Signs and Symptoms | Patient Centered Care and Trauma Informed Care for Pediatric Patients

Pediatric Medical Traumatic Stress

Traumatic stress symptoms - what to look for

Most health care providers are familiar with ways that children and family members may show stress. Traumatic stress reactions go beyond usual stress reactions. At times, these reactions are triggered by reminders or thoughts of the traumatic experience. Sometimes the trigger is not so obvious, such as a sight, smell, or sound that the person is not even aware is a reminder.

There are four main types of traumatic stress symptoms: re-experiencing, avoidance, changes in cognition (thinking) and mood, and hyper-arousal.

Re-experiencing

What to look for

Thinking a lot about the illness, injury, or procedure (unwanted, intrusive thoughts)
Feeling distressed at thoughts or reminders of it
Having nightmares and "flashbacks"

Examples of re-experiencing symptoms

Intrusive thoughts / memories: "The image of my son getting a spinal tap frequently pops into my mind."
Feeling the event is recurring: "At least once a day, I have a flashback to the accident. It's like it's happening all over again."
Distress at reminders: "To this day, I still can't stand the antiseptic smell of hospitals" OR "My heart races every time I hear a siren."
Distressing dreams: "The other day I dreamed that I was in the woods lost, and the doctors and nurses were hiding behind some trees."

Avoidance

What to look for

Avoiding thoughts or feelings about the illness, injury, or hospital experience, or things associated with it
Avoiding places or activities that are reminders of the illness/ injury/ hospital experience

Examples of avoidance symptoms

Avoidance thinking: "I block it out, try not to think about when I was in the hospital."
Avoidance of places/activities: "I try to stay away from things that remind me of the time I was sick."

Changes in cognition (thinking) and mood

What to look for

Exaggerated negative thoughts about self, others, the world
Pervasive negative emotions: fear, anger, guilt, shame
Numbness or detachment from emotions, especially positive emotions

Examples of changes in cognition and mood

Exaggerated negative thoughts: "I will never get over this." "The world is a totally dangerous place."
Numbness / detachment: "Since this happened, I just don't feel anything anymore."

Hyper-arousal

What to look for

Increased irritability
Trouble concentrating or sleeping
Exaggerated startle response
"Hypervigilance" - always expecting danger

Examples of hyper-arousal symptoms

Hypervigilance: "I know the doctors say we are in the clear, but I take my daughter's temperature every day. I am always afraid something bad will happen."
Exaggerated Startle: "I jump at any loud noise."
Difficulty Sleeping / Concentrating: "Most nights, I toss and turn and just can't get to sleep." "It's just impossible to keep my mind on things."

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