Therapeutics Advances
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. May 8, 2016; 5(2): 143-150
Published online May 8, 2016. doi: 10.5409/wjcp.v5.i2.143
Minimizing pediatric healthcare-induced anxiety and trauma
Julie L Lerwick
Julie L Lerwick, Northwest Psychological Center, Milwaukie, OR 97267, United States
Author contributions: Lerwick JL solely contributed to this work.
Conflict-of-interest statement: There is no conflict of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Julie L Lerwick, PhD, LPC, NCC, RPT, Northwest Psychological Center, 6902 SE Lake Road, Suite 202, Milwaukie, OR 97267, United States.
Telephone: +1-503-6522810 Fax: +1-503-6528553
Received: July 8, 2015
Peer-review started: July 8, 2015
First decision: July 27, 2015
Revised: August 14, 2015
Accepted: March 7, 2016
Article in press: March 9, 2016
Published online: May 8, 2016

Frequently, episodes of care such as preventive clinic visits, acute care, medical procedures, and hospitalization can be emotionally threatening and psychologically traumatizing for pediatric patients. Children are often subject to psychological trauma, demonstrated by anxiety, aggression, anger, and similar expressions of emotion, because they lack control of their environment. This sense of helplessness, coupled with fear and pain can cause children to feel powerless in healthcare settings. These emotional responses can delay important medical treatment, take more time to complete and can reduce patient satisfaction. Healthcare professionals are uniquely positioned to prevent healthcare-induced trauma and reduce healthcare-induced anxiety. This article introduces a new way to choice, agenda, resilience and emotion (CARE) for pediatric patients in the healthcare setting by implementing the four following treatment principles called the care process: (1) Choices: Offer power in a powerless environment; (2) Agenda: Let patients and families know what to expect and what is expected of them; (3) Resilience: Highlight strengths and reframe negatives; and (4) Emotional support: Recognize and normalize common fears and responses. Engaging the CARE principles helps patients and families feel empowered and mitigates, reduces, and may even ameliorate risk of anxiety and trauma responses.

Keywords: Inpatient, Ambulatory, Pediatric patient compliance, Patient experience, Pediatrics, Anxiety, Healthcare-induced trauma

Core tip: In an effort to reduce healthcare-induced distress leading to anxiety, trauma, and trauma responses in pediatric patients, this author has developed four principles in the choice, agenda, resilience and emotion (CARE) process to deliver emotionally-safe treatment to children: (1) Choices: Provide power in a powerless environment; (2) Agenda: Letting the patient and family know what to expect and what is expected of them; (3) Resilience: Start with strengths and reframe negatives; and (4) Emotions: Recognize and normalize common fears and responses. Through the process of implementing CARE, a child’s healthcare-induced distress can be minimized.