Post-traumatic stress disorder syndrome in children and their parents after PICU : from improvement of understanding to a better screening and management.

Abstract

The hospitalization of a child in intensive care is a source of acute stress for both the child and his or her parents.  The risk of developing post-traumatic stress disorder (PTSD) has recently been extensively studied in the literature: this real risk (between 25% and 50%), affecting both children and their parents, calls for prevention, screening and, where necessary, appropriate treatment. Risk factors must be identified, whether they predate hospitalization (ACE “Adverse Childhood Eperiences”) or are inherent to it (abruptness of hospitalization, midazolam sedation, mechanical ventilation, sepsis, parental anxiety, severity score for children). Day-to-day prevention is essential, and the role of paramedics is vital: parents need to express their emotions, understand how their child is being cared for, and find their role. Good communication between caregivers, parents and children is also essential to maintain a relationship of trust and a "therapeutic alliance". Ideally, these families should be followed up in post-intensive care consultations, but this is very time-consuming, and the literature describes alternatives (telephone consultations, videoconference group therapy, the role of Advanced Practice Nurses).