Gaps in care for child trauma and stress after injury

An international survey of hospital emergency department (ED) staff has found a gap in knowledge when dealing with child traumatic stress and providing emotional support to children admitted to hospital after injury.

Through a survey of 2,648 hospital ED physicians and nurses from more than 80 countries, an international research team-including a researcher from the University of Alberta's Faculty of Medicine & Dentistry-found knowledge and confidence gaps around child traumatic stress and psychological support, as well as a desire for more education.

Among the millions of children worldwide that sustain injuries requiring hospital care, around one in six go on to develop persistent stress symptoms, such as nightmares, concentration difficulties and negative thoughts, that can impair function and development.

Children's distress related to pain, fear and memories of trauma, as well as distress amongst family members, are all important issues to address, according to recent guidelines.

Sarah Curtis, study co-author and an assistant professor of pediatrics with the University of Alberta's Faculty of Medicine & Dentistry, believes apart from physical care, medical providers can play a key role in supporting injured children from a psychosocial perspective.

"When children are physically injured, our emergency services correctly focus first on treating the physical injury at hand. However, we know that some children (and sometimes parents) are traumatized emotionally from the event due to changes in brain chemicals and neurons related to pain, fright and memory," says Curtis. "This can happen as the physical injury occurs or soon thereafter and may result in permanent changes in the brain. Often, the emotional or brain changes can outlast the physical recovery and may contribute to stress related problems or illness in childhood or later in life."

"Early attention and education for children and families about these possible psychological consequences may improve outcomes for children & families. Our first step was to determine if emergency services staff have enough education and confidence in how to deliver this focused psychological care to injured children and families."

While the respondents saw psychosocial care as part of their job, only half of them knew that toddlers can develop trauma symptoms. About 40 per cent recognized that children who behave calmly in the ED could still develop persistent stress later.

Almost all respondents (93 per cent) wished to receive further education on psychological care for injured children with a minority confident on educating families about how to access mental health services should the need arise.

Only 14 per cent of the ED staff felt confident about educating children and families about traumatic stress reactions in contrast to 75 per cent feeling confident about explaining medical procedures.

"Staff members told us in a previous study that they learn about emotional support mostly by trial and error, and by watching colleagues," says Eva Alisic, lead researcher of the study from Australia's Monash Injury Research Institute.

"These results show that we need a more systematic approach to teaching about the emotional aspects of emergency care, starting at medical and nursing school."

Published in the Journal of Pediatrics, the survey is the first to assess staff through PERN-the international collaboration of Pediatric Emergency Research Networks.