Make a Care Plan

Rate Your Child's Reactions

How often/how much are these true for your child?

You can rate these on your own (based on what you have noticed with your child). Or even better, involve your child in rating his/her reactions or symptoms of trauma with you.

Be sure to scroll down to rate ALL the items. When you're done, click submit.

1. How long has it been since your child's injury? *

Less than a month

One month or more

Re-experiencing: Reliving what happened

Never/
Not at all

Sometimes/
Somewhat

Always/
Very much

2. Thinks a lot about what happened to him/her *

Never/ Not at all

Sometimes/ Somewhat

Always/ Very much

3. Has bad dreams or nightmares since the injury *

Never/ Not at all

Sometimes/ Somewhat

Always/ Very much

4. Gets upset or has physical reactions (headache, stomachache, heart pounding) at reminders of what happened *

Never/ Not at all

Sometimes/ Somewhat

Always/ Very much

Other concerns about your child

Never/
Not at all

Sometimes/
Somewhat

Always/
Very much

15. Is still having pain or discomfort. *

Never/ Not at all

Sometimes/ Somewhat

Always/ Very much

16. Has had other behavior changes since the injury *

Never/ Not at all

Sometimes/ Somewhat

Always/ Very much

17. Is having trouble with returning to school or other activities *

Never/ Not at all

Sometimes/ Somewhat

Always/ Very much

18. If your child has experienced any of the reactions above, overall are they: *

Getting better

Staying about the same

Getting worse

Concerns about how others in the family are coping

Never/
Not at all

Sometimes/
Somewhat

Always/
Very much

19. Brothers or sisters are upset or worried. *

Never/ Not at all

Sometimes/ Somewhat

Always/ Very much

20. You (parent) are stressed or worried yourself *

Never/ Not at all

Sometimes/ Somewhat

Always/ Very much

Leave this field blank

This is not a formal medical or psychological assessment or diagnosis.

See Terms and Conditions for more details.

If you are concerned with how you or your child are doing, please contact your doctor,
mental health professional, or other healthcare provider.

Only he or she can provide a thorough assessment of your child's needs.

To Healthcare Professionals: Please use these ratings as a basis for conversation
to learn more about your patient’s responses to a recent injury.

Created from the After The Injury website developed by researchers at
The Children’s Hospital of Philadelphia.