Children in car crashes should be monitored for acute stress symptoms, whether injured or not

In a national study of children in motor vehicle crashes, researchers at The Children’s Hospital of Philadelphia report that traumatic stress can occur without injury. Looking at a wide range of crashes reported to State Farm Insurance Companies®, researchers found that while most children did well, two percent of the children and five percent of their parents experienced multiple traumatic stress symptoms that disrupted their lives.

There are more than 1.5 million crashes involving children in the U.S. annually, suggesting that more than 25,000 children each year may require help in coping with reactions to a crash. Researchers urge clinicians to screen children and their parents after any crash experience.

“Until now, research on traumatic stress after crashes had only examined patient populations in hospitals or clinics,” said Dr. Flaura Winston, M.D., Ph.D., a pediatrician at The Children’s Hospital of Philadelphia and lead author on the study. “In this study, we found that, although it’s less common, traumatic stress can occur in children and their parents even if a child wasn’t injured in the crash.” Dr Winston is also co-Director and a principal investigator on the Partners for Child Passenger Safety study.

The study, published in this month’s Archives of Pediatric and Adolescent Medicine, examined 1,091 crashes reported to State Farm that occurred in 15 states and Washington, D.C., involving 1,483 child occupants between the ages of five and 15, as part of Partners for Child Passenger Safety, an ongoing research collaboration between the Children’s Hospital and State Farm. While traumatic stress symptoms were seen in children and their parents regardless of injury, if a child received medical care after the crash, both the child and their parents were four times more likely to have serious acute stress symptoms than when no medical attention was required.

Symptoms of acute stress disorder (ASD) can include frequent or upsetting thoughts or memories about the crash; avoidance of reminders of the crash, like refusing to get into a car; jumpiness or constantly feeling in danger; and dissociation or emotional detachment.

“The majority of these children, and their parents, are not diagnosed properly and do not receive the psychological care they need to recover and get back to normal activity,” says Dr. Winston.

Parents Suffer Traumatic Stress After Child-involved Crashes

In the study, parents were more likely than children to show signs of emotional distress following an accident. About one in six children with serious injuries (such as a fracture) and about one in four of their parents showed symptoms of acute stress after a crash. When injuries were minor, about one in 20 children and one in six parents were affected.

“For a family, a crash is like their own personal disaster,” says Chiara Baxt, Ph.D., a co-author on the study and psychologist on the research team. “We found that the disruption a crash causes in the lives of parents was a predictor that the parents especially could suffer from symptoms of traumatic stress.” Having a child recovering from an injury, having a vehicle so damaged it can’t be driven, and dealing with financial repercussions of a crash are factors that may increase the likelihood of traumatic stress symptoms for parents.

The researchers recommend that clinicians screen for symptoms of acute stress in all children who have been in a crash, and in their parents, regardless of whether the child suffered injuries. Most children will recover with time and support, but in some cases symptoms will persist and get in the way of daily functioning, a sign that mental health counseling may be needed in order to recover completely.

What Can Parents Do?

Children’s Hospital researchers say that the most important thing parents can do is to be aware of their child’s emotional reaction to the crash and to their own. Parents can talk openly with children about the experience and answer questions the child might have; encourage younger children to draw pictures and older children to write about what happened and how they are feeling; and keep daily routines as normal as possible.

“Ask for help,” says Dr. Winston. “If you are worried about your child or yourself, talk to someone such as your family doctor.” If symptoms persist for a few weeks and are interfering with school or play, it is important to speak to a doctor or counselor.

Fact sheets for parents and screening tools for physicians are available at traumalink.chop.edu.