Child's Hospitalization May Heal Body but Hurt Mind

"Children who were younger, more severely ill, and who endured more invasive procedures had significantly more medical fears, a lower sense of control over their health, and ongoing post-traumatic stress responses for six months" after hospital discharge, according to lead researcher Janet E. Rennick, R.N., Ph.D., of the Montreal Children's Hospital of the McGill University Health Care Centre, and the School of Nursing, McGill University.

Rennick's team expected to find that children admitted to pediatric intensive care units are more traumatized, and experience more lingering psychological problems, than children on regular medical-surgical units. Children on PICUs are subjected to more invasive procedures, she explains, and previous research has shown that they tend to be more apprehensive, anxious, detached and sad than other hospitalized children.

To the researchers' surprise, they note in the June issue of Developmental and Behavioral Pediatrics, their findings do not support those assumptions. Instead, the results indicate that "it is not PICU hospitalization, per se, that affects children's psychological responses to illness but a number of factors surrounding the hospitalization experience."

Rennick and her colleagues followed 60 children, ages 6 to 17, who were admitted to the PICUs of two university-affiliated children's hospitals in Canada. For purposes of comparison, the researchers recruited a child of a similar age and with a similar medical problem, but on a regular unit, every time they enrolled a PICU child.

The team recorded the details of each child's hospital experiences, including the severity of his or her illness and the number of invasive procedures -- such as the insertion of a chest tube -- each received. The researchers evaluated each child's psychological well-being using a series of questionnaires six weeks after hospital discharge, and again six months after discharge.

"Surprisingly, no significant group differences were found between children hospitalized in a PICU and those on a hospital ward at six weeks or six months post-discharge," Rennick reports. Realizing this, the researchers began to treat all the participants simply as hospitalized children. They then examined which children had lingering psychological problems after discharge, and why.

At the six-week mark, their findings indicate, younger children and those who receive a higher number of invasive procedures are more likely to have medical fears, intrusive thoughts and avoidance behaviors. The children who are younger or more severely ill while in the hospital tend to have a lower sense of control over their health.

At the six-month mark, a decline in the number of persistent hospital-related psychological problems is evident. However, the younger children are still more likely to experience less of a sense of control over their health. They also are more prone to medical fears, as are the children who endure a higher number of invasive procedures.

These findings challenge the traditional belief that the experience of PICU patients is unique, Rennick notes. Instead, she concludes, they indicate that "children's responses to hospitalization may be affected less by the location of their hospital stay and more by their perception of the illness experience."

For this reason, she adds, "hospital programs geared toward providing psychological support to these children [on a uniform basis] are particularly important."

Support for the research came from the Fonds de la Recherche en Sante de Quebec, the Canadian Nurses Foundation, the Ordre des Infirmieres et Infirmiers du Quebec and the Corporation des Infirmieres et Infirmiers de Montreal.