Providing Trauma Informed Care | Patient Centered Care and Trauma Informed Care for Pediatric Patients

By integrating an understanding of traumatic stress in their routine interactions with children and families, providers can change how children and families respond to and cope with emotional reactions to illness and injury.

Providing Trauma Informed Care for Children

Illness and injury can be both physical and psychological stressors for children and families experiencing serious illnesses, injuries, or painful procedures, and can lead to pediatric medical traumatic stress. Health care teams that bring a basic understanding of traumatic stress into their routine interactions with children and families can:

reduce the impact of difficult or frightening medical events, and
help children and families cope with emotional reactions to illness and injury.

How to Provide Trauma Informed and Patient Centered Care in Pediatrics:

1. Minimize traumatic aspects of medical care

Pay attention to the child’s and family’s experience of medical care
Do what you can to reduce frightening or painful aspects of necessary care and procedures.
Remember that both current and prior trauma exposures can impact the child's (and family's) experience and their interaction with the healthcare team.

2. Provide all pediatric patients with basic support and information

Ask children (and parents) about their fears and worries, optimize pain management, and work with parents to help them provide effective support for their child.
- See the D-E-F framework for specific guidance and suggestions.
Maximize continuity of care - help ensure that all those caring for a child are aware of any traumatic stress reactions as well as effective coping resources for this patient.

3. Screen to identify those who may need more help

Consider levels of risk, using screening as one way to determine additional needs
Provide anticipatory guidance about stress reactions and ways of coping.
Assess for more severe distress or risk factors, and make appropriate referrals for additional services if warranted.

4. Remain aware of your own stress

Pay attention to the challenges of caring for ill and injured children, and promote good self-care and organizational support for yourself and your colleagues.

Review this handout , A Guide for Healthcare Providers in the Provision of Trauma-informed Patient Care, co-created with Boston Children's Hospital's Pain and Stress Studies Lab.

Improving the Quality of Pediatric Care

Implementing trauma-informed pediatric care helps to address other important goals shared by many pediatric health care settings, such as

providing patient- and family-centered care for children
providing ethical healthcare
meeting regulatory or accreditation standards
maximizing patient satisfaction

Providing trauma-informed pediatric care can enhance quality improvement initiatives in any of these areas.

Patient- and Family-Centered Care

Trauma-informed pediatric care supports and strengthens patient- and family-centered care:

Pediatric providers familiar with patient- and family-centered care will note many areas of overlap between these concepts and trauma-informed care.
Trauma-informed care brings a distinct focus on awareness of traumatic stress related to medical events, but also includes a central role for involving families and promoting family strengths.

Many key professional organizations, including the American Academy of Pediatrics, American College of Emergency Physicians Pediatric Emergency Medicine, Committee, and the Emergency Nurses Association have identified family-centered care as crucial to excellent pediatric medical care.

See guidance on patient- and family-centered care from leading pediatric healthcare organizations:

Quality Improvement

Remember: Trauma-informed care advances patient- and family-centered care

Health care professionals who practice patient-and-family-centered care recognize the vital role that families play in ensuring the health and well-being of children and family members of all ages. These practitioners acknowledge that emotional, social, and developmental support are integral components of health care.

-From the AAP Committee on Hospital Care (2012)

The Institute of Medicine’s landmark 2001 report "Crossing the Quality Chasm: A New Health System for the 21st Century" drew attention to providing emotional support and relieving fear and anxiety as key to quality patient-centered health care.

Trauma-Informed Pediatric Care can promote health care facilities’ existing efforts to improve the quality of care, meet regulatory and accreditation requirements, and increase patient and family satisfaction with care.

Optimizing pain management to reduce distress also addresses standards (i.e. from the Joint Commission) for appropriate assessment and management of pain.
Clear communication between patients / families and the health care team is key to improving patient safety and reducing medical errors.
Key elements of Trauma-Informed Pediatric Care can be implemented as part of formal quality improvement initiatives.

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Remember: Trauma-informed care advances patient- and family-centered care