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Medically Induced PTSD in Children

July 18, 2011

Five months ago, at the age of three, Joy had major orthopedic surgery. She spent one week in the hospital and came home in a spica cast (a body cast) she wore for four weeks total.

For the next month, the psychological aftereffects  of the surgery were considered to be ASD (Acute Stress Disorder) resulting from Pediatric Medical Trauma. Medical procedures can be scary and physically traumatic. Acute Stress Disorder recognizes that kids’ emotional recovery can lag behind their physical healing and that it often takes about a month for children to come to terms with what happened.

But ASD does not always resolve. When the same symptoms persist at a dysfunctional level longer than one month, they are labeled PTSD or Post Traumatic Stress Disorder. (See the link above for symptoms and resources.)

While some of Joy’s symptoms like nightmares and difficulty falling asleep have abated, other symptoms have not. Most dysfunctional, she still associates the therapists and clinics she visited in her body cast with the trauma of the cast. We’ve had to drop two occupational, one speech, and one physical therapy session per week because she would not tolerate even a familiar therapist. We’ve also avoided going back to the hospital where she had her surgery, following up at other clinics.

This break from the faces and places Joy associated with the trauma has helped. Last Thursday for the first time, we returned to the hospital. Joy tolerated her appointments as long as she could sit on a familiar lap. But being made to lie down on a horizontal surface at the hospital like the height/weight table panicked her. So she’s not fully over it yet.

That was, in fact, the point of Thursday’s visit. Joy needs an out-patient procedure every six months, the next one in September. My research on Pediatric Medical Trauma opened my eyes to the fact that her previous out-patient procedures had set her up for the PTSD she experienced after surgery. I was glad to find her doctor and I are on the same page about minimizing future trauma.

Age is a risk we could do very little about. Kids three and under (chronologically or developmentally) are at highest risk because of their lesser ability to mentally prepare and cope. We did the right things to prepare Joy: talked about it, read books, took a tour of the hospital. But she was only three. She could not really understand and must have felt powerless to stop what was happening to her. Nor did she have any previous frame of reference from which to guess that the hospitalization and body cast would not go on forever.

Or maybe she did have precedent in her adoption. When she was 13 months old, I went to Korea and whisked her away from the only omma and appa she had ever known (her foster parents) to a brand new life in our family. That enormous upheaval has endured for seventy-five percent of her life (so far). So maybe awakening in a hospital bed connected to six wires, three tubes, alarming machines, not-well controlled pain, trapped in a body cast triggered a deep-seated fear that her life was starting over again and this was her new ‘forever.’

Previous procedures also place kids at risk. Even if she was feeling no pain during her outpatient procedures (Botox injections into her spastic leg muscles), the mask used to administer the anesthesia and the twenty seconds of restraint required while the anesthetic kicked in were things Joy remembered. On Thursday, her doctor agreed to add another med that will gently sedate her before she sees the mask. It also has an amnesic effect that hopefully will dull her memory of the experience instead of reinforcing her fear of horizontal surfaces at Gillette.

Previous emergence delirium is another risk factor. Once a year Joy needs a procedure (Phenol injections) that requires a short-acting general anesthesia. Kids her age are prone to waking up from this particular drug in an anesthesia-induced night terror –I only learned afterward, when she was experiencing emergence delirium. They sedated Joy again and she  woke up normally. When I asked the anesthesiologist if they could do anything differently next time to prevent this, he said no. But researching PMT, I read that some hospitals routinely give kids Melatonin before this specific anesthetic, which helps them wake up more gradually. In most cases, this prevents emergence delirium.

*****

Joy’s experience with PTSD is on my heart partly because we’re still living with it. But largely because my friend Julie’s son Elijah, who is Joy’s age and in her Sunday School class (when they are both well enough to be at church). Tomorrow (Tuesday July 19), Elijah enters the hospital again, this time for a bone marrow transplant for life-threatening complications from a genetic syndrome.

Elijah’s family has done everything they know to do to prepare him. But there is only so much parents can do. The rest is up to God. I am praying not only for Elijah’s life, but that God will wrap him in great mercy, so that when these next difficult months are over and Elijah goes home, he feels the love of Jesus, not the fear of man, in his heart.

Isaiah 43: 1-7

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One Comment leave one →
  1. August 19, 2011 1:00 pm

    I was thrilled to find your post while creating my blog about pediatric medical trauma. I applaud your sensitivity to your daughter’s emotional needs and for being flexible, finding what works for her in the healing process. You are doing the right things! Keep validating her feelings! It’s crucial for her long term recovery. 🙂 Feel free to write me. Tanya

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