What is Post-traumatic Stress Disorder (PTSD)?
Most or all children, parents, and caregivers experience stress when a child is admitted to PICU. This is due to the PICU admission and child’s illness/injury, but also due a range of other factors occuring outside of the hospital, such as job stress or loss of work, other children to support, and sometimes staying in another city away from supporting family members and friends.
Acute or temporary stress is the body’s hyper-vigilant (high-alert) response to a perceived threat, causing the brain to pump hormones through the body and heightening the senses to help us deal with the threat or stressor. When the high amounts of stress continues after going home from the PICU it is called Post-Traumatic Stress (PTS), which can be normal after a traumatic event. When PTS becomes severe, persists for a prolonged period of time and affects every day life, it is referred to as Post-traumatic Stress Disorder (PTSD) and requires help to treat and manage.
The below video explains how stress occurs in the body, and when this may lead to PTSD.
Please note that sensitive topics such as abuse are referred to. If this topic may trigger you, consider not watching.
Source: https://www.youtube.com/watch?v=b_n9qegR7C4
PTSD in children
PTSD occurs in 10.5-21% of children and adolecents after PICU, and post-traumatic symptoms occur in up to 84% after PICU (1). PTSD can be difficult to identify in children as they do not always have the language available to describe how they are feeling. Therefore, they may communicate the stress in other ways such as disrupted sleep and feeding/eating, worriedness or irritability, or nightmares.
PTSD may occur in children who are over the age of three years at the time of hospital discharge. However, the hospital admission may impact development and emotional and social wellbeing in children as young as a few weeks old (read more here).
Some possible signs of PTSD in children (3 - 12 years) include:
Nightmares, trouble falling asleep, or refusing to sleep alone.
Seems fearful or worried without good reason.
Complains about aches or pains.
Gets frustrated easily (appropriate to their age), seems “hyperactive” or has frequent temper tantrums.
Creates games, stories, or pictures about the PICU admission (particularly if any descriptions did not actually happen).
Brings up the PICU admission in conversation, OR avoids talking about the PICU admission even when asked.
Seems fearful of things that are reminders of the PICU admission.
As you may have noted, some of these behaviours described are contradictory or opposite (either bringing up or not bringing up PICU may be an indicator of PTSD). Therefore, it is important to consider what your child’s “normal” behaviour was prior to hospital, and any changes that have occurred in their behaviour that is unusual for them.
Other factors to consider include:
A particularly unexpected or emergent reason for PICU admission.
An extended stay in PICU or in hospital.
Frequent or ongoing pain experienced during hospital or afterwards.
A significant difference in physical health and abilities compared to their before hospital functioning.
As these factors may contribute to children’s stress and coping after PICU.
PTSD in teenagers/adolescents
Teenagers may have clear or unclear memories (or a combination thereof) of what occurred during their PICU admission, which can be distressing. These memories may cause fears and anxiety, depression, or disruptions to cognitive (thinking), social, emotional and physical functioning (read more here).
While teenagers may be more able to verbalise/communicate their experiences, memories, and feelings about the PICU stay than children, there may be more overt symptoms that disrupt everyday life and are distressing, without knowing a clear cause.
Knowing some of the signs and symptoms of PTSD can help identify problems as early as possible in order to help your teenager:
Unusual overall mood, behaviours, or fears compared to their “normal” before PICU.
Difficulty concentrating compared to before PICU.
Nightmares, trouble falling asleep, or intrusive (unwanted and invasive) thoughts.
Lower self-confidence or self-efficacy (belief that they can achieve their goals) compared to before PICU.
If your teenager is experiencing some of these symptoms, or is feeling distressed after the hospital admission, see your GP to screen for PTSD and to refer to other professionals such as a psychologist as needed.
Some other ways that you can help your teenager are:
Encourage them to speak about their experiences and feelings, with a family member, friend, or trusted person.
Acknowledge that these feelings are normal after a PICU admission and that there is help available if and when they need it.
Encourage them to engage in self-care activities that they enjoy such as walking, listening to music, catching up with a friend, journalling, or other gentle activities.
Provide information on professionals that they can speak to (on the phone or online) for free, and encourage them that they can seek this help without needing to tell you if you they don’t want to. This could include Beyondblue (Phone: 1300 22 46 36, or online chat 3pm-12am AEST), Lifeline (Phone: 13 11 14). Always call 000 in an emergency (Australia).
Other factors to consider include:
A particularly unexpected or emergent reason for PICU admission.
An extended stay in PICU or in hospital.
Frequent or ongoing pain experienced during hospital or afterwards.
A significant difference in physical health and abilities compared to their before hospital functioning.
As these factors may contribute to teenager’s stress and coping after PICU.
PTSD in parents/caregivers
PTSD makes the brain believe that the previous threat or stressor is currently happening, and therefore unpleasant or painful feelings occur in the body that can be observed. It is important to note that PTSD is higher in parents when the PICU admission was unexpected or an emergency.
For parents or caregivers, some signs that you may be experiencing PTSD include:
Nightmares or intrusive (unwanted and invasive) thoughts.
Avoidance of thinking about the PICU admission or anything that would remind you of it (e.g. photos, the hospital itself).
Feelings of hyper-vigilance or feeling “on-guard” or easily startled.
Feelings of detachment or numbness to surroundings.
Feelings of guilt or self-blame regarding the PICU admission.
If you are experiencing any of these feelings or if you are concerned, seek help from your GP or healthcare provider.
If this topic has caused you any distress, you may wish to consider speaking to a friend or family member, or health professional.
Other free services:
You may need more support if you feel overwhelmed, anxious or depressed. Some further services are:
Beyondblue (Phone: 1300 22 46 36, or online chat 3pm-12am AEST)
Lifeline (Phone: 13 11 14)
PANDA (perinatal anxiety and depression) (Phone: 1300 726 306)
Kids Helpline (Phone 1800 551 800, 24hrs)
Parentline (Phone 13 22 89, 8am-10pm daily)
Australian Centre for Grief and Bereavement (Phone 1300 664 786)
Always call 000 in an emergency (Australia).
References and Sources:
Nelson LP, Gold JI. Posttraumatic stress disorder in children and their parents following admission to the pediatric intensive care unit: a review. Pediatr Crit Care Med. 2012 May;13(3):338-47. doi: 10.1097/PCC.0b013e3182196a8f. PMID: 21499173.
