Spates C Richard, Waller Stacey, Samaraweera Nishani, Plaisier Brian
Department of Psychology, Western Michigan University, 3500 Wood Hall, Kalamazoo, MI 49008, USA.
Pediatr Clin North Am. 2003 Aug;50(4):901-18. doi: 10.1016/s0031-3955(03)00075-0.
Trauma is prevalent in the lives of children. It derives from many sources, and, depending on its characteristics, can produce transient or enduring and devastating consequences. Early trauma, if left untreated, can set the stage for chronic deficits in the behavioral repertoires of affected children, and thus shape personality development. Additionally, when trauma is repetitive and chronic, the developing brain may be affected in ways that impede otherwise effective intervention. Yet diagnosing traumatic stress in children requires a departure from exclusively adult-like considerations and attention must be devoted to the ongoing developmental processes. Trauma-associated clinical features in children are sharply distinct from those that are associated with adult traumatization and must be taken into account from screening and diagnosis through treatment and outcome evaluation. We suggest that a learning foundation for symptom development will best assist the identification and selection of efficacious treatments. Pediatricians should make use of validated screening procedures that effectively identify affected children to facilitate timely referral and ongoing monitoring of treatment outcomes for their patients. A representative list of such instruments can be found in Table 1. With respect to hospital-based trauma work, we suggest the following recommendations: Professionals must be alert to the presence of acute stress symptoms in any child or parent after all injury incidents. These symptoms may occur in any injured child regardless of age, gender, injury severity, mechanism of injury, or length of time since injury. Certain mechanisms of injury, (ie, pedestrian versus motor vehicle collision), place the parent at higher risk for symptomatology. All family members, including parents and siblings, must be considered at risk for acute and long-term functional abnormalities. It is important to educate patients and family members that acute stress symptoms are common after an injury incident and are likely to resolve as the patient's injuries heal. Yet despite this, before discharge from the hospital, parents must be taught to evaluate their traumatized child's behavior, as well as their own, for any evidence of posttraumatic stress disorder. Health care providers must anticipate potential strain upon family relationships and financial resources. Parent's posttraumatic stress symptoms may result in deterioration of their own ability to support their injured child. And finally, reassessment of patient and family members should occur within the first days, at 1 to 2 weeks, 6 months, and 1 year following injury to ensure proper recovery and optimization of psychosocial function.
创伤在儿童生活中很常见。它有多种来源，并且根据其特征，可能产生短暂的、持久的或具有毁灭性的后果。早期创伤若不治疗，可能为受影响儿童的行为技能长期缺陷埋下伏笔，从而塑造人格发展。此外，当创伤反复且长期存在时，发育中的大脑可能会受到影响，进而阻碍原本有效的干预。然而，诊断儿童创伤性应激需要摒弃仅基于成人情况的考量，必须关注持续的发育过程。儿童与创伤相关的临床特征与成人创伤明显不同，从筛查、诊断到治疗及结果评估都必须予以考虑。我们认为，症状发展的学习基础将最有助于识别和选择有效的治疗方法。儿科医生应采用经过验证的筛查程序，有效识别受影响儿童，以便为患者及时转诊并持续监测治疗结果。此类工具的代表性列表见表1。关于医院创伤工作，我们提出以下建议：专业人员必须警惕所有受伤事件后任何儿童或家长出现急性应激症状。这些症状可能出现在任何受伤儿童身上，无论其年龄、性别、损伤严重程度、损伤机制或受伤后时间长短。某些损伤机制（如行人与机动车碰撞）会使家长出现症状的风险更高。所有家庭成员，包括父母和兄弟姐妹，都必须被视为有急性和长期功能异常的风险。重要的是要告知患者及其家属，受伤事件后急性应激症状很常见，且可能随着患者伤口愈合而缓解。尽管如此，在出院前，必须教导家长评估其受创伤孩子的行为以及他们自己的行为，查看是否有创伤后应激障碍的迹象。医疗保健提供者必须预见到家庭关系和经济资源可能面临的压力。家长的创伤后应激症状可能导致其支持受伤孩子的自身能力下降。最后，应在受伤后的头几天、1至2周、6个月和1年对患者及其家庭成员进行重新评估，以确保适当康复并优化心理社会功能。
