Research In Action

May is Mental Health Awareness Month, a time to raise awareness and reduce the stigma around mental and behavioral health needs. When a family experiences a child’s injury or illness, it can be easy to focus on their physical needs and ignore the potential impact on a child's mental and emotional health. However, roughly 1/3 of pediatric patients may develop persistent symptoms of traumatic stress, and the family members of pediatric patients show similar rates. These families could be experiencing pediatric medical traumatic stress (PMTS), “a set of psychological and physiological responses of children and their families to pain, injury, medical procedures, and invasive or frightening treatment experiences.”

What are traumatic stress symptoms?

Traumatic stress reactions go beyond usual stress reactions. At times, these reactions may be triggered by reminders or thoughts of the traumatic experience. There are four main types of traumatic stress symptoms: re-experiencing, avoidance, changes in cognition (thinking) and mood, and hyper-arousal. Visit HealthCareToolBox.org for examples of what to look out for with these symptoms. 

How can healthcare providers look out for traumatic stress?

The D-E-F Framework provides a guide for healthcare providers to offer trauma-informed care and to assess the mental health of their patients after an injury or illness. After attending to the basics of physical health (otherwise referred to as the “A-B-C”s, or Airway, Breathing, and Circulation), use “D-E-F” as a reminder to address Distress, Emotional support, and Family needs using the following prompts:

Distress:

• Assess and manage pain
• Ask about fears and worries
• Consider grief and loss

Emotional Support

• Who and what does the patient need now?
• Barriers to mobilizing existing supports?

Family

• Assess distress of parents, siblings, and others
• Gauge family stressors and resources
• Address other needs (beyond medical)

In addition to the D-E-F Framework, providers may wish to integrate screening tools into their practice. Screening enables them to gauge risk status or distress/symptoms to guide initial care planning and to connect children and families with the appropriate level of care.

When might a family need more support?

Providers may wish to consider a referral for a more thorough assessment with a mental health professional if:

• Traumatic stress reactions are severe or prolonged (more than a month).
• Traumatic stress reactions interfere with recovery or with returning to normal activities.
• Consider: Is the child participating in daily activities to the extent possible given their medical condition? Are stress reactions interfering with treatment adherence? Are new fears or worries troubling the child or parent?

Different types of treatment may be used to help a patient and family overcome medical traumatic stress and to cope with challenges of illness or injury. The details of treatment (like what kind, and for how long) will depend on a family’s unique needs. However, research does suggest that children and families facing traumatic stress reactions, including those related to an illness or injury, are often helped by therapy that focuses specifically on trauma reactions and concerns. Finding the right therapist can take time. It’s an important relationship, and success depends on a good fit. Families should not hesitate to ask questions of prospective therapists.

Key Takeaways

Traumatic stress reactions are common in the aftermath of a medical event. When they persist, these reactions may get in the way of a child, sibling, or parent's daily functioning and may warrant further attention. By recognizing and responding to traumatic stress symptoms, either through the D-E-F framework and/or formal screening efforts, healthcare providers can connect families in need to additional resources. And, with the right care and support, the good news is that most families do well. For additional resources on pediatric medical traumatic stress -- for both providers and families -- visit HealthcareToolbox.org.