Can Kids have Medical Trauma PTSD?
If your child has had many experiences with surgery, procedures, tests, and hospital stays you may have noticed that they have a genuine fear of all things medical. For lots of us medical parents, we start to wonder if this fear is actually a form of Post Traumatic Stress Disorder.
Unfortunately, the truth is yes, children can have PTSD from medical trauma.
Trauma can come from pain that comes after recovery, the constant uncomfortable tests, short and long term stays in a hospital, and from frequent doctor appointments.
A new term that has come about recently to describe this condition specific to children is “Pediatric medical traumatic stress”. Even though there is a new term, it is still considered under the umbrella of Post Traumatic Stress Disorder. This simply means that after a medical trauma stress occurs.
What are the signs of Medical Trauma PTSD in Children?
The signs and symptoms of Medical Trauma PTSD in children will vary a lot based on each child’s experiences. Here is a list of common reactions and signs of stress.
- anxious during appointments or exams
- not wanting to be hugged or touched when in pain
- refusing medications and treatments
- anger and angry outbursts
- crying and screaming during basic hands on care
- nightmares
- talking about or worrying about dying
- repeatedly talking about previous procedures or visits
- fearful or scared of anyone in medical uniforms (nurse scrubs or white coats)
- fearful or scared of basic things like getting their temperature taken or having a stethoscope touch them
- not wanting to talk about anything medical related
- a fear of germs or getting sick
- obsessive about diet, body cleaning, hand washing, etc.
- refusing to speak to any medical professional
- always scared that they are going back to the hospital
Theses symptoms can show up at any time and at any age. There is minimum age requirement to have stress from medical procedures. The symptoms may start very small and build up over time, or they may start at a very noticeable level.
Our experience with Medical PTSD
Sometimes, medical procedures can not be avoided, they are literally life saving things that must be done. My daughter has had about 75 dilation procedures on her esophagus in the last 2 years. These procedures literally open up her throat so she can drink and eat. Without this procedure she won’t be able to swallow her own secretions, let alone eat or drink. Failure to get this procedure done would open her up to aspiration and complications like fluid in her lungs (pneumonia).
We go to our local children’s hospital for the procedure and at times we did this procedure weekly. Thankfully at this time, we are doing them monthly. This is a lot of time spent in the hospital, having tests done, going back to the OR (operating room), and dealing with pain afterwards.
When we first started, she was an infant about 4 months old and she didn’t seem to really be bothered by the frequent trips. She also spend 4 1/2 months in the NICU, so it seemed fairly routine to her.
Around the time that she turned one, we started to notice that her demeanor was really starting to change when we went to the hospital. Unfortunately, she also had two lengthy stays in the hospital. (one for 23 days, and another for 17 days) Both of these stays were fairly close together, one was in October and one was in December/January).
After that last hospital stay, her reaction to just the basic of tests like having her temperature, heartbeat checked, weighing in, or having a blood pressure taken would very visibly upset her. I initially thought she was just having a bad day and was extra grumpy, but I realized that this was starting to happen every time. It also didn’t change when she had her favorite nurses doing them. When it was a nurse she didn’t know, I chalked it up to having a new to my daughter person and she was just being dramatic. When her absolute favorite nurses tried to do these simple intake exams, it was like a light switch went off. My daughter started screaming, had a blank look in her eyes or an absolute terror in her face, and as soon as the test was over, she would snuggle up to me and be fine like nothing happened. Smiling and interacting with the nurse, like nothing happened. It was bizarre to say the least.
What can you do at home to help with Medical PTSD in Kids?
One of the very best ways to get children to understand and to express their emotions is to play with them. Play is so often overlooked, but it is literally the easiest and simplest way to teach a child. After I realized that we were definitely starting to have issues with parts of our must needed medical journey, I knew we had to start trying something. Now my daughter was only a year old and non verbal and not even walking yet, so my options were pretty limited. I couldn’t have a heart to heart talk where she could tell me her fears.
As I was walking through Wal-mart one day, I noticed a Cocomelon themed Doctor’s kit that sang songs. It came with a pretend syringe, a thermometer, stethoscope and kit that held everything together. My daughter is a HUGE fan of cocomelon, so I bought it in hopes of doing a little submersion therapy at home. My thinking was that if I could get her more comfortable with the objects then she would do better at the next hospital visit.
I am all about the no- pressure parenting when it comes to trying to convince my children to do what I want. If you have ever forced a child against their will, you already know that it is a long uphill battle that you will probably not win. So when I brought the toy home, I took it out of the package and just put it down in the center of our living room. I told my daughter, “Look baby, I got you a new toy!” I made it known, that this was a fun toy from the get go, and then I backed off. If she went and played with it fine, if she didn’t touch it that was fine too.
She very carefully examined the case. I showed her how it made noise and how to open it. She took everything out and laid it all nice and neat and then she walked away. She seemed a little confused as to what it was for and how was she suppose to play with it. So I asked her if she wanted to take Mommy’s temperature, and she jumped at the chance. I had a feeling she was so used to being the patient, that maybe she wanted to try being the nurse or doctor!
This quickly became one of her new favorite toys. She took everyone’s temperature, checked our knee reflexes, listened to everyone’s heartbeat & breathing, and gave us all many many shots.
The next time we went to the hospital and it was her turn to get her temperature taken, I very calmly asked her, “Is it ok to take your temperature?” She nodded yes, because she wasn’t quite talking at this point. She definitely could tell you yes or no with her gestures, and she seemed to understand a lot of what we were telling her if we talked in simple sentences. When the nurse took her temperature she was definitely anxious but didn’t cry and scream, so we were getting somewhere.
As we went on with the intake exam, every time the next task was to start, I would ask her “Is it ok to put this sticker on your finger?” (pulse ox), “Is it ok to put this around your arm?” (blood pressure cuff). It actually worked! So just simply exposing her to the objects and giving her permission to check mine or other family members vitals, she understood that it doesn’t hurt and it wasn’t scary.
The asking permission before we started a task, also gave her the control in the situation. She seemed better about doing the procedure if it was her choice. We started to take this a step further, and asking her if she wanted to stand on the scale or to lay down to get weighed. She actually started to enjoy acting like a big girl and standing on the scale and holding on by herself.
As she got bigger and was able to walk, we would ask her if she wanted to stand next to measuring tape on the wall or to lay down on the bed. We started noticing real quick that she never chose the option to lay on the bed. She seemed to be scared of the hospital bed.
So taking these observations in mind, I started putting her on my lap in the exam room, and asking the medical team to do the exam while I hold her. This made a huge improvement.
She also started getting very interested in objects that the nurses had. So for instance, she wanted to touch things before they were used. So if you wanted to check her heartbeat and breathing sounds, she wanted to touch the stethoscope first. She started responding to questions about basic tasks as well. If you held up a blood pressure cuff, and asked her where it went, she would point to her arm. If you asked where her heart was, she pointed to her chest.
This was starting to make a huge difference for us. Her fear of very basic exams was really starting to disappear. Our next big hurdle was when she had to be wheeled back to the OR in the bed. I already knew the bed was an issue, so I asked the staff, if I could carry her back to the OR. I explained to them that she was obviously scared and maybe this would help. They agreed and it was such an easy change. Once we got to the outside of the OR, I would lay her in the bed with a pacifier, her favorite blanket, and I would have her hold her hands together. I told her this was just like holding Mommy’s hands and that I would see her in just a few minutes when it was over. That when it was over, she would get some juice. She still whimpered and cried but it wasn’t as bad.
After we did this for a few times, we had the sweetest OR nurse, that offered to play youtube on her phone for my daughter. We chose a music video from her favorite movie Moana. My daughter was so distracted by her favorite movie that she didn’t seem as bothered by her leaving me. Yes, that kind of hurt, but I was so excited that we found a way that didn’t stress her out so much!
Eventually we figured out, that if we put her in the bed, sitting up, with her blanket and pacifier, and let her hold the railings or hold the phone, she was fine the whole way back to the Operating Room. These little coping mechanisms were really helping ease her anxiety and as a bonus, they weren’t hard to accommodate!
11 tips to help ease medical stress for children
- Play with toy medical objects
- Explain what is going to happen (very basic of what the exam is)
- Asking permission before every task/exam
- Letting her do it herself
- Asking her very basic questions during the exam
- Noticing/ Identifying what specific things caused stress
- Ask the medical staff to help adjust to make things less stressful
- Bring items of comfort (pacifier/blanket/stuffed animal/ toy/etc)
- Keep their hands busy (hold their own hands, hold rails of the bed, hold a phone)
- Use music or video for distraction
- Offer a small reward (like juice after the procedure)
How long does it take to recover or get over medical PTSD in children?
I hate this saying, but in this case it is true….It takes as long as it takes. We noticed the issue of Medical Trauma PTSD around age 1, and now she is about 2 1/2 years old and she is pretty tolerant of all medical exams.
It was a sometimes slow and tedious process but once I really started paying attention to exactly what objects and what specific tasks were causing her stress it became much quicker and easier.
Now hopefully, your child isn’t having to get procedures as often, as my daughter is, but I really think that putting your child in control makes a huge difference. When you think about it from a child’s perspective, they are a small person that gets held down, has things done against their will, and they just have to take it. No adult would want those things, but that’s what we expect of our children. Even the act of getting vaccines and shots, it is almost mandatory and normal behavior to hold a child down.
The last time, my daughter had shots, we focused on her and not making her easier to handle for the nurse. I told her very simply, that was going to hold her on my lap, that I wanted to her to close her eyes, and that we were going to sing a song. I knew if she saw blood, she would freak out so I didn’t want her to see the shot taking place and see any blood that may occur. I told her that after the song, she would get a bandaid. Before the nurse started anything, I asked her to give me two options for a bandaid. She showed me unicorns and batman. My daughter chose batman and was very excited that she was going to get a “sticker.” As the nurse was ready, I asked my daughter to come sit on my lap. We closed our eyes and sang a song. She made a hurt noise with the shot, but I immediately pointed out her new batman sticker on her leg. She was so exited about her new sticker, that she forgot all about the tiny amount of pain from the shot.
What if at home methods don’t work?
Depending on the age of the child and the severity of the trauma, a child may not respond to working at home to overcome their stress with medical procedures and environment. That is ok! This would definitely be something to speak with your pediatrician about and request a referral to a pediatric therapist.
Your child may also benefit to a pre-medication like tylenol or a relaxant before a procedure to calm them down if they are not able to develop coping mechanism. Their stress reaction to anything medical may actually be a symptom of something else.
The biggest thing to remember is that parenting is all trial and error. Some things work really well with certain kids, and some things don’t. Try not to get frustrated and don’t give up. Just like the old saying goes, “if the door doesn’t work, try a window!” Sometimes just slowly approaching the subject from different angles can be very helpful to find what will work.
If your child is older than a toddler, try talking to them in a way that is not confrontational. Explain that you too get very anxious at the Doctor’s office. That you are scared of pain. Ask them for advice on how to feel better and make it easier. Ask them what would make them feel more comfortable.
It’s amazing to me how most kids love to solve a problem, but they don’t always see the answer when it is their problem. If you ask them for help about your problem, they will usually end up telling you what would help themselves!
Please also remember that if you have to hold your child down and force them against their will, this could lead to long lasting traumatic effects on their mental health. Just like you as an adult do not want to be forced into anything, a child does not want to be either. If you feel that you are not the best person to help during a medical appointment, you may want to see if a friend or family member can come with you to appointments.
Lastly, parents can also have PTSD when it comes to medical trauma regarding their children. It happens a lot with parents of special needs kids. If you are overwhelmed with trying to help your child, please ask for help.
