In the past two decades, post-traumatic stress disorder (PTSD) after exposure to a variety of traumatic or particularly threatening experiences has gained recognition as a significant contributor to morbidity in children. The basic features involve the development of impairing stress symptoms, including re-experiencing of the event in the form of “flashbacks” (distressing images, thoughts or perceptions) or nightmares, avoidance of thinking or talking about the event, of places or people associated with the event and of things that remind one of the event. Hyperarousal, or feeling on edge, irritability and exaggerated “startle” responses to stimuli, and emotional numbing (sufferers feeling cut off and detached) have also been described.

PTSD in children was originally described after particularly traumatic events such as physical and sexual abuse^1–3 and the witnessing of violence.⁴ It has been recognised following both natural^5,6 and man-made^7,8 disasters, and extensively documented in refugees,^9,10 war situations¹¹ and in response to terrorism-induced trauma.¹²

More recently, attention has focused on PTSD occurring as a consequence of a variety of paediatric conditions, some life threatening, including cancer,¹³ head injury¹⁴ and motor vehicle accidents^15,16 as well as mild to moderate paediatric trauma,¹⁷ acute illnesses resulting in admission to paediatric intensive care units,¹⁸ children who undergo organ transplantation¹⁹ and after diagnosis of diabetes mellitus type 1.²⁰

Stressful experiences related to serious paediatric illness in children may be expected to affect parents psychologically. Accordingly, high levels of symptoms of PTSD have been reported in parents of children with a variety of problems such as meningococcal infections requiring admission to paediatric intensive care units,²¹ in family members of adolescent cancer survivors²² and of children with newly diagnosed type 1 diabetes.²³

Early identification and appropriate referral …