The National Child Traumatic Stress Network describes medical trauma as “a set of psychological and physiological responses of children and their families to pain, injury, serious illness, medical procedures, and invasive or frightening treatment experiences”. (NCTSN, 2020).
Rather than the specific illness or treatment, children’s responses to medical trauma are more related to their subjective experience of the medical event, rather than its objective severity. Symptoms may look different depending on the developmental age of the infant, child or young person; and can vary in intensity. When these symptoms cause the individual significant distress or it interferes with medical care or life in some way, it can be considered ‘medical trauma’ rather than an expected stress response.
Medical trauma can develop from a once-off experience, such as an injury or negative procedure; or, can be an accumulation of ongoing health care encounters.
What does this look like?
Medical trauma can look different for every individual. The emotional responses to an event can cause physiological symptoms such as sweating, feeling nauseous, increased heart rate or elevated blood pressure.
In infants, you may see changes in sleep or eating patterns, difficulty to soothe, or appearing more withdrawn. Toddlers and young children may show obvious signs of fear, increased clinginess, may be difficult to comfort, increased crying, or regression to earlier developmental behaviours. Older children may have difficulty sleeping or experience nightmares, avoidance of medical situations, or lose interest in previously pleasurable activities. You might find that children can become easily dysregulated and upset over seemingly small things; or develop physical symptoms such as headaches or stomach aches, particularly in avoidance of certain activities. These responses can have a significant impact on their daily functioning and their engagement in further medical encounters.
Research suggests that many ill or injured children and their families (up to 80%) experience some traumatic stress reactions following a life-threatening illness, injury, or painful medical procedure. Infants, children and some young people, often do not have the language to be able to express these feelings of distress or anxiety; therefore, it can be hard to identify and process.
Types of traumatic stress responses
Re-experiencing
It is normal for a child to think and talk about difficult experiences, particularly just following the event, as a way of processing their understanding of what has happened. However, re-experiencing can become an issue when the child has less control over their thoughts. They may experience nightmares or flash backs of an event; and a sound or sight may bring them back to that moment. At these times, the child might experience physical stress symptoms including increased heart rate or sweating.
Hyper- or hypo-arousal
As a normal response to a traumatic experience, our body will often put us into our primal physiological response – fight, flight or freeze. It is our way of dealing with a situation and protecting ourselves from the perceived danger. This is an expected response. It can, however, become an issue when the perceived threat has now gone and yet the body is unable to regulate. The ‘on switch’ remains in position and your child may become hypervigilant and constantly on edge. This can result in increased clinginess, exaggerated fears or being ‘jumpy’ at things such as loud noises. Alternatively, if your child has switched into ‘freeze’ mode, you might find that they seem apathetic, distant and seeking solitude. Both hyper and hypo arousal have their place in survival, but it is important that we can help children learn how to switch them off when they are not required.
Avoidance
You might find after a stressful event, and as a means of coping, that a child will not want to discuss or think about it. This might also extend to avoiding people, places or activities that remind them of the experience. Again, to an extent, this is a normal response. However, when it begins to interfere with life or necessary ongoing medical care, it is important to address it. Exaggerated fears or worries about unrelated things may also develop; causing a reluctance or anxiety about engaging in previously pleasurable activities.
Medical trauma can be a debilitating experience and have life-long implications for children and their families. Identifying the signs and symptoms is the first step in supporting a young person through this process. Seeking help and finding the right resources and people to work through these issues, is the second.
The National Child Traumatic Stress Network has a range of resources to support both health care workers and families in beginning to explore and manage medical trauma.
It is important to reach out, through your medical team or GP, if you have concerns or questions about your child’s response to stressful medical encounters, so that appropriate support and early intervention can be received.
Kate Strickland is a community-based Child Life Therapist with a background in Occupational Therapy and Education. She works with infants, children and young people along with their families in managing the stresses associated with health care encounters, procedures, hospitalisations and medical trauma. Visit healingheartsbeyond.com.au for more information.
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