Trauma to the children undergoing surgery

1. Psychological Trauma in
children
Undergoing Surgery
Presented By
Dr Shirish Silwal,
Phase B, Year 3,Block -5
Paediatric Surgery

2. Psychological Trauma-
A psychologically upsetting experience that
produce an emotional or mental disorder or
otherwise has lasting negative effects on
person’s thoughts, feelings or behavior.

3. • Forsyth (1934) was first to call attention to
the fact that in children "psychological
changes may follow a surgical operation”.

4. • Although invasive, surgery in children is
sometimes an essential component of the
medical care.
• Children undergoing surgery are of different
ages and stages of cognitive development,
which may alter or distort their lasting
impression on surgery.

7. Fear & Emotion
Children’s Understanding of Health and Illness

8. • Infant
• Separation (highest age risk)
• Stranger Anxiety (6-18 months)
• Toddler
• Separation anxiety
• Loss of self-control

9. • Preschooler
• Regression (highest age risk)
• Separation anxiety and fear of abandonment
• Inability to distinguish fact/ fiction
• Unable to understand reason for hospitalization

10. • School age
• Loss of control/ privacy
• Pain
• Bodily Injury
• Death

11. • Adolescent
• Aware of the physiologic, psychological and
behavioral causes of illness
• Concerned with separation from peer group

12. Sources of stress
• Physical harm or injury, resulting in
discomfort, pain, mutilation or death
• Separation from parents
• Fear of unknown
• Uncertainty about behavior
• Loss of control, autonomy, and competence
• Effect of parental anxiety

13. • Various study shows that,
Anxiety of children higher in preoperative than
postoperative period (Li & Lam, 2003), (Thompson & Tielsch-
Goddard, 2014), (Kain et al., 1996)
Psychological stress in children undergoing surgery

16. Impact of Stress on the child
• Preoperative anxiety may prolong the
induction of anesthesia and leads to
maladaptive behavior responses such as
sleep and eating disturbance. (Kain et al 1996)

17. Impact of Stress on the child
• Greater fear or distress prior to surgery is
associated with a slower and more
complicated postoperative recovery. (Johnston &
Wallace, 1990; Mathews & Ridgeway, 1981).
• Increased postoperative pain and delirium.
• Psychosocial adjustment problem

18. • Stress delays wound healing. (Kiecolt- Glaser, Marucha,
Malarkey, Mercado, & Glaser, 1995; Marucha, Kiecolt-Glaser, &
Favagehi, 1998; Padgett, Marucha, & Sheridan, 1998).

19. • In 119 children,54% of children showed negative
behavioral responses at 2 weeks.
• 20% up to 6 months, and 7.4% up to 1 year after
surgery,
• Including having bad dreams, waking and crying,
difficulty separating (separation anxiety), eating
problems, and aggression toward the hospital and
hospital staff.
• These were not associated with type of surgery
(Kain et al., 1996)

20. • Anxiety was experienced before surgery and
was associated with older children of
anxious parents with a history of poor
quality of medical encounters.
• Anxiety increased with separation to the
operating room (Kain et al., 1996)

21. What Are The Solution ??

22. Hospital Setup:

28. Provide Information

29. Good relationship with children

31. Thankyou
Our small effort can make a vast difference.