June 6 2016

Kids can be traumatised by hospital stays, research shows

Professor Justin Kenardy MAPS
By Professor of Psychology, University of Queensland Deputy Director, Recover Injury Research Centre

Children admitted to hospital can experience trauma, not just from their injury but from the experience. Psychological research is measuring the impact and suggesting solutions.

It’s not just the major disasters, such as bushfires and floods, that lead to children experiencing distress and psychological trauma. Every-day adverse incidents such as car accidents, burns and injuries can be traumatic and incredibly distressing for children.

We know that children who survive these common traumatic events and are admitted to hospital for treatment can experience psychological problems which, if left untreated, may delay aspects of their childhood development with the potential for long-term ramifications.

Our research shows about 10 to 15 per cent of children who are admitted to hospital after sustaining an injury develop post-traumatic stress disorder (PTSD), while for those admitted to areas such as the intensive care unit (ICU), the rate of psychological disorder in children is much higher – in the order of 20-25 per cent.

It’s not difficult to understand why children are susceptible to experiencing psychological problems in the wake of a traumatic event and hospitalisation. An injured child in ICU (intensive care unit) can be disorientated and confused about their hospital admission or may not comprehend their medical procedures, either due to their age, their medical condition or as a result of their medication.

The impact of hospitalisation can also linger with children long after their discharge. Children can become distressed at recalling their pain, treatment or even general memories of their time in hospital. Children admitted to ICU can experience medication-induced hallucinations or changes in their cognition due to an altered state of consciousness.

In young children, psychological problems may manifest non-verbally through behavioural issues. These issues can vary from child to child depending on what stage they have reached in their childhood development. Younger children may, for example, return to an earlier developmental stage and its associated behaviours, such as being more clingy around their parents or wetting the bed.

In hospital, our health care practitioners work diligently and effectively to assist patients with their physical injuries but on the downside we are failing to help young patients with their psychological injuries.

While the patient’s physical care should be prioritised, saving a patient’s life only for the patient to be affected psychologically as a result of their hospitalisation reveals that their care was less than optimal.

Reducing the stress of hospital stays

Researchers are working to address this challenge in a bid to improve the way in which our hospitals provide both physical and psychological care and treatment for children.

Our studies are examining the triggers and factors of hospital-delivered care that drive distress and traumatic stress in children. We are also working to better identify these psychological problems in children so that psychologists can deliver essential early intervention.

Our research is focused on developing tools designed to effectively identify distress in children from the ages of two and three right up to teenagers. Once identified, psychologists will then be able to intervene to prevent that distress and reduce the impact it may have on aspects of the child’s development in both the short and long-term.

Researchers are trialling psychological early intervention in children aged six and over. The results show that relatively simple types of resilience building and the provision of similar information to the child’s parents has a positive impact on the child’s overall distress. Soon, we will put to the test early psychological intervention in children, who are at-risk of distress or trauma stress, aged from as young as one to six.

While psychologists are the experts in delivering effective psychological care, the good news is that most health care professionals, teachers and parents who are equipped with the right knowledge can provide a good level of psychological assistance to at-risk children in their care.

Where there are heightened levels of distress or where the psychological problem is more entrenched or complicated, it’s crucial that we engage the skills and expertise of psychologists.

With increasing numbers of young patients being admitted to and surviving ICU, it’s essential we work to reduce their psychological scars. In doing so, we’ll be providing children with a better physical and psychological start in life.

Justin Kenardy receives funding from the National Health and Medical Research Council (Australia), the Patient Centered Outcomes Research Institute (USA) and the Queensland Motor Accident Insurance Commission. Justin is a Fellow of the Australian Psychological Society.