Do you have a child facing major surgery? This article isn’t here to alarm you but to raise awareness and provide parental support to those with children in hospitals. For child patients, Pediatric Medical Traumatic Stress (PMTS) is a real possibility that you should be aware of. Symptoms of PMTS can affect children long after their hospital experiences and into adulthood. Unfortunately, little guidance is available to parents about the lasting impact of medical trauma resulting from early treatments.
Before I continue, this is not a ‘blame the parents’ rant. My parents were amazing and took turns living at the hospital during my surgery. However, there were key parts of my day they missed. These moments turned out to be when I needed them most. None of us could have predicted the impact their absence would have on me.
In writing this article, I collaborated closely with my mum to reflect on key moments during my hospital stays that could have contributed to my trauma development. By sharing these insights, I hope to provide parental support to others navigating the challenges of having a child in the hospital and provide strategies to mitigate stress and long-term effects.
Understanding Childhood Medical Trauma
Surgical procedures cause trauma to the mind and body. Children often lack the resilience to process these experiences effectively. Research has found that trauma before the age of seven significantly impacts a child’s development, often causing lasting health and psychological challenges (Kolk, B. V., 2014). Early hospitalizations disrupt cognitive and emotional development, as young children thrive in secure environments with consistent caregivers (Marsac et al., 2014). Hospitals, however, often provide the opposite experience. Parents may not always stay with their children, and medical staff frequently take young patients away for painful and frightening procedures. These experiences often lead to long-term trauma, shaping how children view themselves and the world.
The American Medical Association Journal of Ethics (Kassam-Adams PhD & Butler, MD, 2017) highlights the psychological distress children experience during hospital stays and treatments. This can often lead to cases of Pediatric Medical Traumatic Stress (PMTS). PMTS includes emotional and physical responses to pain, injury, severe illness, medical procedures, and invasive experiences. The journal emphasizes the ethical responsibility of clinicians to adopt trauma-informed care practices. These approaches are essential for reducing psychological harm and improving short- and long-term outcomes for children and their families. Unfortunately, this is often not consistent after a child is discharged from hospital. As medical advancements improve survival rates for pediatric conditions, PMTS cases are expected to rise. Despite this, research on PMTS prevention and treatment remains limited (Christian‐Brandt et al., 2019).
Key Moments When Parental Presence Matters
Let me set the scene. I was admitted to the hospital for experimental hip dysplasia surgery at 4 years old. I had my 5th birthday in the children’s ward. Outside of the actual surgeries, my spotted memories of this time are not terrible. I remember having a good group of other kids around, kind nurses, a snack cart, a TV, and during the summer, male peacocks walking in with their tail feathers out (yes, this really did happen). What I don’t remember is my parents.
If I take myself back, I can only recall two memories of their faces, despite them having moved into the hospital while I was there. This is alarming, as their absence couldn’t be further from the truth. Even so, this is how my young mind shaped my memories. There are key times of my hospitalisation and recovery that I do remember. Unfortunately, they were not there. These were times as a child I felt most vulnerable, and their absence was deeply felt.
After deep self-discovery work and discussions with my mum, these are some of the key insights we discovered:
Parental Presence in the Mornings is Crucial for Comfort
Mornings are vital times for children to feel comforted and secure. Upon waking, a child is in a vulnerable state, seeking safety as they assess their surroundings. If you aren’t there, they may feel alone and forced to cope with fear by internalizing their emotions. During my hospital stay, my mum often arrived after I had woken up and eaten breakfast. I asked her to come earlier to be there when I woke up, but it didn’t happen. She regrets this decision to this day.
Nighttime Parental Presence Matters
Being present at bedtime and during the night is equally important. While it’s a big ask for parents, especially those balancing the stress of a hospitalized child, it’s critical for a child’s sense of safety. After being discharged from the hospital, I slept downstairs alone because my parents worried about carrying me upstairs while I was immobilized in a brace. I often woke up crying in distress, itchy and uncomfortable, with no immediate comfort. When my grandmother decided to sleep in the same room, I finally felt reassured and began sleeping through the night, which also gave my parents much-needed rest.
Listen to Your Child
Children may be young, but if they ask for your presence, it’s because they need you. Surgery is a traumatic experience, and a child often feels powerless, enduring pain without understanding why their parents aren’t stopping it. They may perceive being handed over to strangers and subjected to painful procedures as abandonment. Their limited cognitive development prevents them from contextualizing these experiences, leaving them with raw fear and confusion. I am not suggesting that from now on you become a slave to your child’s every whim. Just try and listen and evaluate whether a request is a deep need or a surface-level request. There could be moments that, as an adult, you don’t consider a big deal, but to an underdeveloped mind, they could be terrifying.
Personal Reflections on Overcoming Childhood Medical Trauma
My early traumatic experiences left me emotionally numb, aggressive, and reckless. My parents noticed my inability to process emotions and my withdrawal from them shortly after I left the hospital. During adolescence, I spiralled into drug use, violence, and alcohol abuse, harbouring rage toward my parents that lasted nearly a decade. Despite knowing deep down that I had a good upbringing, I was consumed by a darkness that controlled me, filling me with shame and hatred. As an adult, I still struggle with symptoms but am constantly working on self-discovery and self-compassion to navigate and manage them.
These experiences haven’t solely been detrimental. Please do not think that if your child does suffer from PMTS, there is no hope. I’ve become fiercely independent, resilient, and self-aware. I live life on my terms and face challenges head-on, which makes me proud of the woman I am today.
Final Thoughts: Supporting Your Child Through Medical Trauma
To all the parents with children in the hospital, hang in there. You are the most important people in your child’s life, and they are lucky to have you by their bedside. I can only imagine the strength needed to watch your child go through the pain of surgery. I love my parents. I am grateful that they agreed to the surgery, and I am eternally grateful to them because today I can walk and run. They did the best they could with what they had, managing their own stress and the information available to them. It is all I could have ever asked for.
My goal in sharing this story is to help parents understand the profound impact of early medical trauma and the critical role they play in their child’s recovery. By being present during key moments and adopting a trauma-informed approach, parents can help mitigate the long-term effects of these challenging experiences.
Research Articles & Resources
Centers for Disease Control and Prevention (CDC). (2024, May 16). About adverse childhood experiences. Adverse Childhood Experiences (ACEs). https://www.cdc.gov/aces/about/index.html
Christian‐Brandt, A. S., Santacrose, D. E., Farnsworth, H. R., & MacDougall, K. A. (2019). When treatment is traumatic: An empirical review of interventions for pediatric medical traumatic stress. American Journal of Community Psychology, 64(3-4), 389-404. https://doi.org/10.1002/ajcp.12392
Kassam-Adams, PhD, N., & Butler, MD, L. (2017). What do clinicians caring for children need to know about pediatric medical traumatic stress and the ethics of trauma-informed approaches? AMA Journal of Ethics, 19(8), 793-801. https://doi.org/10.1001/journalofethics.2017.19.8.pfor1-1708
Kolk, B. V. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin UK.
Marsac, M. L., Kassam-Adams, N., Delahanty, D. L., F. Widaman, K., & Barakat, L. P. (2014). Posttraumatic stress following acute medical trauma in children: A proposed model of bio-psycho-Social processes during the Peri-trauma period. Clinical Child and Family Psychology Review, 17(4), 399-411. https://doi.org/10.1007/s10567-014-0174-2
