4 year old traumatised after hospital stay, who do I call?

[pinkelephant22]

I don’t know whether i need to get in contact with GP, health visitor, let it all simmer down or just keep her completely away from health professionals.

My 4 year old had her tonsils out last Friday, discharged home. Was absolutely fine apart from the obvious sore throat, pain management etc but was drinking plenty of water eating. Sunday night she coughed up a small blood clot so I thought I better take her even though it says 2 spoonfuls or more. Walked through the doors of A&E and she threw up an entire sick bowl of blood, plum sized clots. So she was obviously terrified but the doctors needed to act quickly hence subsequent restraint to get medicine in to stop bleeding fluids etc. She was shaking when she finally went to sleep stable. Transferred to a different hospital via ambulance who then pricked her again for blood sugars. Woke up screaming. At new hospital needed new cannula involving another restraint and multiple attempts. Got to ward needed bloods another restraint. Was then ready for discharge by Tuesday and she then just upon almost leaving started to wee what looked like pure blood. She was then readmitted under a different team, new line put in old one taken out. Restrained - Settled. More bloods, more restraints - she has become necrotic they said it’s her little body’s response to trauma and her body was firing our protein so it’s an inflammation of something in her kidneys. We finally got home this evening and will see a specialist next week to make sure medicines have treated if not she’ll need now further investigations.

At home all I did was attempt to brush her teeth, she was screaming “stop touching me” for about half an hour and then hid behind her dolls house shaking 🥺🥺 it took 3 hours to calm her down and she made herself sick.

shes absolutely traumatised, we both are. Before the tonsils we wouldn’t go more than 3 weeks without her getting sick. They said her tonsils were grade 3 even when she wasn’t sick. But I completely blame myself. We went in for her tonsils out and came out with a kidney issue and a petrified little girl.

do I address this now via GP if they can access a therapy for her or shall I just keep her away from healthcare, considering she has to go back on Wednesday also!

You’ve had lots of good advice, I’m sorry you’re having such a hard time. I would definitely phone the department you have the appointment with next week & ask them what is likely to happen at the appointment so you can prepare your girl a bit. They may just want a wee sample (you could take one with you ideally from that morning, means she won’t have to perform under pressure you can get the things from your GP or pharmacy) they might well want to take her height, weight and blood pressure.
you could try a little visit to the waiting area of the hospital just to look, so it’s not totally new. They may be able to put you in touch with play therapists.
I wouldn’t recommend operation ouch, I think that’s for slightly older kids, or at least I would watch before you watch with her.
dr Ranj (Get well soon I think it’s called) has lots of videos for lots and lots of different things including BP, bloods, cannulas, x ray.
our local urology/renal team has videos about some of the procedures they do so you can watch with your child to prepare them.

Poor little thing. Does she like role play type playing? If so I would be tempted to get her to brush teddies hair and teeth as part of the game, or do yours just to help her get used to those things now with no pressure on her. Even if you just have them out as part of the normal play for her to approach.

for ds playing doctors and hospitals helped a lot but maybe not this soon. We had a little medical box including things like the bracelets from his admissions and he role played a lot through his toys.

if she likes drawing then that may help too often in free art sessions children will draw things that are worrying them and then that can help.

i would try to be discrete as possible with it all though as you don’t want to turn it into a bigger thing than it is.

also make sure you look after yourself ifs been traumatic for you too not just her.

I agree. I have needle phobia but it's not the pain, it's the thought of a foreign object in me, like it might break off and get left in my body (not rational), or wiggle around and leave a big bruise (rational).

Numbing cream just draws out the process, sometimes just getting it done quicker is better.

Anyway as many pp have pointed out, the dd was in an emergency situation and the medical staff had to act quickly.

Part of the dd's fear could well just be knowing that she was in an emergency situation. The body fills with fear, it's one of the listed signs of sepsis for example "a sense of overwhelming doom". That's a trauma that takes a while to get over, and not something that anyone could have mitigated with numbing cream or soothing words.

If they want bloods I would ask if they can be done on a different day by the phleb team.

I don’t know about the uk but where I live you are entitled to a meeting with the doctor looking after your child in the hospital after a traumatic event like this to talk it through. This might be helpful for you. The hospital may offer some play therapy for your child following this .

For bloods we actively avoid the numbing cream because that wait for DS adds to the tension and makes him more anxious so it becomes more of a thing. His care plan states to use the freeze spray because that works instantly so there is no extra waiting.

I'm so sorry, OP. What a traumatic time you and your DD have been through

We were in a car crash when my DS was 3. Not a serious one, thankfully, but still traumatic for us both. My DS spent the next few days bashing his toy cars together, phoning for policemen to come and help and taking his cars to the garage. It gave us an opportunity to talk about what had happened and it seemed to help him settle down

Does your DD play a lot with dollies and/or soft toys? I'm just wondering whether she would be able to use them to reenact what has happened to her?

Hoping things will settle down well for you both

I don’t think the OP has ever wondered if she needed to complain.
She asked how to handle it seeing how traumatised her dd is. As if therapy, seeing the GP etc…
What the OP describes could easily translates as a PTSD response later on. And I don’t think that ‘cuddles’ will be enough (necessary ofc!!)

Are you able to access any play therapists? My son had open heart surgery at age 6, and we used the play therapists to help him through some traumatic times. The specialist may be able to refer you

Remember to take care of yourself as well. Dealing with a traumatic injury as a parent has a toll on you.

I still get flashbacks in certain situations to my daughter screening in pain when she badly damaged her ankle, that was then paralysed for 3 months so a significant injury. And that was 12 years ago now.

When it is your child all your energy goes to support them, but, as the saying goes, you can’t pour from an empty cup. Forgive yourself - you were acting in her best interests - even though that made her scream.

Interestingly, my son has a big response to doctors (it is on his notes that his heart rate is fine, it is only 120 when he seems a dr) but my daughter is absolutely fine with seeing them. He is 20 and no know traumatic experience with drs so who knows where that can come from.

I agree with the above, take it at her pace. Let her brush her own teeth, maybe get her a special toothbrush and one for her favourite toy.

https://www.pylones.com/en/toothbrush-holder/2609-toothbrush-holder-unicornsmile.html

And I am truly sorry you have had poor treatment from nurses.
But my comment was purely about the child presenting at a&e vomiting copious amounts of blood so a true emergency. And then urinating blood. Another emergency..
As the OP has said she wants help for her child's trauma going forward.. she's actually said that the medical staff were kind.
Again I am sorry for your experiences.

@pinkelephant22 I agree with @LastInFirstOut

For now, I’d stop you brushing her teeth (get an electric toothbrush for her if need be). Let her have a bath and don’t wash her.
Esp the teeth where it can be uncomfortable for them in the first place.

Yes to plenty of cuddles, watching cartoons together, talk about what happened.

I would contact the hospital ahead of time for her next visit and explain what happened. Ask for anything they can put in place, including having a phlebotomist doing her bloods rather than any nurse. Theyre just not quite a good (not an attack on nurses. It’s just that phlebotomists and anaesthesiologists are both excellent at it due to their speciality).

Then in a few weeks, review how she is and how the whole thing has affected her. I’d look for a play therapist if she has nightmares, start to develop random symptoms like tummy aches or headaches or just doesn’t behave like herself oyswim

Poor wee thing. She's probably utterly exhausted as well. At this age, even the small things become massive when they are tired.

She's had months of being unwell and then a big physical recovery, disturbed sleep in hospital etc etc. It's a lot even without the trauma.

I agree with the advice to just try a let her settle in the short term. Perhaps explain to her that we need to clean our teeth every day and change our underwear (just so she understands in advance what will happen so its not he surprise element but not lots). I'd make sure she does it so it does build into a big thing but equally, I'd let standards slide.

A week of her doing a not quite so thorough job cleaning her teeth herself will be okay. Same with having a bath etc. If she wants to sit in a paddling pool it will do the same job but is playing.

Take the stress out of as much as you can and your plan to contact the day ward in advance is good. Hope she's soon on the mend.

Try reading the words. I woke up and witnessed it. It was not a life threatening situation. There was no need to handle my child roughly and under no circumstances was I going to tolerate it.

My DD (13 at the time but autistic) had exactly the same experience of a tonsillectomy and a second additional surgery to do whatever it is they do when the wounds open and blood clots are formed. It is scary - but it is also very common. It’s not a negligence thing but I do think they need to be very clear that this risk is not uncommon. It is a real shame she was given this operation so young (my daughter had to hav3 14 bouts of tonsillitis over 3 years and miss s significant number of days of school before they would agree to refer her, so I do wonder whether they were a little to quick to take this route for your DD.)

What you need to do is stop framing this as traumatic and feeding the cycle of fear. You need to play it down and not show her your own distress. As a parent is is normal to feel protective and anxious and powerless when these things happen to our children, but you cannot allow that to seep into your relationship so that she picks this up. You have to mask it and regulate your emotional responses, even if that means bawling your eyes out when they go to bed to get it out of your system.

Tell her she has been very brave but that sometimes the body doesn’t do what the doctors expect and they have to go in and mend things a second time - but isn’t she marvellous and such a big girl for managing it so well. If she doesn’t brush her teeth properly for a few weeks, and doesn’t want your physical intervention, don’t force it.

As she recovers, distract her - cinema, trips to the park or petting zoos, anything that takes discussion and focus off the tonsillectomy - so that the memory recedes. And it will. At her age she has lots of opportunities to make new memories and you have a whole summer to make some now. Honestly, my DD has largely forgotten all about it now - she remembers the events, but the emotions/fear attached to them faded very quickly as life moved on. It will for your daughter.

However, if there is any residual effects (a fear of hospitals etc), she can have EMDR/hypnotherapy/counselling by therapists specially trained to work with children. You can look into that down the line. For now, just spoil her a bit.

Your experience , while unfortunate, has nothing to do with this situation. Even the kindest nurse in the world may need to restrain a child to put in a needle during a tonsillar bleed which is a life threatening emergency situation. It’s very clear from your posts that you really don’t have a clue .

My comments were in response to another nurse saying that mention of a nurse being unkind was offensive. Some nurses are unkind, even children's ones.

My heart goes out to the op and her dd. How many tonsillectomies result in complications like this? Depending on the number, perhaps protocols regarding length of hospital stay need to be reviewed so that such complications can be managed befire they become life threatening.

This ⬆️ unfortunately scary things can happen during emergencies in hospital. Your job is to help her get through it as calmly as possible.

Of course some nurses are unkind but also some posters will take every opportunity to turn a thread into a nurse bashing , especially people who clearly have zero knowledge of children’s nursing

She’s actually been a really brave girl - lots of cuddles, especially with her favourite soft toy, reassurances and things she likes to do to take her mind off it all. Time is a healer. I’m sure you’ll get lots of good advice on MN.

That was me. And I was offended that you used the word unkind about nurses/medical staff who were reacting to a life and death situation.
People commenting on your posts are reacting to the fact you are telling us your (perfectly reasonable complaint) about the treatment of your child.. but it not in the same emergency situation.
Please don't take my comment out of the context it was written about..please.

And as I have said, the first instance was life threatening, subsequently this was not the case.

I try quite hard to read all the words and points.

Thank you.. although I was a neonatal nurse (and had a complaint that I was handling a baby roughly.. I wasn't I can assure you.. I was turning over the 2lb very unwell baby as he was crashing.. and I can see how it would have looked to the traumatized parents)
All I've read in the OP is that what should have been a straight forward tonsillectomy turned into an emergency on multiple occasions causing multiple restraints to keep this child from bleeding to death or multiple organ failure. Unfortunately this could not be predicted and probably no time for play specialist to intervene? OpPs DC unfortunately then had a cascade of horrible procedures that just needed to be done..
And whilst I'm very aware that there are definitely some not very kind nurses out there.. OP has said that wasn't the case here.

I think age is a vital factor here. A child of 4 takes their world view from the adults around them. So I wouldn't be saying 'you must have been so scared, how did you feel?', but if she mentions it then listen and give a helpful response. So if she says that they held her down, for example, you could say 'when people are very poorly the doctors have to make sure they get their medicine quickly.' She'll process it all over time.

I think it's also important to remember that your experience and trauma isn't the same as hers. You were viewing the situation as a parent who was helpless and afraid, knowing that your child was really sick and that you couldn't fix it. Her experience with a four year old's world view would be very different. She may not, for example, have been thinking she might die, or that she was losing too much blood, etc. She was most likely just thinking that she felt really unwell and scared.

I think you need to just take some time to let your adrenaline fade. You've been through a lot.

Not even just bleeding out, potentially bleeding out into their airway. The kindest thing to do is treat the child asap

Your poor DD OP. This sounds very traumatic, most adults would be traumatised by that experience let alone a 4yo. Her response is completely normal. Personally at this stage I would hold off on speaking to the GP and just give her a bit of time. Don't worry about her teeth right now, see if she will brush her own or even just wipe them with a cloth. Her teeth will survive a few days without being brushed

It would be a good idea to seek some support from the GP in the future, but right now I think I would give her some time away from medical care. To see she's safe and she's home, she's not going to be restrained again. Lots of cuddles if she wants them, she's in control.

You havent done anything wrong, she needed the procedure as she was clearly really unwell before, and unfortunately had a serious complication. Its no ones fault this has happened, and the Dr's acted quickly to prevent further harm to your DD. You mustn't blame yourself