The impact of injury: The experiences of children and families after a child’s traumatic injury

Abstract

Objective: To explore the experiences of children and families after a child’s traumatic injury (Injury Severity Score >8). Design: Qualitative interview study. Setting: Two children’s major trauma centres in England. Participants: 32 participants: 13 children with traumatic injuries, their parents/guardians ( n = 14) and five parents whose injured child did not participate. Methods: Semi-structured interviews exploring the emotional, social, practical and physical impacts of children’s injuries, analysed by thematic analysis. Results: Interviews were conducted a median of 8.5 months (IQR 9.3) post-injury. Injuries affected the head, chest, abdomen, spine, limbs or multiple body parts. Injured children struggled with changes to their appearance, physical activity restrictions and late onset physical symptoms, which developed after hospital discharge when activity levels increased. Social participation was affected by activity restrictions, concerns about their appearance and interruptions to friendships. Psychological impacts, particularly post-traumatic stress type symptoms often affected both children and parents. Parents’ responsibilities suddenly increased, which affected family relationships and roles, their ability to work and carry out daily tasks. Rapid hospital discharge was wanted, but participants often felt vulnerable on return home. They valued continued contact with a healthcare professional and practical supports from family and friends, which enabled resumption of their usual lives. Conclusions: Injured children experience changes to their appearance, friendships, physical activity levels and develop new physical and mental health symptoms after hospital discharge. Such challenges can be addressed by the provision of advice about potential symptoms, alternative activities during recovery, strategies to build resilience and how to access services after hospital discharge.

Educational support needs of injured children and their families after a child’s traumatic injury: A qualitative study

“…It may be that parents who are willing to participate in research are also more engaged in their child's care and different experiences may have been captured for parents who took a less proactive stance. As highlighted in our companion papers, most participants were mothers (20,21). This probably reflects the distribution of child-care responsibilities within UK families, but the inclusion of more fathers or extended family members may have resulted in different perspectives.…”

“…The latter accommodations are likely to reflect a lack of understanding of their needs. The children in the current study expressed a strong preference to remain with their peers, who are often an important source of support ( 16 , 21 ). This suggests that schools need to consider social inclusion from a wider biopsychosocial perspective ( 33 ).…”

“…In agreement with previous research, we found that injured children’s return to school was reliant on parents’ proactive involvement ( 3 ). This added to the demands on families who were already managing the additional care needs of the injured child, their own responsibilities and the array of emotions triggered by their child’s return to school ( 3 , 16 , 17 , 18 , 21 , 30 ). Although “our parents” were able to take on this role, others may lack the confidence or have insufficient understanding of their child’s needs to do so ( 11 ).…”

“…The supplementary material provides a copy of the topic guide, which explored the educational support needs and experiences of injured children and their families. As this paper is part of a larger programme of work, some questions relate to issues reported in companion papers ( 20 , 21 ). The semi-structured format allowed participants to explore their needs and experiences irrespective of their educational pathway (home tuition, return to school), age or type of injury.…”

“…Whilst the longterm impacts for such injuries may be less significant than for head injuries, they can cause symptoms and disabilities (such as fatigue and limited mobility), which affect school attendance and psychosocial functioning (19). Our previous publications regarding injured children's rehabilitation needs demonstrate that children with a wide range of injuries (and their families) consistently identify similar needs and preferences about how services are delivered (20,21). The aim of the current study is to explore the educational support needs and experiences of children with a range of injuries, and their families.…”