A snapshot of medical trauma
It is common for children to feel worried or anxious when receiving medical interventions. However, with enough preparation and planning, choice and coping techniques, children can have a positive experience and medical trauma can be avoided. The National Child Traumatic Stress Network (NCTSN, n.d) state that up to 80% of ill or injured children and their families experience some type of traumatic stress after a life threating illness, injury, or painful medical procedure. Additionally, 15-25% of children and siblings experience persistent traumatic stress reactions that may impair daily functioning and positive experiences for future treatments (NCTSN, n.d).
Don‘t fall for the myths
There are a number of myths around pain and medical procedures with children. These myths include ‘they get used to it’, ‘they don’t feel it’ or ‘they won’t remember it’. Most people think that pain is a signal sent from the injury to the brain, and that the size of the injury equates to the pain felt. However, this quote by David Butler encourages us to have a different lens when viewing pain from a child’s perspective. “All pain experiences are a normal response to what your brain thinks is a threat”. Even the smallest medical procedure can result in medical trauma, depending on child’s experience of stress.
So, although the actual medical intervention may not seem invasive to an adult, a child’s own subjective experience of the event causes them to react a certain way. Pain receptors send messages to the brain, the brain then evaluates how dangerous the message is. The way the brain evaluates the messages is constructed from previous experiences. If a previous procedure was traumatic the first time, this can intensify the pain and reaction the second time around. The reaction increases because the brain is attempting to protect the body from the perceived threat- also known as the ‘fight, flight or freeze’ response (Mackenzie, 2014).
Recognise medical trauma and traumatic stress
Children may experience many different types of reactions from a distressing procedure. Some reactions could be the child’s age-appropriate way to recover from the experience. However, when traumatic stress reactions persist, impairs day to day functioning, affects adherence to medical treatment or inhibits optimal recovery, you may require additional support. It is recommended to talk to your medical team and seek professional guidance (NCTSN, n.d). It is imperative that the child has a safe space to heal and recover from their previous traumatic hospital related experiences.
So how can we prevent medical trauma?
- Preparation through play: On a doll or teddy allow the child to explore medical equipment/procedures on a doll or with a parent/caregiver
- Acknowledge the child’s feelings and experiences: “this is really difficult for you” “you’re feeling worried”
- Co-regulate by modelling and promoting coping techniques: Belly breathing, talking in a soft calm voice, relax body posture/facial expressions
- Promote choice and control: Empower the child to make simple choices- like what to watch on their iPad, what toy to bring in, do they want a count down before they get their injection….
- Create a procedure support plan: Think about positioning, a visual block, creating a calm and quiet environment or bringing in comfort toys.
- In child friendly language explain the procedure in simple steps, so there are no ‘surprises’. A great resource to watch are the ‘B+ videos’ created by the Royal Children’s Hospital. The videos explain common medical procedures from a child’s perspective.
Additional Resources
- The National Child Traumatic Stress Network
- The Royal Children’s Hospital ‘a child’s guide to hospital’
