Marny Hersenhoren has turned the incident over in her mind a thousand times.
It was a warm July day and her then-four-year-old son Ben teetered at the top of a play structure in Toronto's Dufferin Grove park. Another mother was there with her one-year-old daughter and moved quickly to hold her steady. But the mother inadvertently jostled the structure and sent Ben tumbling six to eight feet to the ground before his mother's eyes. His elbow shattered and he needed surgery to have it pinned back together.
Though he sported a cast, her son had all but forgotten the fall in the weeks and few months afterwards. But Ms. Hersenhoren couldn't forget.
"I had a very high anxiety level. The playground and park was no longer a fun place to go to," she says. "I could not relax… It made for a very stressed-out period of my life."
It's completely normal to feel anxious and on edge after a child is injured, experts say. But some parents develop symptoms that could balloon into something worse. More than one in three parents suffer symptoms of acute stress disorder or post-traumatic stress disorder after their child is injured, a study from the Children's Hospital of Philadelphia suggests.
The research highlights a quiet struggle among parents who brush off their own issues when their child is injured, says lead study author Nancy Kassam-Adams, associate director for behavioural research at the hospital's Center for Injury Research and Prevention.
"We always think of the kids, quite appropriately," she says. "But we need to not forget that parents themselves need to do some self-care." When these symptoms aren't dealt with, parents can buckle under the stress, which hampers their ability to be there for their child, she says.
Dr. Kassam-Adams and her team, whose paper was recently published in the Journal of Traumatic Stress, tracked 334 parents of children treated at the hospital for traffic injuries over 28 months. In the first month after their child's injury, 12 per cent of parents were diagnosed with ASD and 25 per cent with partial ASD.
When 251 out of the total group of parents were tested again six months later, 8 per cent were diagnosed with PTSD and 7 per cent had partial-PTSD. Of the children, aged 5 to 17, admitted to hospital for injuries such as fractures, sprains, open wounds, 30 per cent were admitted to intensive care. Sixty per cent of the injuries were cuts and bruises, while only 1 per cent were as serious as an amputation.
The study found that parents struggling with ASD and PTSD symptoms re-experienced the event of their child's injury through nightmares and persistent thoughts or headaches and physical reactions at the thought of it. They avoided reminders - by not talking about the incident or returning to the scene of the trauma. They felt anxious or jumpy, startled easily and were irritable. They had trouble focusing and sleeping.
"What we tell parents as a way to judge is it's normal to feel some of these things for a little while - nothing more than a couple of weeks," she says. "If it's been more than a month since it happened and these symptoms are getting in the way of you getting back to normal, those are signs that you should probably get help."
The incidence of stress was higher among parents when their child's injuries were more severe.
Many parents who experience these symptoms are wracked with guilt and shame, says Alain Brunet, an associate professor of psychiatry at McGill University's Douglas Institute, who specializes in research on post-traumatic stress disorder. These feelings can also arise in adults when children are injured under their care. He recalls the story of a man who hosted a sleepover campout for his nephews in the basement of his house. A fire somehow started and the children were severely injured.
"It's a kind of situation where it's very difficult to forgive yourself," he says. "Guilt is an issue you need to address and confront."
Even small and very common childhood injuries can spur feelings of guilt, as many parents can attest.
In mid-December, 17-month-old Jacob stuffed a pendant in his mouth and choked on it when his mom Amber Strocel, 33, flipped him over to change his diaper. She didn't know the jewellery was in his mouth, but still blames herself for the scare.
"I'm no longer on edge, or terrified about it," says the Coquitlam, B.C., mom. "But if I see my daughter [Hannah]has left something small on the floor, as four-year-olds do, I'm still upset."
Very serious injuries can put a huge strain on daily life.
About five years ago, 43-year-old Toronto mom Helena finally got help to treat anxiety and depression she'd been grappling with in the years after her son Michael, 12, incurred a brain injury. After a year on medication, she learned to set limits on her commitments and pay more attention to herself.
"There's a guilt that you're not doing what you need to do for your child," she says. "I realized… [that I need to]allow for reflection and self-care."
Dr. Kassam-Adams points to safety videos on airplanes in which the mother calmly puts her mask on herself and then her child to explain the logic behind that self-care. "We're not talking about taking care of yourself while ignoring your child, we're talking about taking care of yourself at the same time."
Ms. Hersenhoren says she's well past the incident now, but it did weigh heavy in her thoughts. To get past it, she willed herself to return to the park with Ben.
"It was a part of our lives," she says. "The idea of returning to the playground, whether I liked it or not, helped me move on."
Editor's note: The distahce Ben Hersenhoren fell was incorrectly reported in the original version of this story. This version has been corrected.