The Psychologic Impact on Children of Admission to Intensive Care

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There is growing literature on the psychologic impact on parents and families of having a child on the pediatric intensive care unit (PICU), but less is known about the child's experience. In this article the relevant literature is explored and illustrated with examples from the author's research. Recurring themes are the persistence of distress in a significant minority of children and the association between parental anxiety and child's psychologic symptoms. The evidence on the extent of children's factual and delusional memories relating to PICU is also examined. Finally, the implications of the current state of knowledge for future research and for clinical work are discussed.

Section snippets

Literature review

Following consideration of the methodologic difficulties inherent in this field, the available evidence relating to the following questions is examined:

  • What do children remember about their time on the PICU?

  • What is the evidence that they suffer short-term distress?

  • What is the evidence that they suffer long-term distress?

  • Which variables are associated with poorer psychologic outcome?

Summaries of the main characteristics of the most recent studies discussed are provided in Table 1, Table 2. Other

Discussion

In summary there is mounting evidence that a significant minority of children suffer lasting psychologic problems following their treatment in the PICU. The recent evidence is particularly compelling because, in the past 10 years, greater research effort has been directed at eliciting information directly from the children themselves, rather than relying solely on either observed behavior or parent report. Also there is now a growing evidence base on the long-term psychologic reactions of these

Implications for future research

More longitudinal studies are needed to clarify the natural history of psychologic adaptation of children in this situation [39] and to clarify which aspects of the child's experience related to injury, illness, or treatment are associated with poorer psychologic outcome [40]. Specifically there is a need to develop tools for use across the pediatric age range to assess delirium and withdrawal [41], [42], and to investigate associations with these aspects of experience and long-term psychologic

Clinical implications

The literature has uncovered several aspects of the PICU experience that could theoretically give rise to adverse psychologic effects in child patients and that have the potential to be addressed clinically, even while the child is still in hospital. The possibility that the child may be troubled by disturbing factual or delusional memories should be acknowledged, as should the child's confusion about what has happened to him or her. Age-appropriate explanations about the child's injuries,

Summary

The literature on the psychologic impact of the PICU on children shows a mixed picture of resilience and distress. Children report disturbing nightmares and hallucinations associated with their admission and a significant minority have elevated levels of posttraumatic stress many months after discharge, indicating that there is a need for (a) more support for this group of patients, and (b) further longitudinal research into risk factors associated with distress. By understanding more about the

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