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."
    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:

     1.  Routinely call the family several days and one to two weeks following
         the injury to ask about behavioral symptoms and family function.
     2.  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.
     3.  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.
     4.  Provide supportive care and encourage families to discuss the crash
         and their current feelings.
     5.  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.

     Contact: Suzanne Hill
     Phone: (215) 590-1417
     Email: hillsu@email.chop.edu


                                Note to media:
                      Study is available for download at
          http://www.pediatrics.org/cgi/content/abstract/109/6/e90/

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SOURCE  The Children's Hospital of Philadelphia