We can all agree that surgery counts as a major medical procedure. But what about getting a biopsy or wearing a corrective chest brace or having tubes placed in one’s ears? Do these count as so-called “major procedures?” What about getting an IV? To an adult, an IV may not feel traumatic, but what about to a small child? Young kids have a much broader definition of what feels “major” to them because they feel powerless and can’t understand what is happening even when it’s explained. How then do we figure out what medical procedures are traumatic for kids?
Think of it this way: any medical procedure that overwhelms and confuses your kid can become traumatic. All of this is dependent on:
- the child’s age
- the effected body part(s)
- the amount of pain during and after the procedure
- the possibility of being separated from parents
- the invasiveness of the procedure
- the recovery from the procedure
The child's age
The less a child is able to understand what is happening, the more traumatic a medical procedure can feel. Thus, the younger the child, the more likely simple procedures can be experienced as traumatic. To a toddler, getting a shot is overwhelming and scary, and his screams will nearly pierce a few eardrums. A seven-year-old, who has experience with shots and their pain, might wince and cry a little, but he won’t be raising eyebrows in the waiting room. It’s not only that an older kid can handle more pain, but the older kid understands better what is happening to him. Older kids—and here we’re talking about ages six and up—have more intellectual abilities and they’re able to use their rational thinking to calm their feelings. They know what a broken wrist is and that it heals, whereas a two- or three-year-old may not intellectually understand what bones are and how they break. In fact, a three-year-old may misunderstand what it means to have a “broken” bone. It’s very possible that he will believe his hand—not his wrist, for wrists are less tangible to a three-year-old—is broken and, like a broken toy that is thrown out, his hand might somehow be thrown out, too. I know, it sounds absurd to us adults, but this is how a small mind misunderstands things. In comparison, a four- or five-year-old may not know much about bones, but he has more intellectual ability to learn about bones and how they heal. In doing so, he can then apply this learning to his own experience so that he doesn’t become too anxious or confused.
Often, parents and doctors believe that if a child is too young to remember a procedure—say under three—it will not affect her in the long term. While a one-year-old can’t remember being restrained while being catheterized,[1] she will retain a gut-deep association of being held and hurt. This association isn’t an actual, conscious thought, but rather a bodily experience. Her body remembers even when her mind is too immature to form lasting, conscious memories. Her body will tell her that being confined, held, or constrained is a terrible, terrifying thing regardless of the facts. When this one-year-old-turned-adult needs an MRI—in which she must keep her body utterly still as it enters the tube-shaped machine—she may find herself having an indefinable and overwhelming panic that prevents her from going forward with the procedure.
[1] A procedure in which a tiny tube is inserted into the child’s urethra so that urine can be extracted from the bladder.
Body parts
To sum up, any procedure that involves the child’s face, hands, or genitals runs a high risk of becoming traumatic.
Clearly, many procedures affecting a child’s eyes or mouth will almost certainly be traumatic because these parts are so important. But faces in general—and here we’re talking about noses, cheeks, chins, ears, brows, etc.—are also hugely important. A child implicitly knows that her face is her: she identifies others by their face and knows that she is identified by her own face. The importance of one’s face only increases as the child grows—think of adolescents here! Because faces are so intensely personal and associated to our very being, any procedure that involves a child’s face quickly becomes scary and invasive.
Hands are vital to children because they are so central in helping them explore and learn about their world. Can you imagine a kid trying to play without using his hands? Any procedure involving his hands, especially ones that limit their use, can have long-term, negative effects.
Some parents ask why procedures involving genitals are deemed so important since young kids are not yet focused on these body parts. It’s true that young kids are not sexually minded—though their genitals are very sensitive and kids do experience pleasure through them—but because genitals become so very important in later years, any inaccurate narratives about them will have enormous effects. For instance, a young adolescent client who had successful surgery when five years old to correct for an undescended testicle told me he wasn’t ready to be a grown man because “things are a little messed up down there.” Despite the repair, he believed he was still damaged, though he couldn’t explain how. It was just a feeling he carried with him so that as he entered adolescence, he believed he was not a fully functioning man.
You might wonder why a procedure involving vital organs such as kidneys, lungs, and heart aren’t immediately included in this list. Yes, we need these organs to live, but they are inside our bodies and not visible. To a three- or four-year-old child, having two kidneys somewhere in her little body is a pretty strange idea. When she looks in the mirror, she doesn’t see her kidneys. She can’t touch or feel them like touching her mouth or belly button. Kidneys are just too abstract. If the procedure becomes invasive—as many procedures involving kidneys are—the child will then be more prone to trauma.
Pain and the child's body
Some kids can bang into the wall while spinning about the room and not notice a thing. Other kids can’t stand the tickle of a shirt’s label against their neck. This is how they are wired from birth. Some kids are sensitive, and others less so. Your kid will have his own level of pain tolerance. But whatever level this is, every kid can be traumatized by pain depending on how intense and prolonged the pain is. Fortunately, we live in a time when there’s good medication for pain so that your child will hopefully not experience too much discomfort.
Being separated from parents
If a child has to stay overnight unaccompanied by a parent in a hospital, she might feel abandoned. Hospitals can be scary to a child where a slew of nurses and doctors flit about, examining her, making her take pills, taking her temperature, etc. These strangers come and go, and even though they may smile and seem kind, they are still strangers. Fortunately, most hospitals allow parents to spend the night with their child in their hospital room so that the child doesn’t feel alone and unprotected. When children have a long stay at the hospital so that it becomes logistically difficult or impossible for parents to always be there, it becomes more likely that the procedure and it’s recovery will feel traumatic.
(For a bit more on separation, check out the posts, “Bedtime: The Things No One Is Mentioning” and “Separation Anxiety in Toddlers: How Parents Can Help.”)
Invasiveness
There are degrees of invasiveness, and what is considered invasive is based on the child’s experience. We’d all agree that by its very nature, surgery is invasive: surgery essentially means that something cuts into or enters the body. Likewise, any child who needs a catheter placed in his or her urethra will likely feel some degree of trauma. What about a child who gets an IV? Or a child who must be restrained during an MRI?
I once worked with a four-year-old who had to wear a chest breast while sleeping to correct for a malformed rib cage. At first, because he rarely complained, his parents assumed the brace wasn’t traumatic. They wondered if it even was invasive because he was asleep most of the time he wore it. But when we considered his new behaviors—his refusing hugs, his crying when his parents read to him at bedtime, his backsliding around toileting—we began to appreciate how the brace was likely very distressing and invasive.
Think of it this way: your child’s body is holy to your child, and anything that enters it, restrains it, hurts it, controls it, etc. can feel too much for your child to handle and thus become traumatic.
Recovery
Sometimes there are complications following a procedure. There might be an infection which requires more trips to the doctor’s office. There could be a lengthy period of pain or limited use of a body part. Any extended recovery time allows more opportunity for confusion and fear. It’s also a time when a child can create incorrect narratives. For example, a six-year-old who must use crutches for many months may develop a false narrative that her body has not completely or properly healed and that she must always be careful (i.e. fearful) of another injury.
Related Posts
Medical Trauma, part 3: The Child’s Experience
Looking specifically at the child’s experience of trust and helplessness, confusion and fear.
Separation Anxiety in Toddlers: How Parents Can Help
It’s normal for toddlers to have intense separation anxiety. Here’s what’s actually going on inside your child and what you can do to help both of you get through it.
Bedtime: the Things No One Is Mentioning
When your child has trouble getting to bed, it’s usually an emotional issue. When you understand what’s going on inside your child you can address the actual problem.
