For most children in ICU, step-down or discharge units in hospitals cope with their stay there very well. However, some may experience emotional reactions and feel unsafe and unprotected due to separation from families, medical procedures, and interaction with strange doctors and nurses. Usually these post traumatic reactions fade in a few days or weeks. Reactions that fade are not as severe as PTSD symptoms (post traumatic stress disorder) , but they do need attention. To help these children, medical staff and parents need to recognize the events that elicit these reactions and be able to collaborate and soothe the children.
TYPICAL EVENTS THAT ELICIT STRESS REACTIONS: (DEPENDING ON THE AGE OF THE CHILD):
- Injections, incubations, and imagination of what surgery is like.
- Separation from parents; being alone in the dark, or alone in a hospital room
- Touching by unknown medical staff
- Fear of dying
- Hearing other children cry in pain or fear
- Loss of control of bodily functions or of their choices (food, walking, sleeping)
- Repeated hospitalization with little understanding or age-appropriate explanations.
TYPICAL POST TRAUMATIC PHYSICAL OR EMOTIONAL STRESS REACTIONS:
- Recurring memories or dreams representing memories
- Social and emotional withdrawal (not speaking or connecting to others)
- Call for pain medicine when the pain is not physical
- Appearing nervous, confused, upset, angry, or fearful of repeat experiences
- Worrying about dying, seeing a doctor, seeing a needle
- Stomach aches, headaches, crying with inability to be soothed
- Play activity that re-enacts the stressful situation
- Oppositional behavior (child appears non-cooperative or rebellious)
- Constantly seeking the parent
- Change in eating or sleeping patterns not related to the medical condition
THE MOST EFFECTIVE INTERVENTIONS OF STRESS REACTIONS INVOLVE FAMILIES AND ARE:
- For children younger than 2 ½: they can act out fears with toys or the adult can talk, hold him and soothe with voice and touch.
- Help the older child talk, draw, play or write about the experience in a safe, caring, and accepting relationship with a soothing tone.
- Children can be told that they will not always feel this way – the fear, or sadness, or anger will go away, and they will be helped if they become afraid again.
- Reasonable, consistent and firm behavioral limits must be used, which will make the child feel safe if he is angry or oppositional.
- Parental presence in the hospital units during stays to ease separation anxiety.
- Some parents may need staff coaching and support to remain calm and understand how their own reactions affect their children.