When I took my five-year-old son to urgent care after a minor accident, I never thought that six months later he would be having nightmares and flashbacks or that he would become so distrustful of me that he would flinch when I touched him.
According to the CDC, 61% of US adults experienced at least one traumatic event in childhood. Emergency room staff who work with children need to become more trauma informed so that they—at a minimum—aren’t creating more trauma.
During a game of chase with our Great Pyrenees, Akasha, Cai slammed his finger in the kitchen door. Blood was all over the floor and his fingernail was split in half. I walked Cai the three blocks from our home to the closet urgent care where he was seen by an empathetic doctor who — unfortunately — was not a pediatrician. After an x-ray revealed a bone fracture in addition to the split fingernail, the doctor gave me three options:
- do nothing, let the wound heal on its own, but run the risk of infection.
- have her stitch the wound with a local anesthetic but without sedation which she admitted might be traumatic.
- take him to an emergency room where he could be given mild sedation and his wound could be humanely cleaned, stitched, and tended to.
As a professor who teaches health psychology and a somatic therapist, I have always believed that less is more when it comes to medical care, so I initially opted to do nothing. But when I awoke the next day to Cai shoving his purple and green pinky in my face, we headed straight to the emergency room.
After spending six hours in a hermetically sealed waiting room during the apex of the COVID pandemic, we were finally able to see a doctor who informed me that he would give Cai a local anesthetic before suturing his wound.
When I told the ER physician my concerns about the potential trauma for Cai being treated without sedation, he dismissed them and told me my son would be fine. “In 17 years of practice, I have never sedated a child to suture a wound,” he said.
The only reason why we’d waited six hours in the emergency room was because I expected them to use sedation so that Cai would not be traumatized by some barbaric, painful procedure. Now, I had a choice: let the doctor perform the procedure (which he assured me would last no more than five minutes) or find another emergency room to wait another six hours and perhaps be told the same thing. We stayed.
The five-minute procedure lasted closer to 10; Cai was not fine. I will never forget the look of tentative trust as he climbed onto the papoose board or the look of confusion and betrayal when I helped the doctors and nurses hold him down.
After the procedure, Cai refused to speak to me or even acknowledge my presence. That night his sleep was punctured with cries of “no”, “don’t” and “stop.” He would not let me anywhere near his wound. Who could blame him?
Six months later, there are no signs of Cai’s physical injuries, but remnants of the psychic wounds remain. Thankfully, he is no longer wary of me, but he still has nightmares and panics anytime he feels restrained.
According to noted trauma therapist Peter Levine, medical procedures are rife with the potential to cause lingering trauma. Though we may cognitively process medical treatments as helpful, our bodies often experience them as an attack.
This is particularly true for young children whose ability to intellectually understand their experiences is limited by an underdeveloped pre-frontal cortex. All Cai knows is that he was held down by people much bigger than him—one of whom was his own father—and his body was violated.
Cai’s experience is common. Children are frequently not sedated or under-sedated for medical procedures. Ironically, young children may be even more in need of sedation because of their underdeveloped cognitive processing abilities.
My son is also Black. While under-sedation is a universal problem with children, studies suggest that Black children are 50 percent less likely than white children to receive analgesics and sedation even when pain is severe. Like many people, hospital personnel often have implicit biases that make them believe that Black children are tougher, less honest, and more impervious to pain than white children.
There are concrete actions that parents and hospital staff can take to make a trip to the ER less traumatic. Emergency room staff should be required to go through training on trauma informed care such as the online certification offered by Xavier University. This is a cost-effective approach that has been shown to improve care for patients and job satisfaction for medical professionals. Hospital staff should also follow the recommendations of the Children’s Hospital of Philadelphia that sedation be considered anytime a child is required to sit or lie still even for a few minutes. In addition to sedation decreasing the likelihood of trauma, the procedure itself is more likely to be successful when mild sedation is used.
It can be difficult to question authority in an emergency, but parents need to educate themselves on the effects of medical trauma and how to avoid it so that they can better advocate for their children. Thisnthatparenting.
Of course, physicians may have valid concerns about the safety of administering anesthesia to young children. A literature review published in the Journal of Emergencies, Trauma, and Shock found that the currently available sedation practices are safe and effective when administered appropriately.
Cai will be OK. The nightmares are less frequent and he is learning to trust me again. He would never have had to go through this if the emergency health care providers who treated him were more trauma informed and followed the recommendations laid out by top-ranked child healthcare providers like the Children’s Hospital of Philadelphia.
There are many things that can harm children and leave trauma in their wake. Medical care should not be one of them.
