The initial goals of treatment for children with PTSD are as follows:

• Provide a safe environment
• Reassurance, emotional support and nurturance
• Attend to urgent medical needs if present

Psychological therapy for PTSD in children involves the following:

• Helping the child gain a sense of safety
• Addressing the multiple emotional and behavioral problems that can arise

 Nonpharmacologic forms of therapy include the following:

• Cognitive-behavioral therapy (CBT), especially trauma-focused CBT (TF-CBT)
• Dialectical Behavior Therapy (DBT)
• Relaxation techniques (eg, biofeedback, yoga, deep relaxation, self-hypnosis, or meditation; efficacy unproven)
• Play therapy

In children who have persistent symptoms despite CBT or who need additional help with control of symptoms, pharmacologic treatment may be considered, as follows:

• Selective serotonin reuptake inhibitors (SSRIs) – Medications of choice for managing anxiety, depression, avoidance behavior, and intrusive recollections; however, not specifically approved by the FDA for treatment of PTSD in the pediatric population
• Beta blockers (eg, propranolol)
• Alpha-adrenergic agonists (eg, guanfacine and clonidine)
• Mood stabilizers (eg, carbamazepine and valproic acid)
• Atypical antipsychotics (infrequently used)