Research In Action

After a child has experienced a traumatic medical event involving a visit to the Emergency Department (ED), the follow-up pediatrician visit is crucial to the patient’s emotional recovery. Here’s an exemplar case:

You’re a pediatrician seeing Michael, a 10-year-old boy who was treated the previous week after being hit by a slow moving car while walking to school. Initially brought by ambulance into the ER’s Trauma Bay on a hard board and cervical spine collar, the child was quickly transferred to a regular ER room once it was determined that he had only minor bruises and scrapes. His parents arrived soon afterward, and he was discharged home to return to school the following day.

At the Follow-Up Pediatric Visit

• The sights and sounds of an accident scene and/or ambulance can be very frightening for a child who may overestimate the seriousness of his condition. For example, Michael may have associated being in an ambulance with “dying” because his great uncle was brought to the hospital the same way.
• A child's perception of life threat can be unrelated to actual injury severity. Therefore, how the medical provider assesses the situation may be very different from what the child is thinking or feeling. Because Michael’s initial evaluation happened quickly, with no serious injury, there may not have been anyone there to reassure him that he was going to be fine.
• Like many other children who may be in this situation, the patient was in pain, separated from his parents or other supportive people, and faced with many people “hidden” behind their masks and gowns.  Michael likely felt alone and scared.

All of these factors can contribute to current traumatic stress reactions in children and potential persistent posttraumatic stress. Here’s what to think about when treating patients like Michael in your office:

• How do you minimize the potential for future traumatic stress reactions in these situations?
• Do you ask the parents to help you assess Michael’s risk of developing persistent traumatic stress by asking them how he is feeling and what he’s been like since the incident?
• Do you learn about how Michael’s sleep has been disrupted, how he talks very little about the incident, or how he keeps telling the story over and over despite seeming upset? 

Practice Trauma-informed Care

Learning more about the development of traumatic stress symptoms, even after seemingly minor injuries, is key to helping your young patients make a full recovery. There are ways to help minimize traumatic stress immediately after the injury, during hospitalization, and after discharge:

• Explain that feelings of anxiety are common but that they usually get better over a few weeks.
• Encourage ill or injured children to get back to a normal routine, providing a safe space for them to talk about their experiences using age-appropriate communication, for example, drawings for younger children.
• Help parents help their children reconnect with friends and plan medically appropriate activities, as well as help them prepare answers to common questions that their friends might ask.

How do you help patients cope emotionally after a traumatic medical event? Share your tips for minimizing traumatic stress for children and families on Facebook.