Critical Illness in Children

Causes of the Trauma

Perhaps the most primary cause of the manifestation of trauma for children with critical or terminal illnesses is related to the pain of diagnostic tests and ongoing treatments. These are unfamiliar, often painful, and are often coupled with anxiety on the part of parents or caregivers. Depending on the outcome of tests and ultimate prognosis, anxiety and dread may set in as the child begins to understand the duration of the treatment regimen. The level of pain coupled with the psychological and emotional upheaval may overwhelm their usual abilities to cope, resulting in symptoms of trauma.

Once the traumatic reaction sets in (once the child has mobilized the fight-or-flight response with its burst of adrenaline), a hallmark of the biochemistry of the ongoing traumatic response is that they are people on edge, easily provoked and irritable. In the case of life-threatening illness, however, this is easily moved into anxiety. Any time children question their parents' abilities to remain stable in the face of this challenge, they are apt to swallow this anxiety and manage it silently. This is an attempt to manage internally what they can in order that external stability might be maintained.

Depending on the nature of diagnostic tests and treatment modalities, children may experience separation from their parents at this most critical moment in their lives—one of great uncertainty and unfamiliarity, coupled with physical and emotional pain and separation at the time children most yearn for the touch of reassurance and love that only a parent or surrogate parent can provide.

There are inherent limitations in preadolescents' abilities to perceive and understand the finality of death. Younger children may find some protection in their perceptions because of their more limited understanding; however, John Spinetta's case-controlled study of 6- to 10-year-old children hospitalized with either cancer or a non-life-limiting illness demonstrated that serious illness itself can [Page 163]accelerate cognitive development in often unpredicted ways. Thus, while the developmental stage a child is in chronologically could provide a buffer, the acceleration of his or her cognitive development may propel the child into deeper understanding.

Contributing to Exacerbation

Children often react to trauma more as a result of how they view their parent or caregiver to be coping than in relation to the actual level of threat of loss of life or limb. Often, parents of critically ill children have not seen anyone model for them the behaviors, attitudes, and skills needed at such a time. Unless they had a medically frail sibling, this may be uncharted territory for them.

Parents attempting to navigate such turbulent waters for the first time may feel inadequate in their skills for knowing how best to support their child. In general, children are very “loyal” to their parents' verbal and nonverbal messages, so they may not ask questions they think will be difficult for their parents to hear or answer. The resulting lack of information breeds fear, as does feeling the isolation of being alone in their questions.

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