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14 Chapter 1 | General introduction directly addressed or modified after an accident, thus contributing to the prevention of PTSD. An example of such a factor is acute pain following accidental injury, because pain can be assessed easily and treated promptly. So far, studies on the association between acute pain and later PTSD are scarce but the results of one study suggest a relationship between acute pain and PTSS (Hildenbrand, Marsac, Daly, Chute, & Kassam-Adams, 2016). Little is known about risk factors for longer-term child PTSD after accidental injury. Previous studies on PTSD up to 12 months after the accident suggest that physical impairment, trauma history and new traumatic events are associated with the occurrence of long-term PTSD (Copeland, Keeler, Angold, & Costello, 2007; Gillies, Barton, & Di Gallo, 2003; Janssens, Gorter, Ketelaar, Kramer, & Holtslag, 2009; Landolt et al., 2005; Mehta & Ameratunga, 2012; NICE, 2005; Zatzick et al., 2008). Risk factors for adult PTSS or PTSD after their own trauma are well studied, but less is known about factors associated with parental posttraumatic stress reactions following child accidental trauma or injury (Hiller et al., 2016). Although results are not consistent, suggested risk factors for parental PTSD include prior trauma history (Delahanty & Nugent, 2006), acute stress responses (Bronner et al., 2010) or peritraumatic distress (Allenou et al., 2010), witnessing the event (de Vries et al., 1999) and length of initial hospitalization (Landolt et al., 2012). To date, severe pain in children and permanent physical impairment of injured children have not been studied in relation to parental PTSS. Obviously, parents also experience stress when watching their child in severe pain. Furthermore, permanent physical impairment of children is likely to impact the parents, possibly comparable to the impact of extensive permanent scarring on parents of children with burns (Bakker et al., 2010). Interventions for PTSD and PTSS In a recent systematic review and meta-analysis of randomized clinical trials (Khan et al., 2018), Trauma-Focused Cognitive Behavior Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR) were indicated as effective treatments for PTSD and for the reduction of posttraumatic stress symptoms. Both treatments are recommended in national guidelines in the Netherlands and other countries (NICE, 2018; Nederlandse Vereniging voor Psychiatrie NVvP, 2019). Little is known about the choices regarding treatment and the – short and longer term – effect of those choices. Furthermore, if children and parents do receive treatment, the specifics of