm as possible and show that you want to understand why the child reacts.

Take part in the nursing education about PTSD

Sometimes you may need to learn more about the child’s problems and what you as an adult can do to help the child recover well. Feel free to take part in the education that care in some county councils offers to children with PTSD and their relatives.

Others must not be forgotten

Even if a child with PTSD needs a lot of care and attention, it is important that siblings or other young people in the child’s vicinity are not forgotten. Take the time to socialize and show them that they are just as important as the child who needs a lot of support at the moment.

Contact a support organization if you want to talk to others in similar situations. If you find yourself having trouble after serious events, you may need the care to get well again. Read more about how you can get help in the article PTSD in adults.

Influence and participate in the child’s care

As a custodian, you can, together with the child, seek care at any care center you want throughout the country. This also applies if you want to seek care at open specialist clinics. Sometimes a referral may be required. Being able to influence and participate in their care is a right that is regulated by the Patient Act.

Ask if you do not understand

In order for you as a custodian and the child to be able to participate in the child’s care, it is important that you understand what the care staff says. Ask questions if you don’t understand. When you have received information about what care the child can receive, you can give your consent or express a yes in another way. You can also refuse treatment.

The older the child, the more important it is that the child can participate in their care. There is no age limit for when a child can have an influence over their care. The child’s ability to participate in related to the child’s maturity.

Fixed care contact and interpreter can be a good support

You and the child have the right to a permanent care contact if you have contact with many different persons in connection with the child’s care. It is a person who among other things helps to coordinate the child’s care.

It is also possible to get help from an interpreter if one of you has a hearing loss. The interpreter can often be booked by the care center or the reception that is treating the child. Feel free to inform the healthcare provider at the first contact if you need interpretation.

The interpreter has a duty of confidentiality,  just like everyone else who works in the health care sector. This means that they are not allowed to disclose information about the child.

Ehtisham Nadeem

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