Children in the Emergency Department

Children Emergency DepartmentJonas was a master tree climber.

Until today.

Now his left leg has a strange angle, and he has been knocked out by the fall.


Every year, millions of injured children require treatment at a hospital Emergency Department. Approximately 1 in 6 of them develop persistent stress symptoms, such as nightmares, concentration difficulties and negative thoughts.

Emergency Department doctors and nurses provide physical care but they can also support children’s emotional wellbeing. How well are they equipped to do so?

We conducted a survey among 2648 hospital ED physicians and nurses in over 80 countries. While the respondents saw psychosocial care as part of their job, only half of them knew that toddlers can develop trauma symptoms. About 40% recognized that children who behave calmly in the ED can still develop persistent stress.

With regard to confidence in their own skills, the contrast between different aspects of care was large. 75% of the respondents felt very confident about explaining medical procedures to children and parents, but only 14% felt as confident about educating children and families about traumatic stress reactions.

Similarly, only a minority felt very confident about explaining families how to access mental health care, should the need arise.

Few of the survey respondents (11%) had received any formal training on child traumatic stress and psychosocial care, while almost all (93%) wished to receive such training.

Two example quotes from participants:

“Psychological intervention is not common in China. We urgently need such training.”

“Definitely a gap in our training – needs some work. Clear evidence from current research in our setting that doctors and nurses are inadequate at dealing with childhood death.  Assumed knowledge for doctors but really not taught and learnt with difficulty for many or just avoided. ”

In a previous interview study, staff told us that they learn about emotional support in the EC mostly by trial and error, and by watching colleagues. These new results suggest that we need a more systematic approach to teaching about the emotional aspects of emergency care.

It would be good to integrate the traumatic stress and psychosocial care in curricula of nursing and medical schools. In addition, there are good online training packages, such as the Medical Traumatic Stress Toolkit and the Psychological First Aid training.


Alisic, E., Hoysted, C., Kassam-Adams, N., Landolt, M., Curtis, S., Kharbanda, A., Lyttle, M., Parri, N., Stanley, R., & Babl, F. (2015). Psychosocial Care for Injured Children: Worldwide Survey among Hospital Emergency Department Staff The Journal of Pediatrics DOI: 10.1016/j.jpeds.2015.10.067

Alisic, E., Conroy, R., Magyar, J., Babl, F., & O’Donnell, M. (2014). Psychosocial care for seriously injured children and their families: A qualitative study among Emergency Department nurses and physicians Injury DOI: 10.1016/j.injury.2014.02.015


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