Center for Injury Research and Prevention

AAP Releases New Policy Statement on Improving Pediatric Injury Care

September 19, 2016
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Healthcaretoolbox.org

Last month the American Academy of Pediatrics (AAP) published a Policy Statement on Management of Pediatric Trauma to guide a comprehensive approach for improving outcomes for injured children. With 20 million children injured each year in the US, this guidance is timely and much needed.

I applaud the AAP for recognizing and addressing psychosocial aspects of recovery from pediatric injury in this policy statement. While most children recover well after an injury, several decades of research conducted by CHOP researchers and others shows that a significant minority will develop ongoing emotional distress that can also delay or impede their functional recovery. We summarized current research and best practices regarding pediatric injury and posttraumatic stress in a 2013 review article in JAMA Pediatrics.

Here are key points from the AAP Policy Statement that highlight the need to attend to the emotional recovery of injured children:

  • Pediatric protocols are needed for a child- and family-centered environment of care for injured individuals. Patient- and family-centered care not only improves safety, but also helps to prevent a potentially traumatic medical event from triggering persistent psychosocial distress for injured children and their families. CHOP is working to embed family-centered and trauma-informed care into practice throughout our health system.
  • Management of the injured child requires special considerations beyond adult trauma care, including family presence during resuscitation. As family presence is increasingly accepted by providers and expected by parents, CHOP researchers are working to develop new tools that support family-centered care during pediatric resuscitation across a wide range of emergency care settings. 
  • Medical staff may need additional training to promote timely and effective pain management for the injured child. As my colleague, Joel Fein, MD and others describe in an AAP Committee on Pediatric Emergency Medicine report, children receiving emergency care need medical providers who are well-prepared to provide a full range of pediatric pain management strategies, including: systemic analgesics, regional and local pain control options, and non-pharmacological approaches such as distraction techniques.
     
  • It is important to address acute stress and posttraumatic stress reactions in all trauma patients, and youth injured through interpersonal violence may be in particular need of crisis intervention and ongoing support. The AAP statement reminds healthcare providers that all injured children and their families should be evaluated for stress reactions related to injury and referred for additional intervention if needed. The Center for Pediatric Traumatic Stress (www.HealthCareToolbox.org) provides tools and resources to help providers incorporate trauma-informed screening and interventions across different medical settings. Understanding the specific effects of violence and violent injury for youth and how to prevent it is the mission of CHOP’s Violence Prevention Initiative (VPI).

The AAP statement also links to key resources such as the National Network of Hospital-Based Violence Intervention Programs, the National Child Traumatic Stress Network, and a recently released  AAP clinical report on recognizing clinically challenging mental health related conditions when children are seen for medical care in a hospital’s emergency department or in primary care.

Each year in the US, 1 in 4 children sustains an injury that requires medical care. This AAP statement reflects the fact that it takes a village to improve the management of pediatric trauma. The statement is an important step in recognizing the ways in which all parts of the health care system can come together with parents and families to promote healthy recovery for injured children.