According to a study published in the Journal of Pediatric Critical Care Medicine, spending time in an intensive care unit can traumatize children, and the effects can persist even months after returning home.
The findings come from an analysis of survey data using the Children’s Critical Illness Impact Scale developed by Dr. Janet Rennick (Research Institute of The Montreal Children’s Hospital of the McGill University Health Center) and colleagues. This tool used to measure psychological distress in children following hospital discharge is the first self-report scale ever created to measure how children are affected by intensive care unit hospitalization. It is a 23-item questionnaire that provides health care professionals with enough information to recognize those children who need psychological support after a hospital stay. The Scale was developed using the results of 64 interviews conducted with children who had been hospitalized in an intensive care unit, their parents, and health care professionals in three Canadian pediatric hospitals.
Lead researcher Rennick clarifies that: “We know some children suffer post traumatic stress symptoms after having spent time in the intensive care unit. Parents and children have described delusional memories of their hospital experience which continue to bother the child after they go home. In addition, parents have described behavioral changes and ongoing fears in their children, and children have told us they don’t feel the same as they did before they were critically ill. This tells us something negative is going on with these children, but there was no way to capture the whole story since questionnaires had not been developed specifically for use with this population of children. As a result, we found that some kids were falling through the cracks and not getting the help needed to cope with the stress of hospitalization.”
To help health care professionals recognize potential psychological issues, Dr. Rennick and colleagues designed a questionnaire that is targeted to children between the ages of six and 12. The main challenge for the researchers was interviewing the children in such a way that would encourage them and make them feel comfortable while sharing their feelings and fears.
Interviews took place both individually and in focus groups. Younger children used felt pieces and hospital play sets with a storyboard to relay feelings to the researchers about being hospitalized, returning home, returning to school, and going back to the hospital for a check up.
“This interviewing method worked well for younger children who created detailed stories of their experiences. But we discovered that the storyboard method was less effective for children 10 years and older. While it helped them focus on their hospital experiences, they didn’t interact with the storyboard in the same way the younger children did. They would handle the felt pieces, and simply tell their story as we changed the storyboards,” explains Dr. Rennick.
The researchers are optimistic that this child friendly, self-report questionnaire will aid health care workers in effectively determining whether children are mentally healthy after an intensive care unit stay. “With this new scale we will be better able to pick-up and help the child whose life simply hasn’t returned to normal,” concludes Dr. Rennick.
Journal of Pediatric Critical Care Medicine (2008).
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Written by: Peter M Crosta