By Linda Carroll

NEW YORK (Reuters Health) - A stint in the hospital can traumatize a child for months, a new study shows.

Researchers found that younger children and those who were more severely ill or who endured more invasive procedures experienced nightmares and fear of medical care long after they returned from the hospital, according to the report published in the June issue of the Journal of Developmental and Behavioral Pediatrics.

The study results show that caretakers need to focus more attention on the psychological impact of hospitalization, the study's lead author, Dr. Janet E. Rennick, said in an interview with Reuters Health.

"Psychological support services are essential," said Rennick, a consultant for nursing research at the Montreal Children's Hospital of the McGill University Health Care Centre and an assistant professor at the school of nursing at McGill. "I think we have to be very aware of the importance of offering those kinds of support services to both the children and the parents."

Rennick and her colleagues studied children both in the pediatric intensive care unit (PICU) and those in the regular medical-surgical wards. The researchers expected to find that the PICU patients would be more traumatized and be more likely to have lingering psychological problems than those on the wards because those in the PICU tend to be sicker, Rennick said.

In addition, previous research had shown that children in PICUs are more apprehensive, anxious, detached and sad than other hospitalized children.

But ultimately, it made no difference whether the child was in the PICU or the general wards, Rennick said. One explanation for this might be that children in the PICU were more likely than those treated in the general wards to receive sedation and pain-killing medications.

"Children on the wards had quite a large number of invasive procedures done to them and were fairly sick," Rennick said. "But they received much less sedation than those in PICU. We need to be more conscious that invasive treatments are very threatening to children. Sedation and (pain medication) are important. On the wards we need to be more conscious of the children's needs."

The researchers also found that parents could make a big difference. Children were comforted and had fewer lingering psychological problems if parents stayed by their sides during frightening procedures.

"Sometimes when a child is sedated the parent will ask, 'Do I need to stay at the child's bedside? He's on so much medication I don't think he even knows I'm here,"' Rennick said. "We're finding that the parent's presence is important, whether the child is completely awake and alert or not. A support person is reassuring."

For the new study, Rennick and her colleagues followed 120 children who had been hospitalized in either the PICU or the regular wards at two local hospitals. The average age of the children in the study was 11 years.

Six months after hospitalization, the youngest children and those who received a larger number of invasive procedures had persistent psychological problems, the report indicates.

Support for the study came from the Fonds de la Recherche en Sante de Quebec, the Canadian Nurses Foundation, the Ordre des Infirmieres et Infirmiers du Quebec and the Corporation des Infirmieres et Infirmiers de Montreal.

SOURCE: Developmental and Behavioral Pediatrics 2002;23:1-12.

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