Pediatric emergency medicine trisk 4210 4210
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to provide the child with adequate protection and support. A child’s PTSD
symptoms may be observed through repetitive play by which themes or
aspects of the trauma are expressed. Recurrent and distressing dreams of the
event may also occur. Hallucinations and flashbacks may follow the child’s
sudden reliving of the experience. In addition, events that symbolize or
resemble some aspect of the traumatic event may produce intense anxiety
and distress; the connection between precipitating event and distress is not
always evident to parents or child.
Other PTSD symptoms experienced by children include generalized
numbing of responsiveness to events and people. Stimuli associated with the
trauma may be consistently avoided. The emergency physician should also
be alert for signs of increased arousal—anxiety and agitation, difficulty
falling asleep, irritability or anger, suspiciousness, difficulty concentrating—
and various physiologic complaints in response to events that resemble or
symbolize the traumatic event. The key task for the emergency physician is
to recognize PTSD in the differential diagnosis of an agitated, confused, or
even psychotic child or adolescent. A careful history usually provides clues
to this diagnosis. Supportive management in the ED, including using family
and friends, is often sufficient. Low-dose antipsychotic medication may be
recommended after psychiatry consultation for those who are frankly
psychotic and who do not respond to reality-based support. Often, an
antihistamine or anxiolytic medication may suffice.
The ED physician may also have an important role in the prevention of
PTSD. When patients are being treated for an acute traumatic episode, refer
a patient for mental health counseling.
When parents dismiss or doubt the child’s symptoms or worries, the
emergency physician can encourage the parents to respond supportively to
their child. When the physician suspects parental abuse, this concern must be
addressed directly with the family. Many children with PTSD benefit
significantly from individual and family therapy. If child and family are not
already in treatment, a referral is appropriate.
PANIC ATTACKS
Children experiencing panic attacks commonly present to the ED. After
ruling out any medical cause for the child’s symptoms, the ED physician
should educate the patient and their family about the nature of panic attacks
