Cancer? Heart attacks? Seizures? Death? Many things can cause pediatric medical traumatic stress (PMTS) but not everyone has the same symptoms.
April 1, 2002 A little girl was born named April. She was born with a syndrome called EEC. April has had 58 surgeries and she never realized that she has PMTS; until recently. Whenever she went into surgery they never gave her laughing gas because she was already giggly. April just thought they didn’t give it to her because she was anxious. She now realizes that the giggling was her way of coping and dealing with what was about to come.
Twelve to fourteen percent of children go through the same thing April went through and about 29% of parents develop PMTS when they see their children go under anesthesia (Meentken, 2017). Pediatric medical traumatic stress is a mental health condition that's triggered by a terrifying medical event; either experiencing it or being a witness. Most PMTS patients go through some sort of surgery or fatal accident that triggers the mental illness.
Children have many different triggers ranging from a trip to the emergency room all the way to life changing surgeries. Maya G. Meentken says in a study, “Medical procedures and treatments often cause pain, fear, a feeling of helplessness, and may give a sense of life threat,”(2017). Young patients tend to over evaluate what is about to come. They look at their surroundings and what people are feeling while in the waiting process. “Pediatric medical traumatic stress is a constellation of reactions that can occur after extremely difficult or frightening events” (Healthcare Toolbox, 2015). Children react differently and some may get PMTS and others will not . Hospitals are prone to trigger these types of PMTS reactions because they are accompanied by different tests being run, unfamiliar complex equipment, unfamiliar places, and many new faces.
While staying at a hospital, “it is common for ill and injured children to experience distressing traumatic stress reactions such as unwanted and intrusive thoughts, bad dreams, hypervigilance, exaggerated startle response, and avoidance of reminders of the medical event, which are symptoms of posttraumatic stress disorder,”(Kassam-Adams, 2017). These are just a few conditions that children may have after visiting a hospital or an emergency room. Adults experience the same symptoms children do; children just have it more intensely because they don’t know what to expect. The therapist, Cathy Derman, told one of her patients, “Children at young ages don’t know any better. So when something happens; they think it’s their fault,” (Derman,2020). Young patients absorb everything and think of the worst possible situations. Unlike adults, children think about the worse outcomes and they don’t realize they will be ok. Adults already know they will be fine at the end of the day.
There are three stages to pediatric medical traumatic stress. “... 1, peri trauma; II, early, ongoing, and evolving responses; and III, longer-term PMTS,” (Kazak, 2006). Every kid has a different experience that leads to them developing PMTS. Depending on how severe their experiences are they will have one of the three different phases.
Children have different symptoms depending on how severe their trauma is. Most kids that have acute procedures such as getting shots, check up appointments, and teeth cleanings have a lower risk of getting PMTS. Children that have more severe procedures, “often undergo various invasive medical procedures at a very young age and some need lifelong checkups at the hospital and re-interventions . Therefore, children with ConHD [Congenital heart disease] seem to have a heightened risk for developing PMTS,” (Meentken, 2017). When children have a lot of doctor appointments, they tend to worry about the rest of their lives and have to live around the doctor visits. ”Other conditions, such as burns, sickle cell disease, diabetes, and severe asthma, affect large groups of children, and every day children undergo painful procedures and frightening treatment experiences as part of medical care. Although much less common from an epidemiologic perspective, children with cancer and complications of other chronic and potentially debilitating conditions are common in tertiary medical settings,” (Kazak, 2005). Even the smallest things like burns can affect a child and traumatize them for a long time (Kazak, 2005).
Not only do children react to the fear of the unknown when facing illnesses in hospitals, but parents also react. This reaction and the fact that children are often separated from their parents for tests, also plays a role in the cause of PMTS. The Healthcare Toolbox describes the way children judge danger by looking for, “cues from adults and the environment. They may misinterpret cues (e.g. blood, sirens, parents’ visible upset) and over-estimate danger and life threat” (Healthcare Toolbox, 2015). When parents are unsure about what is going to happen to their child in the future, or even in the moment, they create their own sense of fear. This fear not only plays a major role in the development of PMTS in adults, but children also read this fear off of their parents' expressions and it adds to the child's stress and this plays a major role in their reaction to the situation, ultimately aiding the development of PMTS. Furthermore, the Journal of Pediatric Psychology explains that, “Investigations of PMTS in ED and intensive care unit (ICU) settings have shown that child and parent responses immediately following the trauma can help to predict the course of [PMTS] over time” (Kazak, 2005). Since the reactions of both the child and parent often go hand in hand, understanding and recognizing these reactions can help determine the level of PMTS that may result from the situation.
The Journal of Pediatric Psychology expands on this idea by describing how, “Growing empirical support exists to guide the development of assessment and intervention related to PMTS for patients with pediatric illness and their parents” (Kazak, 2005). The guidance enables support and awareness programs such as, Trauma-Informed Care, which work to recognize, address, and prevent symptoms of PMTS during trauma (Kassam-Adams, 2017). The Integrative Trajectory Model of PMTS, breaks PMTS into three phases, each of which focuses on preventing the next phase in order to limit the severity of PMT. These phases include: phase 1 which identifies a potentially traumatic event, phase 2 which analyzes responses to early medical treatment, and phase 3 which focuses on long term PMTS (Price, 2015). Programs like these have been put in place to reduce the risk and number of those suffering. Resilience in Children and Their Parents Enduring Pediatric Medical Traumatic Stress, expands this idea saying, “Such interventions can include decreasing distress, counseling children and their parents, and enabling strong connections to health care providers” (Isokääntä, 2018). All of these interventions work to help comfort children and their parents. By doing so and by understanding PMTS, it is likely that the number of cases will be significantly reduced.
Right now, the number of parents and children suffering from PMTS is similar to that of veterans suffering from Post Traumatic Stress Disorder after war (Ryan’s Case for Smiles, 2020). There are many factors that lead to PMTS in both children facing life-changing illnesses and their parents. Although these factors cannot be completely eliminated, there are interventions that can be done in order to minimize these.
In doing so, there are methods that use a variety of programs, models, and organizations to help with the symptoms that accompany PMTS. There are many different types of treatments, like psychotherapy and medications. “Cognitive therapy. This type of talk therapy helps you recognize the ways of thinking (cognitive patterns) that are keeping you stuck,”(Mayo clinic staff, 2020). This is one way that people try to recover from PMTS. There are more as well; exposure therapy and eye movement desensitization and reprocessing (EMDR). These channel the fear children have and try to figure out the core elements that scare them, to try and FIX their PMTS. There are many more treatments like medicine, antidepressants and anti-anxiety medications.. Some children stay on the medication throughout their lives. The medicine can make the symptoms calm down and can subside the trauma.
Is PMTS real? Some will say that it is not and it is just in the child's head. Others will say it is real. “It is not necessarily the case that children feel emotions more strongly than adults, but rather that the nature of emotional experience and expression changes over development,”(Kolitz, 2018). Children's imaginations are a lot more advanced than adults. They don’t know they will be ok until after their treatments and are already traumatized from before. “The first time I got the medicine through the needle, I started to cry and forgot about all the things Anita taught me,”(Jordan, 37). Jordan was nervous about getting the medication she needed, didn’t think anything would help, and that it couldn’t get any better. Even with the hospitals and parents trying to help: the children still don’t believe they will get better.
Organizations outside of the hospital try and help make hospital visits not so harsh. Health care systems and health care professionals work to combat PMTS by using a variety of programs and models, and organizations also take donations, either monetary or goods, like pillowcases, to help everyday people work with these health care professionals to combat PMTS.
The problem of PMTS in children is not due to a lack of care from health care systems and professionals, but because of the frightening and confusing experience as well as the separation and reactions from the parents. Kids can have long term effects like flash backs, triggers, anxiety, and panic attacks. Indeed, there are many different ways people exhibit symptoms of PMTS. The symptoms can be overwhelming and scary. Fortunately doctors have developed many treatment approaches to help prevent or minimize the stress and impact of PMTS.
Works Cited
Anne E., K.-A., Nancy, Schneider, Stephanie, Zelikovsky, Nataliya, … Mary. (2005, August 10). Integrative Model of Pediatric Medical Traumatic Stress. Retrieved from https://academic.oup.com/jpepsy/article/31/4/343/925275
Ben Ari, A., Peri, T., Margalit, D., Galili-Weisstub, E., Udassin, R., & Benarroch, F. (2017). Surgical Procedures and Pediatric Medical Traumatic Stress (PMTS) Syndrome: Assessment and Future Directions. Retrieved February 25, 2020, from https://www.sciencedirect.com/science/article/abs/pii/S002234681730667X
Children's Hospital of Philadelphia. (2020). Pediatric Traumatic Stress. Retrieved February 25, 2020, from https://www.chop.edu/conditions-diseases/pediatric-traumatic-stress
Do Kids Feel Stronger Emotions Than Adults? (n.d.). Retrieved from https://gizmodo.com/do-kids-feel-stronger-emotions-than-adults-1828933152
Healthcare Toolbox. (2015, May 4). Basics of Trauma Informed Care- What Providers Need to Know. Retrieved February 25, 2020, from https://www.healthcaretoolbox.org/what-providers-need-to-know.html
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Kassam-Adams, N., & Butler, L. (2017, August 1). What Do Clinicians Caring for Children Need to Know about Pediatric Medical Traumatic Stress and the Ethics of Trauma-Informed Approaches? Retrieved from https://journalofethics.ama-assn.org/article/what-do-clinicians-caring-children-need-know-about-pediatric-medical-traumatic-stress-and-ethics/2017-08
Kazak, A. E., Kassam-Adams, N., Schneider, S., Zelikovsky, N., Alderfer, M. A., & Rourke, M. (2006, May). An integrative model of pediatric medical traumatic stress. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/16093522
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Marsac, M., Kassam-Adams, N., Delahanty, D., Widaman, K., & Barakat, L. (2014, December). Posttraumatic Stress Following Acute Medical Trauma in Children: A Proposed Model of Bio-psycho-social Processes During the Peri-trauma Period. Retrieved February 25, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4319666/
Meentken, M. G., van Beynum, I. M., Legerstee, J. S., Helbing, W. A., & Utens, E. M. W. J. (2017, February 13). Medically Related Post-traumatic Stress in Children and Adolescents with Congenital Heart Defects. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5303720/
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Price, J., Kassam-Adams, N., Alderfer, M., Christofferson, J., & Kazak, A. (2015, August 26). Systematic Review: A Reevaluation and Update of the Integrative (Trajectory) Model of Pediatric Medical Traumatic Stress. Retrieved February 25, 2020, from https://academic.oup.com/jpepsy/article/41/1/86/2580213
Ryan's Case For Smiles, Helping Kids Cope With Cancer & Life Threatening Illnesses. (2020). Retrieved 25 February 2020, from https://caseforsmiles.org/