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PACEs in Medical Schools

My son was hospitalized and now he has PTSD

 

“Grant, do you remember when you were in the hospital?” “Yes… they came to take the blood and I turned into a werewolf.”

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It happened quickly. A year ago my three year old had a collarbone fracture, it became infected and within 24 hours the situation was emergent. A week long hospital stay, one month with a PICC line and two months on oral antibiotics. Finally, the labs finally came back normal. The X-Ray was clean. Gillette Children’s Hospital closed our case. But the healing wasn’t over. It had just begun.

In my personal life, I am a mom trying to navigate parenting a child with PTSD. In my professional life, I am an elementary school teacher and trainer for trauma responsive approaches to nervous system regulation. (I know, odd coincidence).

I share my story to empower parents in similar situations. To create a framework of understanding for teachers. To normalize the conversation around trauma. Grant gave me permission to share his story, to help others. When we learn about the brain, we move out of shame.

Identifying the Issue

Grant is a loving, silly, joyful four year old. He is normally very happy.

Then, something will trigger the response. Sometimes I can see it coming. Sometimes I can’t. He will crumple up, grab his shoulder and scream “Owww” in pain. He will thrash on the floor. If I try to comfort him, he will hit and spit and kick. It is like someone flipped a switch.

I knew something wasn’t right. We called them fits. We thought he was overly emotional.

The thing is, it’s not emotion. It’s trauma.

Diagnosing the Trauma

When Grant was in the hospital, he was held down and suffered through multiple IV insertions and blood draws. Everything in his system was telling him to fight the danger. Protect the body. But he couldn’t. This unresolved cycle of the stress response is what created the trauma.

Now, one year later, Grant’s body still has a spontaneous protective mechanism. The amygdala says, “Remember when you were hurt? Quick, do what you can to escape the pain!” The fascinating component of his trauma response is that his collarbone, long healed, actually relives and experiences the pain. The trauma resides in his nervous system, not in the hospital. The body remembers.

The wonderful (and terrifying) part is that if the trauma cycle can’t be completed, the body will keep trying. It will never give up. The trauma responses are indeed protective, not defective.

Once we received the diagnosis of post-traumatic stress disorder, I knew it was going to be a long road ahead. However, I also felt relief. I know the research. We now know about neuroplasticity — the brain can change.

Addressing the Trauma

Our treatment plan addresses all areas of the brain. A model of the brain can be divided into three parts. The upper brain provides executive functioning, the middle brain creates emotional connections and the lower brain is the survival center.

Upper Brain:

There is cognitive work that can help heal trauma. Our therapist uses play therapy and social stories to build Grant’s understanding of the event. We are able to put his fears in context. Fear of needles, fear of hospitals, fear of being held down. However, this is only the tip of the iceberg.

Middle Brain:

Our therapy model includes emphasis on co-regulation and secure attached relationships using the Conscious Discipline model as a framework. We are working on reading Grant’s cues and figuring out how to best respond. Less language, consensual touch and open body language are our tools for connection.

Lower Brain:

This is where the magic happens. We need to reset Grant’s nervous system. No small task.

It always amazes me that when I pay attention, the universe provides exactly what I need. For my job, coincidently, I have been part of a team developing Move Mindfully® products for Early Childhood. Our family beta-tested the products featuring yoga-based movement and breathwork. The results are amazing. I can see his nervous system unwind before my eyes.

We soothe the lower brain with daily activities like drawing and music. Spending time in nature is incredibly theraputic. We also allow the “fight” response to release in taekwondo class. I feel like a conductor, trying to cue up the right rhythm of calming and releasing activities to meet the needs of the body.

Trauma Responsive Parenting

Let me start by saying, it’s complicated. There is no one answer. Trauma manifests itself differently in each individual and Grant’s experience is not representative of all PTSD cases. However, here is what I know for sure. No matter the size of the carrot or stick, rewards and punishments do not impact trauma responses. Let me say that again.

Rewards and punishments do not impact trauma responses.

Think your child is being manipulative? Nope. That would be the upper brain. Manipulation is a plan. Trauma is lower brain. Survival. Put your hand on a hot stove. Did you have to make a plan to pull it away? Would you pull it away faster if I gave you ice cream?

A great one liner our therapist gave us is, “I mean what I say, so you know what to expect.” Kids with trauma shouldn’t have a free pass to do as they please. They need boundaries, firm boundaries, probably more than others. But, let’s be real. Even with all of the above interventions, the trauma response still occurs.

However, when an episode does happen and the chair gets thrown or I get hit, “consequences” need to repair, not shame. Grant already thinks of himself as a “werewolf”. Missing out on the party, taking away a special toy, only drives him further down the shame spiral. Trying to process through “why” he did it, or what he would do differently next time, or even asking him to apologize can be counterproductive and actually harmful to healing.

Yep. That was a hard one for me.

His “consequences” are focused on regulating activities that strengthen relationship, like yoga. It’s a bit of a paradigm shift from, no T.V. for a week.

We will make it to the other side, one day at a time. I have cried and screamed. Some days are hard, but I always find my way back. If this story resonates with you, know that you are not alone. Please reach out. I’d love to connect.

Stephanie Kennelly

stephanie.kennelly@gmail.com

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