Emily* was an eight-year-old I regularly saw in ED. She had a chronic medical condition that will require regular medical attention for the rest of her life.
When I first met Emily, I arrived at her bedside with the numbing gel in hand. Emily took one look at it and ignored me. I attempted to explain that she was going to have a blood test when her Mum stepped in.
‘Brooke, she knows what that is for, and she says it doesn’t work. She knows what putting it on means. She won’t let you or anyone else do it.’
Very briefly, I was thrown off-track. ‘What happened to her?’ I asked her mother.
‘When Emily had her first IV, she was taken to a room, wrapped up and pinned down. It took four adults, including myself, to hold her down so that they could put the IV in. Now, she puts up a bigger fight, and it is nearly impossible.’
It is easy to forget about or ignore the unseen psychological damage we can cause a child when we are caring for their physical health, but once you have seen the result of the damage, it’s hard to forget.
Something that seems so small to an adult can be traumatic for a child.
Putting in an IV can be a quick, trauma-free experience to us, but it can have long-lasting effects on a child.
Emily is a real person, and she is suffering.
Every time she comes to the hospital, she suffers more.
That suffering worsens as she has to deal with the fears associated with the present treatment while reliving her previous hospitalisations’ fear and emotions.
Now, her response is to avoid and fight.
The part of our brain that activates in these situations is the reptilian brain. It’s the bit that is leftover from our prehistoric days when we needed to make quick escapes. It is highly sensitive to sights and sounds.
When a perceived threat activates the reptilian brain, it will recruit other areas of the brain to initiate a response such as tightening specific muscles and releasing hormones such as adrenaline.
The frontal cortex, which deals with reasoning, also makes an assessment and decides if the threat is real. If it is a false alarm, it signals to the reptilian brain, to calm down and everything settles back down again.
The person sighs with relief and relaxes.
A traumatised person cannot reason and settle the fear response due to the storage of memories of previous traumas distorting their perspective.
To us, getting an IV inserted or getting a vaccination is a perfectly safe environment, but to kids like Emily, their memory tells them otherwise.
When the cortex does not calm the reptilian brain, the body continues to prepare itself to fight or flee.
You better have your best running shoes and boxing gloves on!
There is no reasoning.
We have little choice other than to administer Emily’s treatment against her will and so we use restraint.
Again. Again. And again.
Each time we immobilise her, we reinforce her fear and her ability to reason or calm down diminishes.
She cannot escape!
When we are unable to fight or flee threatening situations successfully, trauma is the likely result.
Now bear with me for a second because I am going to explain how this all happens. It’s a bit technical, but we need to understand it so parents and health professionals (i.e. You) can appreciate the importance of avoiding these situations.
When a person is overcome and unable to flee or fight, their body enters into what Dr. Peter Levine calls the freeze response in his book, “Trauma through a child’s eyes”. A person in the freeze response looks like a person in shock — their body undergoes many bodily changes that slow it down.
Once the danger passes, the person appears to return to normal; however, they have just stored the energy and memories of the trauma in their nervous system.
In Levine’s research, he found that wild animals can release the traumatic event’s energy when returning to a normal state. He describes this release as a process of completion that closes off the experience by freeing any trauma in the body.
It’s worth watching a fascinating video of a polar bear is going through this completion following a freeze response brought on by a tranquilliser dart — if only it were that easy for humans!
Levine’s research has found that this natural process of healing the body after traumatic events does not occur naturally in humans. Instead, humans generally store the trauma in their nervous system and suffer from the debilitating effects of traumatic events held in their nervous systems.
What does all this have to do with Emily’s restraint?
Levine points out that “one common and frequently overlooked source of trauma in children is routine medical and emergency treatment” (p.183).
During these procedures, children are often placed in situations when being treated that induce a fight or flight response.
When they cannot fight or take flight because of several adults restraining them (as in Emily’s case) — children freeze and are at risk of storing their trauma. This trauma then makes them susceptible to re-experiencing the traumatic event when placed in similar situations.
So, restraint is terrible. Really terrible.
The good news
There are other, less traumatic ways, to gain the child’s cooperation and stop them from spiraling into a fight or flight response (and storing trauma), such as:
- Adequate preparation using Medical Play — this can start a home!
- Slow your approach to work on a time frame that considers the child
- Honesty — if it will hurt, be honest and gentle about it. For example, ‘Some children have said it can be uncomfortable.’
- Giving the child choices to provide them with a sense of control
- Using the One Voice Technique during the procedure
- Embrace the tears– it is ok to cry or express emotion, and allowing the tears to flow helps the child release stress hormones.
- Learn about therapeutic/comfort holding (you can contact The Standish Foundation to organise some training)
* Emily’s name has been changed for privacy
This article is for general advice purposes only. If you suspect your child or a child you care for has suffered trauma, please seek professional help. Professional help may include counselling, psychology or play therapy (my favourite!).