For Parents and Children | Patient Centered Care and Trauma Informed Care for Pediatric Patients

Does My Child Need Therapy?

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Does my child need to talk to a therapist or counselor?

Knowing when to ask for help if your child is having trouble coping with his/her illness or injury is tough. Some children have trouble coping with stress reactions in the hospital, and for a while after an injury, illness or hospital stay. If your child’s reactions bother him/her, or get in the way of getting back to normal activities, you should consider getting additional help and support. Start by talking to your child’s doctor or nurse, a school counselor or religious leader about child’s symptoms.

Are these symptoms getting in the way of your child’s recovery?

Listen to one mother's advice: "When help is offered - take it!"

If your child (or your other children/ yourself/ your partner) is experiencing any of these symptoms, take this quick quiz to help you gauge your child’s emotional recovery and identify any signs of traumatic stress that might need special attention. (Note: The quiz was developed for parents of injured children, but others may find it helpful as well.)

While doctors and nurses can help your child recovery physically, a mental health professional’s job is to help your child (and family) recover emotionally. These professionals can be psychologists, psychiatrists, social workers, counselors, or psychotherapists. When choosing a mental health professional for your child, it is important to find a provider who has the right training and experience in working with children and teens after illness, injury, or other difficult and potentially traumatic experiences. Also, it is important that your child (and you) feels comfortable with his/her therapist.

getting help - pediatric medical traumatic stress

What is the “right help” for my child or my family?

Different types of treatment may be used to help your child and family overcome medical traumatic stress, and cope with the difficulties and challenges of a child’s illness or injury. The details of treatment (like what kind, how long, by whom) will vary for each child and family. Generally, treatment for medical traumatic stress should:

directly address the traumatic experiences related to illness, injury, or hospitalization, and your child's reactions to them,
include you as parent in the treatment in some manner,
support family needs so you can best support your child, and
focus on reducing traumatic stress symptoms for the long run, but also on helping your child cope and function better with any current challenges.

Online resources - help in finding a mental health professional

The National Child Traumatic Stress Network (NCTSN) lists national resources for assistance with various types of child trauma.

The Society for Clinical Child & Adolescent Psychology provides useful information on effective treatment and finding a therapist - Effective Child Therapy: Evidence-based mental health treatment for children and adolescents

Where can I find help near my family?

I don't have insurance. Can my child still get help?

If you do not have insurance, it may be helpful to contact local therapists or agencies and ask if they offer a sliding fee scale or payment plan. Also, find out if your child or family is eligible for federal or state coverage like the State Children's Health Insurance Program (SCHIP).

What kind of therapy is best for my child after a trauma?

Research suggests that children and families facing traumatic stress reactions (including medical traumatic stress related to injury or illness) are often helped by therapy that focuses specifically on trauma reactions and concerns.

More information about specific, evidence-based trauma treatments, as reviewed by the National Registry for Evidence-based Programs and Practices (NREPP) can be found via the National Child Traumatic Stress Network (NCTSN) (look under “Trauma Treatment”).

My child is starting therapy. What can I do to support him/her?

Once you have found a mental health professional to work with your child and family, it is helpful to discuss with them what to expect before, during, and after therapy. Also, KidsHealth offers information about taking your child to therapy. These resources will provide you with more information on what to expect before, during, and after therapy.

Helpful Resources:

Do I need to talk to someone?

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Parents

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My Worries as a Parent

Are you worried because you:

Feel overwhelmed, stressed, worried, or jumpy?
Are reliving your child’s accident or illness diagnosis?
Are staying away from reminders of your child’s injury or illness?
Are staying away from normal activities, family, or friends?

When your child is ill or injured it is normal to feel stressed and worried. An injury, illness or hospital stay can be traumatic for you as parents/caregivers too. Having a sick, injured or hospitalized child often results in feelings of frustration, sadness, worry or helplessness. It’s a stressful time when relationships with medical staff take priority, and other important relationships and activities get interrupted or put on hold. Having a sick or injured child often challenges your innermost beliefs about the safety of your children.

You’re probably worrying about will happen to your child, even if you’re not showing it to others. You might feel unprepared to talk to your sick or injured child (or your other children) about feelings, fears, and questions.

What can you do to help yourself?

Understand normal reactions and feelings.

In the first few weeks after a diagnosis or injury, it’s normal to feel upset, worried, and more stressed.
Dealing with a new diagnosis, injury, relapse, or other medical event is difficult and an unexpected disruption to day-to-day family life.
These feelings and reactions usually get better with a little time and with support from family and friends.

Listen to one mother speak about her fear... and guilt:

Know when you should ask for help.
While it’s normal to feel upset, worried, and overwhelmed in the first few weeks following your child’s illness or injury, continuing to feel this way may mean you need to seek out help.

Signs to look out for include:

If your feelings make it hard to get back to (or enjoy) your usual activities;
If you find it hard to talk with your child about happened;
If you seem to be getting worse rather than better; or
If your feelings and reactions that bother you last more than a month.

Be aware of your own feelings and reactions.

Some parents may find it upsetting to talk with their child about what happened, or they feel anxious or overprotective when their child starts to return to normal activities.
If this is true for you, be sure to get support for yourself so that you can best help your child.

Take care of yourself.

If you are worried, upset, not sleeping or eating, it will be harder to help your child.
Let other people help you and be sure to tell them what kind of help you need.
Make a list of thing you might need- bringing a meal or taking care of your other children - you can refer to this when people call to ask how they can help you.
Do fun or meaningful things. Distract yourself from your reactions by engaging in hobbies, helping others, and participating in satisfying activities.
Try calming strategies, such as breathing exercises, writing about your feelings, meditation, exercise, stretching, yoga, prayer, listening to music, or outdoor activities.
Talk with people you trust (family, friends, clergy, and your doctor) about how you are feeling.

Watch out for problematic ways of dealing with stress.

Be especially careful not to increase smoking, alcohol, or other unhealthy ways of coping when you feel worried, upset, or stressed.

Talk to your own doctor, your child’s medical team, or others you trust to find additional help for yourself.

If you find yourself very upset or worried and this does not seem to be getting better after a few weeks, be sure to talk with your own doctor about ways to help.
Consider talking with a counselor or therapist.

Listen to one mom's advice to other parents coping with their child's cancer:

Helpful Resources:

A Caregiver’s Guide: Taking Care of Yourself While Your Child is in the Hospital
Guía Para Cuidadores: Cómo cuidarse mientras su hijo está en el hospital
CopingSpace, from Case for Smiles, provides information to help parents understand and cope with their own responses to their child's life-changing illness or injury.

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Siblings

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Helping Siblings

Are you worried because your other children:

Are upset or worried?
Are missing out on getting your attention like they usually do?
Are having problems with friends, school, or family that are out of the ordinary?

Injury or illness can affect the whole family. When a child experiences injury or illness, siblings may be sad, worried, frightened, or even angry.

It’s hard for parents to meet everyone’s needs at the same time.

Siblings will need time to adjust to their brother/sister’s medical needs and treatment. Most siblings react in very positive ways and often describe feeling glad they’re able to help. But some will also have trouble adjusting. They will miss you and may not understand what happened to their brother/sister. They might want to help out, but not know what to do. They might also feel angry, jealous or even guilty and aren’t sure if that’s okay.

What can you do to help siblings cope?

Remember that siblings and other children may also feel afraid, worried or jealous

Notice when siblings are feeling sad, worried or lost in their thoughts - or when they seem angry or irritated - and ask what’s on their mind.
Siblings’ needs are sometimes overlooked when one child is ill.
Remember that changes in behavior can come from worries or upset feelings.
Set aside time to talk with your other children about what is happening, what to expect, and what they are feeling.
Let them ask a lot of questions.

Get support from family and friends

There may be times when you have to focus on one child’s needs.
Enlist the help of family, friends, and possibly the school to provide your other children with some special attention.
Encourage siblings to have fun. Often times, siblings feel guilt about wanting to have fun while their brother or sister is not feeling well.
Remind them its okay for them to spend time with friends, doing activities or hobbies they enjoy.

siblings - pediatric medical traumatic stress

Check with hospital staff about sibling support programs

If your injured or ill child is still in the hospital, ask hospital staff about programs for siblings.
Hospitals may offer sibling support through their social work, child life, or chaplain services.

Answer their questions honestly and help them feel involved

If your other children have questions about their illness, injury, or what is happening, try to answer simply and honestly.
Help siblings feel involved by allowing them to be a part of the sibling’s care.
Plan a visit to the hospital and introduce them to the healthcare team.
Let them choose what toys and games to take to the hospital.
Make sure you let them know how much you appreciate the extra things they do to help out.

Listen to one mom talk about transitioning from sibling rivalry to healing relationships:

Helpful Resources:

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School

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School Concerns

Are you worried because your child:

school problems - pediatric medical traumatic stress

Is having trouble keeping up with schoolwork?
Is having trouble with returning to school or other activities?
Does not want to go to school or having difficulties getting ready in the morning?

For you and your child, it can be a challenge to deal with the injury or illness and also keep up with schoolwork. Returning to school may raise concerns, or if your child is not able to return to school, keeping him/her up to date can be stressful.

If schoolwork concerns or your child’s feelings and reactions are getting in the way of him/her returning to school, ask the school about a more thorough evaluation with the school counselor or school psychologist.

What can you do about your schoolwork concerns?

Ask hospital staff about schoolwork support

Your hospital may have programs to help children keep up with schoolwork.
If your child will be in the hospital for more than a few days, ask if they have programs to help your child keep up with their schoolwork.
Make sure to contact your child’s school. Ask your child’s school about schoolwork at home or in the hospital, and how to arrange needed support for returning to school (an individual education plan for your child).

Contact your child’s school

After an injury, illness diagnosis or hospital stay that occurs during the school year, it’s a good idea to talk with your child’s school (teachers, school nurse, and/or principal) to let them know what happened.
Ask about getting schoolwork to do at home or in the hospital and ask them to make a plan with you to help your child manage schoolwork during his/her recovery.
Work with them to arrange support your child may need for returning to school (for example, help with any physical or learning limitations your child may have and pain management/medications).
Ask the school to be in touch with you about how your child is adjusting when back at school.

Work with your child and the school counselor to make the return to school easier

Work with your child to prepare answers for the questions classmates might ask about his/her illness or injury.
If you have schoolwork concerns or concerns about how your child’s feelings and reactions are affecting his/her schoolwork, get in touch with the school and ask for their assistance.
For your elementary school child, talk with your child’s teacher or counselor about how to help and make a plan to stay in touch regularly.
Help your older child or teen identify a person who they can go to with any concerns (this might be a counselor, teacher or coach).

Listen to one mom talk about the benefits of having your children talk to other professionals:

Helpful Resources

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Quiet or Withdrawn

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Quiet or Seems Withdrawn

Are you worried because your child:

Doesn’t want to talk about his/her injury or illness?
Tries to push injury or illness out of his/ her mind?
Not interested in usual activities, friends or family?

Many children who don’t talk much about their feelings or reactions are finding other ways to cope, and are doing well. Others just aren’t ready to talk yet. And some (especially teens) may be talking with friends even if they’re not talking much about it with parents.

If your child seems very “down” or withdrawn, and this does not get better within a few weeks after the diagnosis or injury, talk with your child’s doctor about getting additional help.

How can you help your child who isn’t talking about it or seems withdrawn?

Be patient with your child

Strong feelings are common but temporary reactions to the injury, illness, and hospital experience.
Younger children’s early reactions- including crying, whining, clinging or acting out- are common and expected in small amounts.
Teens may feel confused, angry, or scared. Remind them these feelings are okay.
If your child or teen’s behavior gets to be too much, it’s okay to set rules and limits like you would normally.
Work with the medical team while in in the hospital to plan a daily routine so that things are more predictable and familiar.

Younger children are often more upset at being left alone

When you are not with your child at the hospital, have a family member or familiar adult stay with your child.
Always tell your child when you are leaving, why, and when you’ll be back.

Help your child connect with family and friends

Everyone needs some time alone, but be sure that your child also spends some time with friends and family.
Encourage your child to to keep in touch with friends by phone, email, text, or social media on a regular basis.
Talk ahead of time about how to explain the injury, illness, or treatment complications/side effects and answer questions.
While at the hospital, ask your child’s nurse to introduce your child to others on the floor with similar experiences.
Being in the hospital can increase feelings of loneliness, especially in teens.
If you notice that your child seems less interested in being with people he/she usually enjoy, bring this up with your child and help them sort out their feelings by asking questions and listening.

Let your child know you’re available to listen when he or she is ready

If your child does not want to talk about things now, “keep the door open” for talking at your child’s time and pace.
Encourage connections with friends and with adults you both trust.
In the hospital, use phone, email, and other ways to stay in touch.

Encourage your family to share feelings

Remember everyone in the family can be affected – often in different ways.
Talking about what things have been like for each person is often helpful.
Talks can happen in different ways at different times (dinnertime, bedtime) and in different places (in the car, at home, in the hospital).

Help your children name their feelings, such as being sad, scared, lonely, or angry

Sharing your own feelings can show children that it’s okay to do the same.
When children or other family members talk, accept their feelings and be a good listener, even if what they have to say is hard to hear.
You know your child and how she or he likes to share thoughts and feelings.
Younger children might show them through play, drawing, or telling a story.
Older children or teens might want to write about their experiences and feelings, or express them by writing poetry, a song, or drawing).

Help them get back to their normal routine as quickly as possible

Notice if your child seems withdrawn or is losing interest in things they used to enjoy.
To help with emotional recovery, it’s important for your child to get back to his/her normal routine as much as possible (taking their physical condition in to account).
Encourage them to do their usual activities, even if they don’t really feel like it at first (this is usually the best way to start feeling a little better).
Make a plan for the week’s activities.
Start with small steps and build on these.

Listen to one mom talk about the benefits of talk therapy:

Helpful Resources:

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Worries and Fears

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Worries and Fears

Are you worried because your child

Thinks a lot about what happened?
Acts afraid of something that s/he was not scared of before, or seems to be more afraid than before?
Worries that something else bad will happen?

Feeling worried, fearful or anxious while in the hospital, and in the first few weeks after an injury, illness, or being in the hospital is normal.

But if these reactions last more than a few weeks, seem to get worse, or make your child afraid of getting back to normal activities- then they may signal a problem that needs attention.

How can you help your child who is worried or fearful?

Help your child understand what is happening

Use simple words that he or she can understand.
If your child needs to go through a painful procedure, be honest about the fact that it may hurt but also explain its purpose is to help him /her feel better or to help fight the illness.
Remember children have active imaginations. They can tell when others are upset or not telling them things. Without the facts, they can easily misunderstand and “fill in the blanks” with their imagination.
Sometimes, children mistakenly believe they did something wrong to cause their illness or injury. Ask questions to figure out what they know and what they imagine.
Use words appropriate for your child’s age to share the facts about the injury or illness and let your child know that s/he has done nothing wrong to cause it.

While in the hospital, help your child think of the hospital staff as helpers and include your child in medical discussions when appropriate

Remind your child that the staff has a lot of practice helping other ill or injured children.
Encourage your child to ask questions- no topic is too big or too small!
When possible and appropriate, allow your child to make choices to give him/her a feeling of control.
Help teens participate in medical decisions by planning how to cope with pain and stressful procedures in advance.
The "Hospital Hero" workbook has specific tips for kids to get to know the health care team.

Allow your children to talk about feeling and worries, if they want to

Ask your child (andtheir brothers and sisters) what they are thinking, feeling, and imagining.
Help them name their feelings, such as being scared, angry or sad.
Be a good listener - share the facts, and share your feelings and reactions.
For younger children, encourage play, drawing, and story-telling.
For older children and teens, encourage them to write about their experiences and feelings.
Some teens find it useful to use their creative side – writing poetry, a song, artwork.

Help your child identify triggers

Notice when your child is feeling worried, extra “jumpy”, on guard or nervous- are there situations in which this seems to happen more?
Help your child understand that feeling this way is a reaction to going through something scary, and that it will get better with time.
Help your child to identify things that trigger worries or scared feelings.
Talk with your child about how you can help them at those times.

Encourage small steps towards facing fears and worries

New fears, or wanting to stay away from things that remind them of what happened, may keep your child from getting back to normal as quickly as possible.
If fears or strong worries keep your child from doing safe things that they need to or want to do (like going back to school or sleeping alone), encourage any effort towards these activities.
It might take a lots of little steps for a child to be able to do the whole activity.
Praise their courage every step of the way!

Allow them to “take a break” from their thoughts

Help your child deal with overwhelming or troubling thoughts by learning how to “take a break” from them at times.
Do something fun.
Spend time with friends.
Get busy with other activities.

Helpful Resources:

At the Hospital: Helping My Child Cope
En el hospital: Cómo ayudar a mi hijo a sobrellevar la situación
Hospital Hero- A Child’s Workbook
¡Héroe Del Hospital! Una historia sobre tu hospitalización
Does my child need talk to someone?
Do I need to talk to someone?
Worry Wise Kids website: Information to help children with excessive worries or fears

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Behavior Change

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Behavior Change

Are you worried because your child

Seems irritable or has angry outbursts/temper tantrums?
Gets upset or has headaches/ stomachaches/ heart pounding at reminders of injury/ illness?
Startles easily (for example, jumps if there is a sudden noise)?
You've noticed changes in your child's behavior, for example: crying, whining, clinging, or acting out in frustration?

Some behavior changes or physical ailments after an illness/injury come from feeling worried or stressed. These feelings, ailments, and behaviors are common.

How can you help your child through behavior changes?

Be patient with your child

At the hospital, children’s early reactions, including crying, whining, clinging, or acting out, are common and expected in small amounts.
If they happen too often, it’s okay to set rules and limits like you would at home.
Work with the medical team to plan a daily routine so that things are more predictable and familiar.
With teens, remind them it’s okay to be confused, angry, or scared and to talk about their feelings.
Recognize that your teen may want to appear “grown up”, while also feeling afraid and in need of your comfort and support.

Help your child put feelings into words

Sometimes kids show their feelings through their behaviors.
Help your child put feelings into words.
Listen carefully and help your child express frustrations and worries.
When you help your child find words for strong feelings, you give him/her tools for coping.
Describing and understanding his/her reactions is a first step in dealing with them.

Help your child understand how feelings can affect their behavior

Help your child understand how feeling jumpy, tired, stressed or in pain, can lead to angry or irritable behavior.
Set normal limits and consequences for behavior, but also let your child know that you understand that it may be hard right now to control their feelings.
Help them notice when they are starting to get angry or irritated, and suggest that they take some time out to calm down or do something they enjoy.
Talk with your child when they are not experiencing a change in behavior about what they can do to calm down the next time they tart to get angry or irritated (deep breathing, count to ten, go for a walk, talk to someone, etc.)

Set normal limits

You may be tempted to relax the rules in order to help your child feel better, or to make up for the hard times he or she has been experiencing.
However it is often better for your child if you set normal limits on behavior and keep most of your family rules and expectations the same.

Listen to one mom share the perils of holding your children to different standards:

Remind them of their coping skills

You can help your child cope with stress by helping them remember how they coped well with stressful events in the past.

Helpful Resources:

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Sleeping Problems

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Sleeping Problems

child - sleep problems after medical trauma

Are you worried because your child:

Has trouble falling asleep, staying asleep, or waking in the morning?
Has bad dreams or nightmares?

In the hospital, things like noise, vital sign checks, pain, and worries can cause sleep problems. At home, sleep problems may persist due to disruptions in your child's schedule and routines. Pain, worries, and other thoughts that make it hard to relax cay also make sleep problems worse.

How can you help your child sleep?

Promote healthy sleep patterns

When your child is in the hospital, sleep is an important part of healing, so talk with the health care team about what can be done to promote and protect your child’s sleep as much as possible. For example, keeping the room dark and limiting entry to the room during your child's typical sleep hours.

Bad dreams can be a normal response

Help your child understand that bad dreams can be a natural response when things are stressful or scary, and will probably get better with time.
If bad dreams wake your child in the night, listen (briefly) to what was in their dreams, give them a hug and reassure them that they are safe, then help them get back to sleep.

At home, set up (or continue) regular bedtime routines

Regular bedtime routines can help your child relax before falling asleep.
Work with your child to create bedtime routines that make sense for your family.
For younger kids, read a story or spend quiet time together just before tucking them into bed.
For older children and teens, help them create good sleep habits and routines, like going to bed at the same time every night, reading before bed instead of being on electronics, and help them take charge of following these routines themselves.

Manage pain

If your child has pain that is making it hard to fall asleep or waking them up during the night, talk with your child’s nurse or doctor about controlling pain at bedtime and through the night.

Keep a list of concerns and questions

If your child is losing sleep most nights for more than a week because of bad dreams, pain,or other reasons, it’s a good idea to talk with your child’s nurse or doctor about it.

Helpful Resources:

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Family Voices: Stories of Coping and Healing from Medical Trauma

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Family Voices

Families of children experiencing the emotional trauma of life-threatening illness or injury can feel alone and without a voice. The Center for Pediatric Traumatic Stress wants to give a voice to those family members who find themselves in the midst of a medical trauma and who then summon the courage, strength and resources to find their way through it.

In this installment of Family Voices, we share the audio stories of two mothers, Darlene and Kathy, whose children fought very different medical battles, but whose families experienced emotional trauma as a result. With remarkable candor, they share stories of their family's ups and downs and how they coped. Darlene and Kathy have agreed to share their stories so that other families going through the same experience may also find hope and strength from their example, and know they are not alone.

Darlene's Story ...

Darlene is a mother of a pediatric cancer survivor. Darlene's daughter, Lauren - now 11 - was diagnosed with cancer at age 6. Shortly after diagnosis, Lauren also suffered a stroke. With wit and wisdom, Darlene talks about how she, her husband Pete, and their other daughter Katherine coped with the trauma of Lauren's diagnosis and treatment. Darlene also talks about what it was like to go off-treatment ("I equated it to being pushed off a plane and hoping my parachute opened") and the process that she and her family had to go through to put cancer in its place and move forward. ("Cancer is not who my daughter is: cancer is just something our family had to get through.")

Listen to Darlene's story now:

#1: "Does my child have Leukemia?"

#2: A mother's fear... and guilt

#3: Family responses: unsung heroes and post-it notes

#4: Family coping: Trying to keep things normal... when they weren't

#5: On being an overprotective mother

#6: Talking each other off the ledge: the benefits of talk therapy

#7: Coming off treatment: Learning to put cancer in its place

#8: The benefits of having your children talk to other professionals

#9: Advice to other parents coping with their child's cancer

Kathy's Story ...

Kathy's 8-year-old son Stephen went outside to play one day, and woke up six weeks later in the ICU to the sight of his mother standing by his bedside with a mass of grey hair that had not been there before. With sensitivity and raw honesty, Kathy tells the story of her family's odyssey with medical trauma, which began with being told that Stephen would not live through the night, followed by years of surgeries, emergencies, and setbacks and by still more years of grappling with physical and emotional aftershocks. Kathy speaks movingly of how Stephen's trauma not only interrupted her daughters' lives, but how they felt like they needed to sacrifice for Stephen some of the love in the family that was meant for them. Finally she discusses how the healing lessons she and her family learned in the process, including the need for professional help. ("I resisted talking to professionals in the early days, because I thought 'we're fine, we don't need that.' And we did.")

Listen to Kathy's story now:

#1: Stephen's journey: one step forward, two steps back

#2: One mother's miracle is another mother's loss

#3: Impact on siblings: doing without and on your own

#4: From sibling rivalry to healing relationships

#5: Stephen: "Someone is finally speaking my language"

#6: Trying to do it all on my own

#7: Realizing we're not out of the woods… we now live in the woods

#8: The perils of holding your children to different standards

#9: A mother's advice: when help is offered - take it!

Coping with Stress Reactions after Injury or Illness

Read more about Coping with Stress Reactions after Injury or Illness

Coping with Stress Reactions after Injury or Illness

child and family coping with injury and illness

Coping with stress reactions is common after a serious illness, injury, or a hospital stay. Even though it is your child who is ill or injured, your whole family can be affected. It’s normal for you, as a parent, to feel overwhelmed trying to help your family or yourself cope. You might notice that you and your family members feel stressed about different parts of the illness or injury:

Children may feel scared about being alone in a hospital with strange sounds, smells, and people, and about being separated from their friends and family.
Parents may feel helpless seeing their child in pain or uncomfortable, or may be scared that their child might die.

Many parents have trouble coping with stress reactions, also called traumatic stress symptoms, when their child is very ill or injured or in the hospital.

Hospitals can be distressing or traumatic for children, teens and parents in many ways:

Not knowing what will happen next
Seeing medical equipment that looks or sounds scary
Being in pain or going through painful procedures
Fear of dying
Being left alone
Side-effects or complications of treatment
Concerns about relapse, a noticeable injury or being permanently injured
Being separated from siblings, friends, and pets
Changes in appearance- hair loss, weight loss/gain, scars, use of wheelchair, etc.
Seeing other hurt or sick children or knowing others in the hospital who have died
Fear about what others will think of them being sick or in the hospital

Signs and symptoms of traumatic stress include reliving what happened (re-experiencing), staying away from reminders (avoidance), feeling anxious or jumpy (hyper-arousal), being easily upset or angry, being irritable or uncooperative, and/or feeling empty or numb. Children, teens, and parents having trouble coping with stress reactions may show these signs and symptoms in different ways based on their age. and/or at different times (at the hospital, after the hospital, months/years later):

Young children might experience a feeling of helplessness and anxiety expressed as a loss of previously acquired developmental skills. For example, wetting the bed or sucking their thumb. They might have nightmares or temper tantrums. They may also fear separation from parents of caregivers.
School aged children may have feelings of concern over their own safety and the safety of others. They may feel the injury or illness is their fault. They are likely to use their imagination to fill in what they do not understand. Their concentration and sleep may also be impacted.
Teens may experience feelings of fear, vulnerability, shame, or guilt. They may try to act more grown up or cover up their feelings. They may feel self-conscious or upset about “not fitting in” with their friends. Some adolescents may engage in self-destructive or accident prone behaviors.
Parents may feel “on guard” or be overprotective. You may have a short fuse, trouble eating or sleeping, and get upset at seeing their child in pain or discomfort. Most parents will feel overwhelmed about caring for their child’s medical needs as well as the needs of other children/spouse/family. You may worry in private that your child might die, but not want to share your worries with anyone.

With information, support, and talking about their experience, most children and families are able to cope with these stress reactions.

Many parents share common worries about recovery and coping with stress reactions, such as:

Coping with a Child's Injury and Illness: Resources for Families - 20th Anniversary Webinar

If you are looking to view this webinar for APA continuing education credit, please log in and view it here instead.

Coping with Stress Reactions: Resources for Children and Teens (English/Spanish):

InvisiYouth helps teens and young adults around the world with various chronic illnesses and disabilities with lifestyle programs, empowerment tools and fun resources

Band-Aides and Blackboards is fun interactive website for kids and teens growing up with medical problems.

The Experience Journals are a collection of stories for children and teens living with physical or emotional illness.

Nemours KidsHealth offers online information about child health, behavior, and development for kids / niños and teens / adolescentes.

Coping with Stress Reactions: Resources for Parents (English/Spanish):

The National Child Traumatic Stress Network (NCTSN) features a section on Resources for Parents and Caregivers / Información para Padres, Cuidadores y Familias in English and Spanish.

After The Injury helps parents understand their child's reactions to injury and learn what they can do to help their child. Also in Spanish: AfterThe Injury en español

CopingSpace, from Case for Smiles, provides information to help parents understand and cope with their own responses to their child's life-changing illness or injury.

Beyond the Cure offers information and resources for survivors of childhood cancer and their families. Listen to a teleconference presented by Anne Kazak, PhD, ABPP of the Children's Hospital of Philadelphia on Parenting a Child with Cancer: Have You Hugged Yourself Today?

The American Academy of Child and Adolescent Psychiatry (AACAP) features a section For Families / Para la Familia offering educational handouts in several languages on issues like childhood chronic illness and posttraumatic stress disorder.

The American Psychological Association (APA) has information and resources related to trauma, posttraumatic stress disorder, child issues, and a search for local psychologists across the US.

Nemours KidsHealth offers information about child health, behavior, and development for parents / padres.

The National Institute of Mental Health (NIMH) has created a booklet Helping Children and Adolescents Cope with Violence and Disasters: What Parents Can Do / Ayudando a Niños y Adolescentes a Superar la Violencia y los Desastres: Que Pueden Hacer los Padres.

Distracting Children During Medical Procedures: Resources for Parents

These resources, created by researchers at the University of Iowa, are aimed at helping parents and providers minimize pain and distress during a child's procedures through distraction.

Parents can learn more and learn how to use distraction techniques to help children during medical procedures in these "Distraction in Action" videos

At this site, parents can also sign up (for free) to use the Distraction in Action Tool, a web-based tool that provides parents with specific recommendations on how to use distraction with their child.

Additionally, the Cystic Fibrosis Foundation has developed a Procedural Anxiety Guide for patients and caregivers to help manage anxiety associated with painful or uncomfortable procedures.

Books and reading materials for parents

Children and Trauma: A Guide For Parents and Professionals.
Cynthia Monahon, Jossey-Bass Publishers; San Francisco; 1997

Freeing Your Child from Anxiety: Powerful, Practical Solutions to Overcome Your Child's Fears, Worries and Phobias.
Tamar Chansky, Broadway Books; New York; 2004

A Parent's Guide to Building Resilience in Children and Teens: Giving Your Child Roots and Wings.
Kenneth R. Ginsburg & Martha M. Jablow. Published by the American Academy of Pediatrics; 2006

Afraid of the Doctor: Every Parents Guide to Preventing and Managing Medical Trauma.
Meghan L. Marsac and Melissa J. Hogan; 2021.

Books and reading materials for children and teens

What to Do What You're Scared and Worried: A Guide for Kids.
James J. Crist, Free Spirit Publishing; Minneapolis; 2004

What to Do When You're Sad & Lonely: A Guide for Kids.
James J. Crist, Free Spirit Publishing; Minneapolis; 2004

When I Feel Scared. (for young children)
Cornelia Maude Spelman, Albert Whitman & Co.; Morton Grove; 2002

What About Me? When Brothers and Sisters Get Sick
Allan Peterkin, Magination Press; Washington D.C., 1992

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Resources

Does my child need to talk to a therapist or counselor?

Are these symptoms getting in the way of your child’s recovery?

Listen to one mother's advice: "When help is offered - take it!"

What is the “right help” for my child or my family?

Online resources - help in finding a mental health professional

Where can I find help near my family?

I don't have insurance. Can my child still get help?

What kind of therapy is best for my child after a trauma?

My child is starting therapy. What can I do to support him/her?

Helpful Resources:

My Worries as a Parent

Are you worried because you:

What can you do to help yourself?

Understand normal reactions and feelings.

Listen to one mother speak about her fear... and guilt:

Signs to look out for include:

Be aware of your own feelings and reactions.

Take care of yourself.

Watch out for problematic ways of dealing with stress.

Talk to your own doctor, your child’s medical team, or others you trust to find additional help for yourself.

Listen to one mom's advice to other parents coping with their child's cancer:

Helpful Resources:

Helping Siblings

Are you worried because your other children:

What can you do to help siblings cope?

Remember that siblings and other children may also feel afraid, worried or jealous

Get support from family and friends

Check with hospital staff about sibling support programs

Answer their questions honestly and help them feel involved

Listen to one mom talk about transitioning from sibling rivalry to healing relationships:

Helpful Resources:

School Concerns

Are you worried because your child:

What can you do about your schoolwork concerns?

Ask hospital staff about schoolwork support

Contact your child’s school

Work with your child and the school counselor to make the return to school easier

Listen to one mom talk about the benefits of having your children talk to other professionals:

Helpful Resources

Quiet or Seems Withdrawn

Are you worried because your child:

How can you help your child who isn’t talking about it or seems withdrawn?

Be patient with your child

Younger children are often more upset at being left alone

Help your child connect with family and friends

Let your child know you’re available to listen when he or she is ready

Help your children name their feelings, such as being sad, scared, lonely, or angry

Help them get back to their normal routine as quickly as possible

Listen to one mom talk about the benefits of talk therapy:

Helpful Resources:

Worries and Fears

Are you worried because your child

How can you help your child who is worried or fearful?

While in the hospital, help your child think of the hospital staff as helpers and include your child in medical discussions when appropriate

Help your child identify triggers

Encourage small steps towards facing fears and worries

Allow them to “take a break” from their thoughts

Helpful Resources:

Behavior Change

Are you worried because your child

How can you help your child through behavior changes?

Be patient with your child

Help your child put feelings into words

Help your child understand how feelings can affect their behavior

Set normal limits

Listen to one mom share the perils of holding your children to different standards:

Remind them of their coping skills

Helpful Resources:

Sleeping Problems

Are you worried because your child:

How can you help your child sleep?

Promote healthy sleep patterns

Bad dreams can be a normal response

At home, set up (or continue) regular bedtime routines