How chronic illness can cause trauma in children

May 6-12, 2012 is National Children’s Mental Health Awareness Week

Stacy Flowers, PsyD, a pediatric psychologist at Dayton Children’s discusses the issue of trauma symptoms in children with chronic illnesses.

When people hear the word TRAUMA, they typically think about an individual who has been in an abusive situation, been through a natural disaster or perhaps military personnel who have experienced the intensity of combat.   What pediatric psychologists and health care providers know is that children with chronic illnesses and/or life threatening injuries can also experience trauma symptoms.

Who is at-risk for developing trauma symptoms?

Children receiving painful or invasive medical procedures or long-term treatment as a result of chronic illness, accidents, or injuries are at a higher risk of developing post-traumatic stress symptoms. Research has also indicated that children’s perceptions of the event are critical- if children perceive the event as extremely frightening, life-threatening, sudden, or extremely painful they will also be at greater risk for developing post-traumatic stress symptoms.

According to the National Child Traumatic Stress Network:

Childhood injuries and illnesses are common:

  • 5 out of 100 American children are hospitalized for a major acute or chronic illness, injury, or disability.
  • 20 million children in the US each year suffer unintentional injuries.
  • Over 11,000 children are diagnosed with new cancers each year in the US, and there are an estimated 250,000 children who are cancer survivors.
  • More than 1,000 children have organ transplants each year and several thousand more are awaiting transplants.
  • Research has indicated that 25 – 40 percent of children develop some post-traumatic stress symptoms as a result of life-threatening chronic illness, accident or serious injury.

These experiences can lead to traumatic stress reactions in children, their parents, and other family members.

Post-traumatic stress symptoms:

Children who have post-traumatic stress symptoms generally experience:

Re-experiencing:             Arousal: Avoidance:
  • Nightmares
  • Flashbacks- feeling that the experience is reoccurring
  • Intrusive Thoughts-the unwanted thoughts/images that “pop” into mind
  • Difficulty falling/staying asleep
  • Increased irritability
  • Difficulty concentrating
  • Hypervigilance
  • Exaggerated startle response
  • People, places, or things that trigger memories of the event
  • Efforts to avoid thoughts, feelings or conversations associated with the trauma
  • Feeling detached or estranged from others
  • Sense of shortened future

 

Impact of development

The way children cope and deal with symptoms of medical or other trauma also vary based on the child’s developmental level.

  • Preschool children who have experienced a trauma may have more difficulty separating or may regress behaviorally (i.e., begin having accidents, become more clingy, or start using baby-talk).
  • School-aged children may experience significant guilt or believe that they caused the trauma to occur (i.e., I did not wear my helmet like my mom told me and now I’m being punished).  They tend to become more concerned for their own and loved one’s health and safety. School-aged children are also likely to have increased somatic complaints following a trauma (i.e., headaches, stomachaches, general pain) as they show their emotional pain through physical symptoms.
  • Adolescents often struggle with trying to “fit in” and may feel self-conscious about their experience. They may isolate themselves more and struggle with ways to be more independent in the face of a medical condition requiring them to be more dependent on parents and caregivers.
  • Preschool, school-aged children, and adolescents may all have difficulty concentrating and learning once they return to school following the experience of a medical trauma.

The intensity of post-traumatic stress symptoms experienced in combination with the child’s developmental stage have the ability to greatly impact academic, emotional, social, physical, and behavioral functioning.

How parents can help:

The first thing parents need to do is recognize that their child is having difficulty or impairment in some area of functioning as a result of medical trauma.  Once parents are aware, one of the best ways to manage these symptoms is to talk to your child about how they are feeling or what they experienced.  Younger children tend to have more difficulty describing what they are experiencing emotionally but may benefit from drawing a picture, playing out the experience, or telling a story.  Regardless of age or developmental level, family support and involvement is essential.

The good news is you do not have to deal with this alone.  The psychology staff at Dayton Children’s has specialized training to treat children of all ages and developmental stages who are dealing with frightening or life-threatening illnesses, injuries, and/or accidents. We can work with children and their families to teach specific coping skills that will decrease post-traumatic stress symptoms.  Talk to your doctor if you think your child might be experiencing post-traumatic stress symptoms.  Also, remember you do not have to wait until symptoms significantly interfere with your child’s functioning, often times long-term impact can be reduced by getting treatment early.

For more information and a list of resources please refer to the National Child Traumatic Stress Network at:  http://www.nctsnet.org/trauma-types/medical-trauma

About Stacy Flowers, PsyD

Dr. Flowers is a pediatric psychologist who works with children and families dealing with issues related to chronic medical conditions. Her clinical and research interests have been in the area of children’s psychosocial functioning, specifically adjustment, coping, and long term outcomes of children and their families in response to being diagnosed with a chronic medical condition.

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