Natalie Holman @ MRF Childhood Amputee Day - Pushing the Boundaries

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  • 1. The psychological impact ofchildhood meningococcalsepticaemiaDr Natalie Holman, Clinical PsychologistPsychological Services (Paediatrics)Alder Hey Children’s NHS Foundation Trust31stMay 2013
  • 2. Psychological impact• Emotional & behavioural difficulties, including traumaticstress symptoms• Adjustment to changed appearance• Adjustment to change in cognitive ability, hearing, or sight• Managing acute & ongoing hospital treatment• Impact on the whole family• These can be influenced by:– Age & developmental stage– Severity of illness & admission to intensive care– Experience of hospital, treatment, pain & length of admission
  • 3. Normal reactions to a veryfrightening event– Nightmares or sleep disturbance– Memories of the eventunexpectedly popping into themind– Appetite change– Clingy behaviour, not wantingto be left alone– Temporarily losing skills (such aswalking, toileting)– Being more jumpy & on thelookout for danger– Seeming to be in a daze,withdrawn, anxious, fearful– Avoiding reminders of the event& not wanting to talk about it– Playing or drawing about theevent– Problems at school & difficultyconcentrating– Getting angry or upset moreeasily– Changes in behaviour, eg.increased temper tantrums
  • 4. Reactions to a traumatic event• For all ages, it is quite normal to experience these symptoms, even forquite a while, after a frightening event• Parents, siblings & other family members can experience traumatic stresssymptoms too• Importantly, these symptoms can occur at any point after a traumaticevent; some children may show an immediate emotional response whileothers may not do so for some time• Children will worry less if people around them can help them to see thatthese reactions are normal and understandable• With help & support from those around them, most children can recoverfrom these fairly quickly, usually within a few weeks
  • 5. What helps?• Try and make things as normal as possible– Ensure children feel safe. They may need lots ofreassurance (eg “Yes, you were hurt but you’re in hospitalnow & you’re safe/getting better, etc”)– Children feel safer when they know what to expect.Sticking to normal routines where possible and lettingchildren know what is going to happen will help– Make sure that parents & family members understandwhat is happening so they are able to support & reassurethe child
  • 6. What helps?• Help children to understand what has happened– Children need honest explanations of what happened tothem that are age appropriate– Even young children can really benefit from being given anexplanation– Helps the child to make sense of the event and can reduceunpleasant feelings, eg. fear– Can correct misunderstandings, eg. some children mayincorrectly think that it was their fault– Helps prepare children for answering other people’squestions
  • 7. What helps?• Letting children talk when they are ready to– Be ready to listen if a child wants to talk about whathappened – no need to ask questions, just show you’relistening– Sometimes people avoid talking about what happened sothat they don’t upset the child. However, research showsthat children are really likely to benefit from talking aboutfrightening events– Talking needs to be done sensitively and when the child isready. It can be useful to provide opportunities for thechild to talk without forcing them to. Some children mayprefer to use dolls or draw instead of talking– Talking can help the child feel more in control of thememory and less afraid of it
  • 8. Adjusting to a changed appearance• Factors that affect adjustment include– age & developmental stage of child– views about appearance before illness– permanent reminder of meningitis, eg. scars– expectations for future recovery, treatment &healing
  • 9. What helps?• Helping children improve their:– Self-confidence– Self-esteem– Social competenceAll help build resilience & adaptive copingstrategies
  • 10. Building positive self-esteem• Notice your child when they do well and give them specificpraise• Help your child to notice and remember the good thingsother people say about them• Make time to sit down and talk to your child – encouragethem to discuss their ideas and feelings• Encourage your child to do something they are particularlygood at• Help them celebrate their achievements• Increase body confidence, eg. through sport• Peer support & meeting others in a similar situation
  • 11. Helping your child with friendships• Encourage your child to have contact with friendsoutside school– e.g. Inviting other children to play/tea, activities such asyouth clubs/sports• Help your child stay in touch with friends– e.g. arranging to meet up/telephoning them/textmessages/msn messenger• Help your child with social skills– e.g. what to say when they meet someone new
  • 12. Managing others’ reactions• Does your child know what happened to them?• Benefits of having a ‘ready–prepared’ answer to curiousquestions – age-appropriate• Talk to your child about their operations & hospitaladmissions• Use photographs• EXPLAIN – REASSURE – DISTRACT technique to managecurious questions – taking control of the situation– eg. “It’s just a scar(EXPLAIN). It’s lumpy & red but it doesn’t hurt(REASSURE). Are you playing football at lunchtime? (DISTRACT)”• Lots of advice on Changing Faces website
  • 13. Resilience & Positive adjustment• Some survivors report positive changes followingmeningococcal septicaemia– increased empathy for others– change in attitude towards & tolerance of difference– re-evaluating life– opportunity to make changes
  • 14. Where to access support• www.meningitis.org• www.meningitis-trust.org• www.limbless-association.org• www.changingfaces.org.uk (for support with appearanceconcerns)• www.youngminds.org.uk (support for young people aroundemotional wellbeing & mental health)• www.mind.org.uk (as above but for adults)• Or, see your GP for a referral to local counselling or mentalhealth services (eg. Child & Adolescent Mental Health Service– CAMHS)