Acute Stress Reaction

Acute stress reaction (ICD-10: F43.0) is a brief, intense psychological and physical response to an exceptionally traumatic event. These include an accident, a sudden death in the family, violence, an assault, or a natural disaster.

The reaction usually begins within minutes. In most cases, it subsides over the course of hours to a few days. According to the ICD-10 description, it lasts no more than a few days and should have subsided by about one month at the latest. It is an expected response of a healthy nervous system to an extreme situation and is generally temporary.

The symptoms often change rapidly and involve both physical and emotional aspects. Common symptoms include:

• a racing pulse, nausea, sweating, trembling, flushing, or noticeable paleness
• Confusion and impaired alertness; the child appears dazed or absent-minded
• severe restlessness or, conversely, freezing up and withdrawal
• Sleep problems, irritability, and being easily startled
• Difficulty concentrating; some children cannot find the words to describe what they experienced

Younger children sometimes reenact the event repeatedly or cling more strongly. Adolescents withdraw, react irritably, or report intrusive images of the event. An everyday stimulus that reminds them of the event—a trigger—can reignite the tension.

The most important difference is the timing.

An acute stress reaction begins immediately and usually subsides quickly. If symptoms such as flashbacks, nightmares, and avoidance persist for more than four weeks, experts refer to this as post-traumatic stress disorder (PTSD). PTSD can also develop with a delay, sometimes not until weeks or months after the event.

An adjustment disorder develops following a stressful event that does not necessarily have to be as extreme as a trauma—such as a move, a parental separation, or a change of schools. It manifests with a delay of several weeks and often presents as low mood, worry, and withdrawal. A professional is always needed for an accurate diagnosis.

In the early days, safety and a calm, supportive presence are what matter most. Specifically, it often helps to:

• staying with the child, not leaving them alone, asking few questions, and simply being there
• maintaining familiar routines: set mealtimes, the usual bedtime, and small daily routines
• Ensure they get enough sleep and make sure they’re eating and drinking enough
• offering gentle breathing and relaxation exercises without pressure
• keeping an eye on alcohol and stimulants when dealing with teenagers

Parents influence their children through their own calmness. If your nervous system radiates a sense of security, that feeling is passed on to the child. Experts call this co-regulation. If the symptoms persist, trauma-focused behavioral therapy can help. Sedatives or sleep aids should be used only for a short time and only if prescribed by a doctor, as they tend to slow down the healing process in the long term.

Seek professional help if the symptoms do not subside after about four weeks, if they worsen, or if your child is having difficulty coping with daily life, school, and social interactions. Warning signs include persistent nightmares, extreme startle responses, marked withdrawal, or statements about no longer wanting to live.

The first places to turn are child and adolescent psychiatry departments (KJP), child and adolescent psychiatric practices, or psychotherapy practices specializing in trauma. In cases of immediate danger, call 112 or contact a crisis hotline.

Rückenwind is here to guide you as parents through this time and provide you with support. Janike is a social worker and parent coach currently training to become a child and adolescent psychotherapist; she does not make diagnoses. The assessment of an acute stress reaction and its consequences should be handled exclusively by a child and adolescent psychiatry clinic or a medical or psychotherapeutic specialist.