What Do Clinicians Caring for Children Need to Know about Pediatric Medical Traumatic Stress and the Ethics of Trauma-Informed Approaches?

Abstract

Medical experiences can be frightening and traumatic for children. Ill and injured children can experience pediatric medical traumatic stresspsychological and physiological distress responses related to their medical event and subsequent medical treatment experiences-which can lead to symptoms of posttraumatic stress disorder (PTSD) and suboptimal health outcomes. Trauma-informed care provides a framework for acknowledging, addressing, and mitigating the risks of psychological trauma associated with medical treatment experiences and is congruent with the ethical principles of respect for autonomy, beneficence, nonmaleficence, and justice. Health care systems and professionals are encouraged to apply the principles of trauma-informed care to address the effects of pediatric medical traumatic stress. IntroductionFor the sick or injured child, being treated in the emergency department (ED) or admitted to the hospital can be a frightening and confusing experience that leads to subsequent psychological distress [1]. Experiencing pain, feeling helpless and out of control, and being separated from one's parents are all factors that contribute to the potentially traumatic nature of medical events. How does a physician's ethical obligation to "first, do no harm" square with the prospect of providing a therapeutically necessary procedure for a frightened child who does not understand what is being done and why? How do we understand the ethical issues involved when a medically beneficial course of treatment for a pediatric patient also has the potential to engender stress, fear, anxiety, pain, or discomfort for this child? In this brief review, we first describe two concepts that are key to understanding and addressing the psychological distress that can affect ill and injured children: pediatric medical traumatic stress and trauma-informed pediatric care. We then discuss four core principles of medical ethics (respect for autonomy, beneficence, nonmaleficence, and justice [2]) and explain how the application of these principles underscores the need for trauma-informed care.

The Scarcity of Literature on the Psychological, Social, and Emotional Effects of Gastroparesis in Children

“…Among these events, medical trauma arises from hospitalizations, surgeries, procedures, or even significant disease symptoms and can manifest in post-traumatic stress (PTS), which has many overlapping symptoms with PTSD [34,35]. Most research in this area exists in pediatric patients with a history of cancers [36,37], accidents including traumatic brain injury [38][39][40][41], or, more generally, intensive care unit hospitalizations [42].…”

Computerized Symbol Digit Modalities Test in a Swiss Pediatric Cohort – Part 2: Clinical Implementation

“…Although both the SDMT and the c-SDMT are rapid and easy to administer bedside tools for the assessment of IPS, little is known about how hospitalization may influence performance of these tests. It is well recognized that hospitalization can cause a variety of reactions in children, which include distress, pain, the feeling of not being in control, being overwhelmed, discomfort (Perry, 2009) and fear (Kassam-Adams and Butler, 2017). Such reactions can occur regardless of the reason for hospitalization (Kassam-Adams and Butler, 2017).…”

“…It is well recognized that hospitalization can cause a variety of reactions in children, which include distress, pain, the feeling of not being in control, being overwhelmed, discomfort (Perry, 2009) and fear (Kassam-Adams and Butler, 2017). Such reactions can occur regardless of the reason for hospitalization (Kassam-Adams and Butler, 2017). Furthermore, it is probable that even minor procedures can be frightening for children (Kassam-Adams and Butler, 2017).…”

A web-based educational intervention to implement trauma-informed care in a paediatric healthcare setting: protocol for a feasibility study using pre-post mixed methods design

“…Trauma-informed care requires recognition and understanding of the widespread impact of trauma and recognising how it presents differently across the lifespan. It is also means being responsive and applying trauma-informed care knowledge into practice to minimise the risk of further traumatisation [ 9 , 10 ]. Adoption of sound trauma-informed care practices in hospital-based paediatric care may help mitigate the downstream costs associated with treatment delivery [ 11 ].…”