PTSD in children & teens
Kids can heal from frightening things, especially with a calm, caring adult beside them. You don’t have to be perfect to be that adult.
By the numbers
Trauma is common in childhood. PTSD is less common, and treatable.
United States
After a trauma
Help that works
How trauma can show up at different ages
Kids often show what they feel through behavior, play and their bodies.
The National Child Traumatic Stress Network (NCTSN) describes child traumatic stress as reactions that keep getting in the way of daily life after a frightening event is over. Signs often flare when a child is reminded of what happened.
Children often don’t say “I’m scared” or “I keep remembering.” Instead, you may see changes in sleep, eating, behavior, schoolwork or friendships. Aches and pains with no clear cause can be part of it too.
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Signs SAMHSA describes
- Crying much more than usual
- Fear of being separated from a parent
- Nightmares
- Poor appetite
NCTSN adds that young children may lose skills they had, like talking or using the toilet. Their reactions depend on their age and development.
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Signs SAMHSA describes
- Aggression or acting out
- Anxiety
- Feeling guilty
- Pulling away from others
- Trouble concentrating
- Trouble sleeping
Children this age may play out the event, ask the same questions again and again, or worry that it will happen again. Their questions are a way of making sense of things.
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Signs SAMHSA describes
- Aggression
- Depression
- Risky behavior
- Self-harm
- Substance use
- Withdrawal from family and friends
Teens may hide how they feel, even from themselves. See the section “Teens: extra things to know” below.
What can be traumatic for a child
It isn’t only about what happened, but how it felt to them.
NCTSN describes a traumatic event as one that threatens a child’s life or physical safety. Seeing that kind of threat to someone they love, like a parent, can be traumatic too.
Events SAMHSA lists
- Abuse or assault
- Disasters or terrorism
- Losing their home or having to move suddenly
- Military family stress, like a parent’s deployment
- Neglect
- Serious accidents or life-threatening illness
- Sudden or violent loss of a loved one
- Violence at home, at school or in the community
- War or refugee experiences
What matters most is how the child experienced it. An event that looks small to an adult can feel terrifying to a child, and the reverse can be true too.
Why some kids are hit harder
What happens after the event matters a lot, and that’s where adults can help.
A large review of 64 studies looked at what makes PTSD more likely in children and teens. How scared the child felt, and what happened afterward, mattered more than how serious the event looked from the outside.
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Strong fear during the event and feeling that their life was in danger were among the factors most linked to later PTSD.
This is why two children in the same event can react very differently. Neither reaction is “wrong”.
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Factors linked to more PTSD
- Family having a hard time working together
- Low support from people around them
- Pulling away from friends and activities
- Trying hard to push thoughts away
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A review of 43 studies found that about 1 in 6 trauma-exposed children developed PTSD. The rate was highest for girls after trauma caused by another person, and lowest for boys after accidents or disasters.
Among U.S. teens, events involving violence between people carried the highest risk. Earlier trauma and existing worries or fears also made PTSD more likely.
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NCTSN notes that a child’s cultural identity can be a protective factor, while racism and discrimination can increase risk.
Family traditions, faith, language and community can all help a child feel rooted and safe again.
Hospital stays, injuries and illness
Medical care can be frightening for kids, and for their parents.
NCTSN uses the term pediatric medical traumatic stress for reactions children and their families can have to pain, injury, serious illness, and frightening medical procedures. It can follow one event or many.
How a child reacts depends more on how they experienced it than on how serious the illness or injury was. A short but scary procedure can stay with a child more than a longer, calmer stay.
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- Bring a comfort item from home, like a blanket or toy
- Explain what will happen in words that fit their age, without frightening details
- Let them make small choices, like which arm or which sticker
- Stay close and calm when you can
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Some children become frightened of check-ups, act out medical scenes in play, or struggle to sleep after a hospital stay. Many of these ease with time and comfort.
If they don’t ease, or they get in the way of needed care, tell your child’s doctor. They can help you find support.
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NCTSN describes medical traumatic stress as affecting children and their families, not just the child who was ill.
Brothers and sisters may feel scared, left out or guilty. A little one-to-one time with each child can help. The “Kinds of PTSD” guide has more on medical trauma in adults.
Trauma at school and in learning
Trouble focusing or behaving at school can be a sign of trauma.
NCTSN lists attention and school difficulties among the signs of child traumatic stress. A child who seems “not to listen” or can’t sit still may be on high alert inside.
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- Being very startled by loud noises or sudden changes
- Grades or homework slipping
- Outbursts, fights or tears that seem to come from nowhere
- Seeming far away or not hearing instructions
These can look like defiance or attention problems. Knowing about the trauma helps the school respond with support instead of punishment.
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You don’t need to share details. Something like “Our family went through something hard, and they may be more anxious for a while” can be enough.
School counselors can support your child and help connect you with a trauma-trained therapist.
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- A calm corner or pass to step out when overwhelmed
- A trusted adult at school they can check in with
- Extra time or a lighter load for a while
- Warning before fire drills, loud events or schedule changes
How caregivers can help
Safety, believing them, patience and gentle routines.
NCTSN says how caregivers respond really matters. Believing the child, taking their reactions seriously and meeting their needs all help protect them.
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SAMHSA suggests reassuring children that they are safe, and explaining the steps being taken to keep them safe at home and at school.
Only promise what you can keep. “We are doing everything we can to keep you safe” is honest and comforting.
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SAMHSA notes that children often feel responsible for events outside their control. Saying clearly that it wasn’t their fault matters, even if they don’t seem to be blaming themselves.
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- Answer questions honestly and simply, and it’s okay to say “I don’t know”
- Let them use drawing, play or stories if words are hard
- Name feelings: “That sounds really scary”
- Notice when they want to talk, like in the car or at bedtime
Being patient is important: every child recovers at their own pace, and they shouldn’t feel guilty about their feelings.
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NCTSN says addressing reminders of trauma and loss is critical for a child’s ongoing recovery.
Notice what sets your child off, like certain sounds, places or dates. Give a heads-up when you can, and have a calming plan ready. The “Our calm-down & reminders plan” worksheet can help.
Looking after yourself as a parent
Your calm helps your child. Your care matters too.
When something frightening happens to a child, parents are often shaken too. You may have been there, or you may feel guilty you weren’t. Both are very human.
The VA reports that when a parent has PTSD, it has a clear effect on children’s distress, PTSD and behavior. Getting help for yourself is one of the best ways to help your child.
Ways to care for yourself
- Ask your child’s therapist how you can support them, and what support there is for you
- Find someone to talk to: a friend, faith leader, support group or therapist
- Keep simple routines for yourself too: meals, sleep, a short walk
- Notice your own reminders and reactions, and take a breath before responding
- Share the load with other trusted adults when you can
Therapy for children and teens
Treatments designed for young people, with caregivers involved.
If a child doesn’t recover on their own, a mental health professional trained in proven trauma treatments can help. Pediatricians, school counselors and faith leaders can help you find one.
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TF-CBT is designed for young people ages 3 to 18. The therapist works with the child and the caregiver side by side, with some sessions together.
It is supported by 25 randomized trials, with improvements seen in 8 to 25 sessions.
Children learn about trauma, practice calming skills, and slowly, safely make sense of what happened. Caregivers learn ways to support them at home.
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CPP is for children from birth to about age 5. The child and their main caregiver attend together, and sometimes other caregivers or siblings join.
It works by strengthening the bond between child and caregiver. Together, they build a shared story of what happened and learn to handle reminders.
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Questions to ask
- “Are you trained in TF-CBT, CPP or another trauma therapy for children?”
- “How will I be involved as a parent?”
- “How will we know if it’s helping?”
- “What do you do if my child doesn’t want to talk?”
The “Therapies for trauma” guide explains more trauma therapies, including a section for children and teens.
Teens: extra things to know
Teens may hide pain behind anger, risk-taking or silence.
Most U.S. teens have been through at least one potentially traumatic event. Violence between people, like assault or abuse, carries the highest risk of PTSD, and girls are affected about three times as often as boys.
NCTSN notes that older children may turn to alcohol or drugs, take risks, or engage in unsafe sexual behavior after trauma. These can be ways of trying to cope with pain they don’t have words for.
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- Ask what would help, rather than telling them what to do
- Keep showing up, even when they push you away
- Listen more than you talk, and try not to react with shock
- Talk during shared activities, like driving, cooking or walking
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Let your teen choose a therapist they feel comfortable with when possible, and respect that some of what they share in therapy will stay private.
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If something scary or painful happened to you, it is not your fault, and you don’t have to deal with it alone. Telling one trusted adult is a brave first step.
You can also text HOME to 741741 or call or text 988, any time. The “Teens’ mental health” guide has more for you.
When and where to get help
Reaching out early is a sign of good care, not failure.
Talk to your child’s doctor or school counselor if reactions aren’t easing after a few weeks, or are getting in the way of sleep, school, friendships or family life. You don’t need to be sure it’s PTSD to ask.
Where to start
- Ask for a therapist trained in TF-CBT, CPP or another trauma therapy for young people
- If a child is being abused or neglected, call or text the Childhelp National Child Abuse Hotline: 1-800-422-4453
- Talk to your child’s pediatrician, school counselor or a faith leader for a referral
📝 Worksheets for this guide
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Sources
- Substance Abuse and Mental Health Services Administration (SAMHSA). Understanding Child Trauma
- National Child Traumatic Stress Network (NCTSN). About Child Trauma
- National Child Traumatic Stress Network (NCTSN). Medical Trauma
- National Child Traumatic Stress Network (NCTSN). Trauma-Focused Cognitive Behavioral Therapy
- National Child Traumatic Stress Network (NCTSN). Child-Parent Psychotherapy
- McLaughlin et al. (peer-reviewed) (2013). Trauma exposure and posttraumatic stress disorder in a national sample of adolescents (Journal of the American Academy of Child and Adolescent Psychiatry)
- Alisic et al. (peer-reviewed) (2014). Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: meta-analysis (British Journal of Psychiatry)
- Trickey et al. (peer-reviewed) (2012). A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescents (Clinical Psychology Review)
- U.S. Department of Veterans Affairs, National Center for PTSD. PTSD and the Family
- Childhelp. Childhelp National Child Abuse Hotline
- U.S. Department of Health and Human Services, Children’s Bureau. Child Welfare Information Gateway
- Substance Abuse and Mental Health Services Administration (SAMHSA). Crisis Text Line
- 988 Suicide & Crisis Lifeline. 988 Suicide & Crisis Lifeline
This guide is for education and self-care. It is not a diagnosis or a substitute for professional care. Please talk to a counselor or clinical provider about your health. Reviewed October 2026.
