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130 Chapter 8 | Summary also examined the association between acute pain, trauma history, new traumatic events and long-term posttraumatic stress but we found no association. Our findings showed that the long-term prevalence of PTSD in children following accidents is comparable to the short-term prevalence. Over the long term, PTSD was related to a new traumatic event or to the initial accident. In our study, a small number of children completed trauma-focused psychotherapy after the accident. At follow-up they had still no symptoms or low levels of symptoms, in contrast to those who did not complete psychotherapy. A substantial number of the participating children reported permanent physical impairment, ongoing physical problems and negative consequences on their education, social life and future plans. Adolescence in combination with permanent impairment may have an influence on later PTSD, as this can be a sensitive period during which this age group is making future plans. The consequence may be that adolescents are more at risk for long-term negative psychological outcome when permanent physical impairment negatively influences their future plans. Further research, preferably in a larger sample, is needed to test this hypothesis and other possible explanations regarding an association between permanent physical impairment and PTSD. Long-term parental posttraumatic stress after a child’s accident In Chapter 5 , we presented the results of a study on parental posttraumatic stress. Accidental injury in children also affects the parents and puts them at risk for developing PTSS. Parents’ PTSS can influence the adaptation of their children after an accident and can increase the risk of child PTSS. We determined the prevalence of PTSS in 69 parents 2–4 years after accidental injury of their child (T2) and compared the results with PTSS in 135 parents 3 months after the accident (T1). Children were 8-18 years old at the time of the accident. Parental PTSS was 9.6% at T1 and 5.8% at T2. However, 9 out of 13 parents with PTSS at T1 were lost to follow-up. If all parents with PTSS at T1 had participated at T2, it is likely that the prevalence at T2 would have been higher. We also examined the association between parental and child factors and severity of parental PTSS. Acute parental stress was significantly associated with parental PTSS severity (T1 and T2), as was child’s hospitalization of more than 1 day at T1 and the child’s permanent physical