Could Your Family Be Affected By Traumatic Stress?
Research has shown that both children and their caregivers may experience symptoms of medical traumatic stress after life-threatening medical events or ongoing painful and invasive medical procedures. Medical traumatic stress is described as “a set of psychological and physiological responses of children and their families to pain, injury, serious illness, medical procedures, and invasive or frightening treatment experiences” (Center for Pediatric Traumatic Stress [CPTS], 2004, p. 11).
Risk Factors of Posttraumatic Stress Disorder
Being exposed to one or more traumatic event(s):
Traumatic events can include anything perceived as scary and life-threatening to your child. Medical events that may be potentially traumatic include getting a blood draw, having surgery, receiving a diagnosis, or hospitalization.
While the severity of the event is a factor, it is your child’s perception of the event that will usually dictate whether or not the brain processes it as trauma.
Proximity to the event:
Did the event happen directly to your child, or were they observing the event as a bystander? Children (and adults) who witness something frightening or disturbing happening to someone else may experience it as a traumatic event.
Prior history of trauma:
Children with prior traumatic experiences are often more likely to develop traumatic stress symptoms after a later trauma. Did they see something scary on TV and have an unexpected reaction? Did something happen at school that caused a behavioral outburst? Often memories of previous traumatic events can be triggered by reminders of the original event. Even bright lights or loud noises can serve as a trigger that can bring up uncomfortable emotions.
When faced with a scary event, many children, especially younger children, look to others for clues on how they “should” be responding. If other people (such as caregivers) are having a difficult time, children may pick up on this. This does not mean that parents should pretend they are not affected. But parents learning and modeling helpful coping strategies can go a long way to helping children cope as well.
Signs and Symptoms
Children can manifest symptoms of trauma differently from adults. Some symptoms of trauma in children include:
Difficulties with self-regulation
Problems relating to others
Regression/loss of previously acquired skills
Attention deficits and academic difficulties
Behavioral issues and outbursts
Unexplained aches and pains
Repeating the event in play
Some of the overlapping symptoms in children and adults include:
Intense and ongoing emotional upset
Depression or anxiety
Avoidance of things that trigger memories of the event
Dissociation (feeling as though what is happening is unreal or a bad dream)
While many people experience some of the above symptoms in the aftermath of a trauma, they will persist differently for different people. Some may experience few if any symptoms and they may last only a few days or weeks, while others may struggle more persistently. Recognizing and addressing persistent traumatic stress as soon as possible will be important. There are several options available for treatment and therapy to address traumatic stress resulting from ongoing medical interventions. There are even some things you can do at home! An important thing to remember is that different approaches work for different people. What may work for someone else may not be the best solution for your family. It’s important to keep trying to find the solution that works best for you and your child.
There are a few types of therapy available to address traumatic stress. Talking to your child’s doctor or calling your health insurance provider to ask for a referral can help you find a qualified professional. When seeking help from a psychologist or behavioral health provider, try to find someone who has experience and training in evidence-based treatment for trauma with children and medical populations. Evidence-based treatments have been shown through research to have a positive benefit. These approaches, including Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) and Parent-Child Interactive Therapy (PCIT), work by teaching children effective coping skills and/or working with parents on how to model and reinforce these skills. There may be a part of therapy called “exposure” sessions. This involves gradually exposing children to aspects of the event in a supportive environment that helps them cope and gain a sense of mastery over it.
Child Life Specialists:
Child Life Specialists are trained in child development and work in many pediatric medical settings. They can help during difficult procedures and hospitalizations by reviewing certain coping strategies, providing procedural education to children in developmentally appropriate way, and providing active distraction.
How to support your child:
Showing lots of positive attention and praise, even if it not focused at all on the medical situation, can be very helpful. For younger children in particular, taking a few minutes per day for a one-on-one play session where you give a lot of positive attention can help them develop confidence that will assist them in navigating difficult emotions later.
Engaging your child in discussion about the event can provide a nurturing space for them to process difficult emotions. Asking gentle questions such as, “How did that make you feel?” Or validating them with statements like, “That must have been really scary” can help encourage your child to talk. This can also model for them that it is okay to talk about it. Your child may not want to talk about the event right away, and that’s okay too. What’s important is that they understand you are available to listen when they are ready, and that they will be supported and safe. Showing them how you use coping skills to help with difficult or scary situations can go a long way as well.
Breathing Techniques and Mindfulness:
When children (or adults) experience a traumatic event, they may slip into a “fight, flight, or freeze” reaction. Many of the symptoms listed above fall into these categories. When this happens, it can be difficult to access the logic and reasoning centers of the brain. This can result in anxiety and even panic responses when facing a frightening situation, like a blood draw, or when a memory of the original event is triggered. Breathing and mindfulness practices can help activate the part of the brain that tells the body to calm down.
Yoga uses breath and mindfulness in conjunction with physical activity. Coordinating the breath while focusing on aligning the body in yoga postures can help foster the connection between the logic and reasoning centers of the brain and awareness of the body. This can help you and your child develop better self-regulation skills after a traumatic event, and minimize the effect of dissociation.
Getting Help for Yourself:
Watching your child go through a traumatic or life-threatening experience affects you, too. In order to provide emotional support for your child to help them navigate these difficult experiences, you also need to find support for yourself. This will help you model helpful coping for your child as well as just simply for your own well-being. A trained therapist can help guide you through your own difficult emotions as well as teach you how to recognize the signs of trauma in your child and provide helpful suggestions on how you can support them.
There are many helpful resources to help you better understand traumatic stress and help you navigate some of the difficult emotions it can cause.
Trauma Through A Child’s Eyes by Peter A. Levine, PhD
The Body Keeps Score: Brain, Mind, and Body in the Healing of Trauma by Bessel Van der Kolk, MD, Sean Pratt, et al.
Mindful Games: Sharing Mindfulness and Meditation with Children, Teens, and Families by Susan Kaiser Greenland
I Am Yoga by Susan Verde and Peter H. Reynolds
Yoga Pretzels Yoga Cards by Tara Guber, Leah Kalish, et al.
Jasmine Hollingsworth, RYT-500, RCYT, Trauma Informed Yoga Teacher
Liver Mommas & Families, Inc.
Micah Brosbe, Ph.D.
Dana Griffith, Ph.D.
Professor of Arts & Sciences
Christ College of Nursing and Health Sciences
Micah Brosbe, Ph. D.
Georgia Anderson, MSW, LISW-S, Ph.D.
University of Cincinnati
Pediatric Liver Transplant Advocate
Sources: Childhood Stress In Healthcare Settings: Awareness And Suggested Interventions by Al-Yateem NS1, Banni Issa W, Rossiter R.; The Pediatric Birth to Three Clinic and Early Childhood Mental Health Program: Meeting the Needs of Complex Pediatric Patients by Kroupina M and Elison K; Helping the Smallest Patients Cope by Duda M; Medical Traumatic Stress Symptoms on Pediatric Patients on Dialysis and Their Caregivers by Neul S; Integrating Play in Trauma-Informed Care: Multidisciplinary Pediatric Healthcare Provider Perspectives by Stenman K, Christofferson J, Alderfer M, Pierce J, Kelly C, Schifano E, Klaff S, Sciolla J, Deatrick J, Kazak A; The Role of Mindfulness in Reducing the Adverse Effects of Childhood Stress and Trauma by Ortiz R, Sibinga E; Yoga as an Intervention for Psychological Symptoms Following Trauma by Nguyen-Feng V, Butler M, Clark C; Impact of traumatic medical events on children, parents, and healthcare providers, Centers for Pediatric Traumatic Stress (CPTS)