PTSD in toddler?

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Hi,

My toddler recently underwent a difficult time that included both an acute illness and a hospital stay and I believe he's suffering from PTSD as a result, but I'm unsure.  I'm hoping that you can help me understand what he's dealing with emotionally and help him through it gently.

For around 10 days, he was sick with fever of over 104 degrees and vomiting (with a brief 2-day respite, during which time his body apparently knocked his illness down but not out).  During that period, we visited the pediatrician's office 3 times (which he hates), and although they took a urine specimen and did bloodwork, they told us he had a virus and would eventually heal on his own.  Long story short, we forwarded the urinalysis and CBC results to family members who are physicians and they assured us it was NOT viral but bacterial and sent us to the emergency room, where it was found that he had a severe UTI that had become an acute kidney infection, since it had gone undiagnosed.

In the process of diagnosing the infection in the emergency room, my baby (who is 21 months old), who had been sick and obviously in a good deal of pain for over a week, had many vials of blood drawn (some not very skillfully), was catheterized for his urine sample, had his temperature taken rectally many times and had a nurse "miss" several times so that his anus had several small cuts and was bleeding, had an IV inserted, had a probably painless but nonetheless traumatic in that he was held down ultrasound on the kidneys--all of this while still hurting with high fever.  During the whole process, and especially when I had to help hold him down while they were drawing blood and inserting the catheter, he kept crying and begging, "No, no, Mommy, no!" over and over.  It was truly heartbreaking.

Over the course of the next 2 days, after he was admitted to the hospital, he was absolutely terrified whenever someone he didn't know entered the room (which was very often, since vitals are checked with unrelenting frequency).  I never left his side except to use the restroom when he was sleeping, and he could not stand to be anywhere but in my arms.

We've now been home for nearly 2 weeks.  He is interacting normally with his siblings and dad and with a few other trusted adults and children, but he does not want to be in unfamiliar places or around even somewhat unfamiliar people, even if I am holding him the entire time.  He panics and begins saying, "No, Mommy, no!" again.  He is also having some trouble sleeping at night, even though he sleeps in the bed with me--he wakes panicked and sometimes refuses to nurse or go back to sleep.  One thing he asks to do often is "go outside," which he also asked frequently at the hospital; it's almost as if "outside" means escape to him.

I don't know what to do to help my sweet baby.  I've considered taking him to a child psychologist, but his fear of medical people and strangers seems to preclude that.  I'm trying to give him extra time with me (I stay home with him, so I'm almost always with him) and show even more affection than usual, but I don't know what else will help. I don't want his bad experience to traumatize him for life, if that makes sense.  He has always been such a sweet, loving, easygoing baby; I hate to see him fearful and panicky.  Do you have suggestions as far as things my husband and other two children can do to help him heal emotionally?

Thanks for any help you can give me.

[DrLauraMarkham]

Brackin-

What a traumatic experience for all of you! Thank goodness you got your baby the help he needed to heal physically. But as you are sensing, he now needs help to heal psychologically.

Whether we would diagnose this as actual PTSD or not, there is no question that your little guy was subject to repeated physical injury. It doesn't matter that it was done to save his life. In his mind, people were constantly, unpredictably, hurting him, while he fought to escape, to stay alive. Your presence must have been deeply soothing to him, but it still must have been confusing that even his all-powerful mommy couldn't save him from these experiences, or let them happen, or even at times assisted.

So, yes, he needs help to heal. He needs to take these upsetting, visceral memories and make sense of them. Right now, he has concluded that the world is a dangerous place, that he can be held captive inside and hurt, that strangers can randomly attack him. What he needs is to integrate his experience into his understanding, so he draws a different conclusion -- that this was a specific, unique event that ended and is over, and that he is safe in the world.

1. Help him begin to show you what happened to him and process it through play. Buy a doctor kit and start playing doctor. Take his teddy bear and give the bear shots and draw blood. Hopefully, your little guy will be fascinated. Let him give you shots and draw your blood. We all have a compulsion to act out what was done to us. That helps us process it from another perspective. Let him become the powerful doctor instead of the powerless child. If you can ham it up and act frightened -- just enough to make him giggle, not enough to scare him or make him feel like he is actually hurting you -- you will help him to giggle and let off tension about this issue. The more laughing, the better. Laughter really is healing. It lets off the same anxieties as crying.

2. Help him understand what happened. Make a book called "Goodbye Hospital: ______ Gets Better" by gluing photos with captions onto paper in a 3 ring binder, or you can laminate the book if you want. Hopefully he will read it a lot.

Begin with photos of your family, including him, being happy. Then show a photo of him looking not so happy and say, "One day, _____ felt very sick. He slept and cried and nursed." Use appropriate photos throughout the book, that he will recognize and understand. Tell the story in little captions under the photos, something like this:

" _____went to the doctor but no one could figure out what was wrong. He felt hot and sad and his body hurt. Finally Mom and Dad took _____ to the hospital. ______ did not like the hospital. Nurses had to use needles to take some blood for tests and to give him shots. That hurt! Mommy stayed with _______ all day and night. Be sure to emphasize this point with a photo of you holding him.

" _______ felt so bad. He had an IV for special medicine to make him better, but it hurt his arm. His whole body hurt! He was scared! He wanted to leave, to go outside, to say 'Goodbye Hospital!! He asked every day to go out. The doctors and nurses worked hard to help ______ 's body heal. But sometimes that hurt. Ouch!

_________'s body was strong, and the medicine helped his body heal itself. His body felt stronger. He was getting better He could go outside! Goodbye Hospital!

Mommy and Daddy took _____home to _____(siblings). He was so happy to be home. Every day his body got stronger and he felt better. Sometimes he still felt scared, but Mommy said "It's okay. You're safe. Your body is strong. You're all better. You're home with your family! Goodbye Hospital!"

Read your son this book as often as he will let you. The goal is to help him express what happened and begin to put words to it. The more he can intellectually process what happened, the more he can put it behind him rather than having it haunt him. You are giving him the story of what happened, and you will keep reading it over time so it becomes part of his childhood, a story of a little guy who successfully triumphed over adversity and got well and said "Goodbye Hospital" rather than what he feels now -- that he was a powerless victim who was held captive and tortured.

If he cries, stop reading and hold him. Say "I am right here. You're safe. You can cry now." He won't be able to express much in words, but he has a lot to tell you about this experience. He just needs you to be a witness, to listen, even when he doesn't have words for his pain and fear. He may get sweaty and red in the face and struggle or writhe in your arms, which is his way of letting his fear surface. Just keep reassuring him that he is safe now. Tell him that you will keep him safe, that you won't let anyone hurt him.

3. When his fear bubbles up, help him process it. In the hospital, your son was overwhelmed by terror. He is carrying that with him, so that when he is in unfamiliar places or around even somewhat unfamiliar people, he is afraid that he is in danger. For now, minimize those experiences to help him regain trust in you and the universe. But you do have to help him with these fears so they don't end up shrinking his world. When he panics and begins saying, "No, Mommy, no!" use that as an opportunity to help him face his fear. Move away enough (from the unfamiliar person or place) so that he is not in a panic, but stay close enough to the source of his upset that he is still in touch with his fear. (For instance, stand in the doorway between inside and outside.) Look him in the eye and invite him to tell you about his feelings: "You were scared, right?" Hold him and let him cry and reassure him that he is safe now. Let him know you understand by saying "You are saying No, Mommy" because you are scared. I will keep you safe, it's ok. You are safe in my arms. You are safe now. I won't let anyone hurt you."

When he is wakes panicked, he was probably dreaming of the hospital. Try to do the same thing. In other words, help him to cry. That is better for him than nursing, which will "stuff" his feelings. After he gets his upset out, he will either fall asleep or nurse.

When he asks to "go outside," he is telling you that he is remembering that awful feeling of being trapped in that place where strangers randomly hurt him. Listen and empathize even if he doesn't have words to tell you: "When you were at the hospital you wanted to go outside. You were hurting and scared." He might well cry at these times also. Or he might just agree, or go get his doctor kit to give you a shot.

4. Give it a happy ending. In all of these cases, after he "vents" his fear or you help him tell his story about what happened, help him to integrate this experience by giving it a meaningful ending. "You were in the hospital. You were so scared and hurting. But your body is strong. It got better! And now you are safe at home. You are with your family. Goodbye Hospital! What a good, strong body you have."

Are you making him dwell on a bad thing? No, you are helping him process those feelings so he can let them go and they won't stay in his body and drive his behavior with anxiety and phobias. Are you making him afraid of hospitals? No, he is already afraid of hospitals. You are containing his fear so that it doesn't generalize beyond hospitals, and you are making it clear that while the hospital was a scary place it helped his body get better. He needs the "Goodbye Hospital" as a way to distance himself from this experience, to leave it behind him, so the whole world doesn't become a scary place. And you are leaving him with the certainty that his body is strong, that you will keep him safe, and that he lives in a friendly universe. As Einstein said, that's one of the most important things for each of us to decide.

With your help, your son will heal. I wish you and your family every blessing.

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Thank you SO much for your insight and advice.  These are exactly the kind of ideas I was looking for and I think that putting them into action will help him heal.  I truly appreciate your taking the time to help us.