Pediatric Trauma and Critical Illness Branch (PTCIB)

Female doctor listening to young girl's heart with stethoscope while mother looks on.Overview/Mission

PTCIB supports research and training focused on preventing, treating, and reducing all forms of childhood traumatic injury and critical illness across the continuum of care.

These activities include research to understand the biobehavioral, psychosocial, and pathophysiologic aspects of trauma; to improve prevention, diagnosis, and treatment of trauma and critical illness in infants, children, adolescents, and young adults; and to reduce secondary injury and comorbidities. 

We are interested in applications that align with the following research priorities. For more information about NICHD’s research themes, cross-cutting topics, and aspirational goals, visit the plan’s Scientific Research Themes and Objectives.

Optimal Time Periods for the Prevention and Treatment of Traumatic Injuries

Strategic Plan Theme 4: Improving Child and Adolescent Health and the Transition to Adulthood
Strategic Plan Cross-Cutting Topic: Disease Prevention

Gap: Injury is the leading cause of morbidity and mortality in children and adolescents, yet it is an understudied public health problem in the United States and around the world with serious effects on health, well-being, and developmental transitions. Research is needed to prevent adverse health outcomes and developmental sequelae by improving early detection and treatment and by identifying optimal time periods for prevention and intervention efforts. 

Priority: Research to develop the most effective prevention, diagnostic, and treatment strategies for the leading causes of traumatic injury in children and adolescents, including all forms of violence against children; unintentional injury, including motor vehicle crashes; critical illness and life-threatening injury; and self-injurious behavior.

Gap: Little is known about multiple forms of trauma in children or about the independent and combined effects of multiple forms of physical and psychological trauma or traumatic stress in children. More research is needed to understand how these forms of trauma affect children’s short- and long-term recovery, as well as overall health and well-being, through key developmental transition points.

Priority: Multidisciplinary research that examines the distinctive aspects of psychological and physical trauma, the complex interplay of those traumas, and the implications for trauma-informed systems of care and treatment of diverse pediatric populations in primary care, community, humanitarian, emergency medical, or critical care contexts.

Collaborative Multidisciplinary Research Across the Continuum of Care

Strategic Plan Theme 4: Improving Child and Adolescent Health and the Transition to Adulthood
Strategic Plan Aspirational Goal: Facilitate application of precision medicine approaches in children

Gap: The current approach to studying pediatric trauma, injury prevention, and critical illness is often compartmentalized, with each discipline operating independently. This approach is insufficient to advance the science, accelerate discovery, inform clinical practice, and establish the scientific evidence needed for effective treatment of critically ill, injured, or traumatized children. 

Priority: Research involving multidisciplinary and interdisciplinary teams to develop, test, and evaluate effective therapeutic agents and modalities, medical devices, precision medicine interventions, behavioral interventions, and large-scale datasets to optimize outcomes for traumatized, injured, and critically ill children.

Care and Treatment of Critical Illness in Pediatric Populations

Strategic Plan Theme 4: Improving Child and Adolescent Health and the Transition to Adulthood
Strategic Plan Cross-Cutting Topic: Infectious Disease

Gap: Critical illness in children is an under-recognized major public health problem that accounts for more quality of life years lost than any other medical condition. Critical illness may occur with a wide variety of medical conditions, rare diseases, and life-threatening injuries, making the completion of generalizable studies quite difficult. The impact of these illnesses on the developmental trajectory is poorly understood. Additionally, therapies for these illnesses and rare conditions are most often based on extrapolated adult data. Given that a child’s physiological responses to critical illness differ substantially from those of an adult, there exists a large gap in knowledge regarding optimal therapy for these conditions among children.

Priority: Research that optimizes recovery for children who experience critical illness and/or traumatic injury. This includes research that examines the epidemiology, pathophysiology, diagnosis, prevention, and treatment of all forms of critical illness and life-threatening injury among non-neonatal pediatric populations, as well as identifying sensitive time periods when prevention and treatment strategies are most optimal for children.

Gap: Children with complex medical conditions or rare diseases are frequently dependent upon technology and highly specialized care to survive and thrive, especially during periods of life-threatening illness, such as infections or respiratory distress or failure. Balancing the unique needs of these patients due to their underlying condition or disease with the life-saving measures and technology required can be challenging, at best, yet little research exists to substantiate and direct care. Empirical efforts are needed to develop, test, and evaluate safe and effective solutions that meet the unique needs of critically ill children with complex medical conditions.

Priority: Research designed to determine the optimal use of—and identify patient populations most likely to benefit from—innovative critical care interventions (e.g., extracorporeal membrane oxygenation [ECMO], renal replacement therapy [RRT], etc.), including research that assesses morbidities and functional outcomes related to those treatment modalities.

Psychosocial Issues Related to the Care of Critically Ill and Injured Children and Their Families

Strategic Plan Theme 4: Improving Child and Adolescent Health and the Transition to Adulthood

Gap: Stress related to critical care illness and injury, as well as the inherent ethical concerns and conflicts that contribute to that stress, create a myriad of psychosocial concerns for the child, family, and healthcare providers, yet these concerns and how they might affect clinical outcomes remain grossly understudied. Similarly, both the short-term and long-term psychological consequences of critical illness and injury on these populations are largely unknown. 

Priority: Research aimed at understanding psychosocial issues in critically ill children and their families, as well as ethical and communication issues that arise in the Pediatric Intensive Care Unit, and approaches to reducing the negative sequelae of these issues. Also prioritized is research aimed at understanding the effect of environmental and palliative care interventions in critically ill or injured children on functional outcomes and the psychological consequences of critical stress.

  • Valerie Maholmes, Branch Chief
    Main Research Areas: Childhood adversity, child traumatic stress, violence and violence-related injury, abuse, neglect, and maltreatment; training (child maltreatment, violence); psychological response/services to children experiencing/affected by trauma; trauma-informed care and systems; child protection; child welfare
  • Leah Gilbert, Medical Officer
    Main Research Areas: Pediatric trauma (diagnosis, treatment, prevention); childhood adversity, child traumatic stress, violence and violence-related injury, abuse, neglect, and maltreatment; training (child maltreatment, violence); emergency medical and psychological response/services to children
  • Cinnamon DixonMedical Officer
    Main Research Areas: Emergency medical services for children (EMSC) (prevention, diagnostics, interventions, treatment, utilization, quality); pediatric disaster science  (preparedness, mitigation, response, acute recovery); pediatric unintentional injury prevention and trauma care; global health advancements in EMSC and pediatric disasters; education and training (unintentional injury prevention, EMSC and trauma care, disaster science)
  • Tammara Jenkins, Program Official/Nurse Consultant
    Main Research Areas: Pediatric critical care and injury (general, diagnosis, treatment, prevention, ethics, end-of-life issues, environment of care, and psychosocial aspects of critical care); palliative care in the hospitalized child; acute care in the hospitalized child; training and career development (pediatric critical care, and acute care)
  • Lauren Jones, Extramural Support Assistant
  • Zsuzsanna Kocsis, Program Analyst
  • Laureen Lee, Staff Assistant
  • Tessie October, Medical Officer
    Main Research Areas: Pediatric critical care and injury (general, diagnosis, treatment, prevention, health care communication, decision-making, small business innovation); training (pediatric critical care, trauma, palliative care)


  • Now Available: HEAL KIDS (Knowledge, Innovation, and Discovery Studies) Pain Program. NICHD is leading activities for the KIDS Pain Program, part of NIH's Helping to End Addiction Long-term Initiative® (NIH HEAL Initiative®), through two Requests for Application (RFAs), RFA-HD-24-011 and RFA-HD-24-012. Check out these newly posted Frequently Asked Questions and the recording from a technical assistance webinar related to the KIDS Pain Program and the RFAs on the HEAL Initiative website.
  • PTCIB leads and participates in NICHD’s activities related to COVID-19, which includes co-sponsoring NOT-HD-21-026: Notice of Special Interest (NOSI): Research on the Impact of the Covid 19 Pandemic and Risks for Abuse and Injury Among Vulnerable Children and Youth
  • PTCIB also co-sponsors NOT-HD-21-048: NOSI: Research on Drowning Prevention
  • Highlights from selected branch-funded research:
    • Lurie Children’s Hospital Launches App to Help Screen Bruises in Young Children for Potential Abuse. Lurie Emergency Medical Physician Mary Clyde Pierce, M.D., used the evidence she and colleagues helped gather for an NICHD-funded study on the prevalence of bruising among infants in pediatric emergency departments (EDs) (PMID: 26233923) to develop the Lurie Children’s Child Injury Plausibility Assessment Support Tool (LCAST) app. According to the study, many cases of physical child abuse (PCA) are missed initially because early signs of abuse go unrecognized. Bruising is one of the most common signs of PCA and is missed as an early warning sign in up to 44% of fatal and near-fatal cases. Dr. Clyde Pierce and colleagues based LCAST on the study’s research that derived, refined, and validated a bruising clinical decision rule that specifies body regions on which bruising is likely due to abuse in infants and young children. Learn more about LCAST from this CBS News Chicago interview with Dr. Clyde Pierce external link.
    • ED Pediatric Readiness and Short-Term and Long-Term Mortality Among Children Receiving Emergency Care. This cohort study of nearly 800,000 children who received care in close to 1,000 U.S. EDs demonstrated significantly lower odds of in-hospital death among children who received care at EDs with a high readiness to care for children. Additionally, for children followed beyond hospitalization, the benefit of high-readiness ED care continued for up to 1 year. (PMID: 36637819)
    • Licensing Examination and Crash Outcomes Postlicensure in Young Drivers. This cohort study of more than 130,000 adolescents and young adults (16 to 24 years old) revealed that driver license applicants between the ages of 16 to 17 who underwent comprehensive licensing requirements (including graduated driver licensing, driver education, and behind-the-wheel practice) performed better on licensing exams than their older counterparts who were not subject to these requirements. Moreover, this younger population with comprehensive licensing requirements had lower crash rates 1 year postlicensure. (PMID: 35467733)
  • Video: PTCIB Chief Dr. Valerie Maholmes Talks About TBI in Kids external link
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