Thursday, 11 January 2007

A case of post-traumatic stress in a five-month-old baby

Babies can experience post-traumatic stress disorder (PTSD) just as older children and adults can, reports Aletha Solter, a former student of Jean Piaget.

Solter describes the case of Michael, a five-month-old who showed signs of traumatic stress after a three-day hospital stay for surgery to correct the shape of his head. Babies can’t meet the usual adult criteria for PTSD, which relies on verbal reports of symptoms. But Solter says that after returning home, Michael cried more, experienced night terrors, displayed a regression in his motor skills (he stopped rolling from his back to his stomach as he had previously learned to do), he displayed terror when lying on his back, and had become fearful of strangers. “The implication is that surgery followed by a fairly short hospital stay can be emotionally traumatising to an infant”, Solter said.

Solter prescribed ‘flooding’, a behaviourist term to describe exposing someone to that which they find frightening, until their terror subsides as what’s feared fails to materialise. In this case, the baby was left lying on his back to scream to exhaustion, while his father stayed close by offering comfort. After about 20 minutes Michael calmed down and from that point on he was far happier lying on his back. Occasionally lying on his back again triggered terror in Michael, in which case his parents left him on his back, but stayed close, offering comfort. Gradually Michael’s other problems reduced too and a year later all was well again. However, as Solter acknowledges, this is a single case study, so there’s no evidence Michael would have remained traumatised had the flooding technique not been used.

Flooding should only be used if the trauma is very specific and relatively minor, Solter advises, otherwise gradual desensitisation is recommended. And she warns that a traumatised infant should never be exposed to a situation that an un-traumatised baby would resist.

“It would be useful for paediatric surgeons to warn parents of the possible emotional and behaviour sequelae in their infants following surgery”, Solter concludes.
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Solter, A. (2007). A case study of traumatic stress disorder in a five-month-old infant following surgery. Infant Mental Health Journal, 28, 76-96.

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.

10 comments:

  1. Kevin5:19 pm

    This is a piece of interesting research.. in theory but i have some difficulty with excepting that this type of expereince leads a child to have PTSD. As the authors indicate infants of tbhis age cannot forefill the more verbal criteria perscribed for adults with PTSD. In this case then how can we be sure that Micheal's problems were not the result of pain after sugery.. or related to his condition prior to operation?

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  2. I have an 8 year old child that underwent similar surgery at 10 weeks, 8 months and 23 months. He displayed similar behaviours as an infant and was subsequently diagnosed with autism.I have only recently began to appreciate that many of his symptoms and behaviours may be attributed to PTSD. His extreme fear associated with medical/institutional environments,distrust of adults, hypervigilance and anxiety in new environments, negative reactions to children crying, extreme negative reactions to sounds associated with sawing and drilling all indicate memories of his experience which he has until recently been able to verbalise due to language delay. What really has indicated that PTSD could be a contributor to his condition is his recent role-play in drama therapy in which he uses puppets to express his fear about doctors (his language has improved over the last 12 months), and finding him watching and weeping over a hospital reality television program that was showing an operation.

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  3. Anonymous3:48 pm

    I have a daughter who at 1 month had a partial colon resection & colostomy. At 1 1/2 years she had another to join her colon. After that, her surgeon "dilated" her lower colon per rectum to break scar tissue. He did not use graduated size dilators, but used a large size every time and twisted it around to "break" the adhesions. My daughter would scream and cry so hard she burst blood vessels around her eyes. After that her entire personality changed. She hated to be covered or restrained, and it took 2 people to change her diapers - one to hold her down & one to change her. To this day (she's 27) she does not like to be hugged or restrained in any way. She has also been very angry and cold at times. Could this be PTSD?

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  4. Very interesting research and findings indeed, something of which many folks would not expect I would think.

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  5. my daughter might have this problem i am just not sure but she just turned 7 months old and it really worrie's me it really does because to me it is very serious because i had the same problem's when i was little i hope my daugther will be ok she is not rolling over she is not trying to sit up she dont hold her own bottle i had all of these's problems and much more and now she has them i hope my daughter will be ok i really do is this hard to cure but its hard for me to focus because of this its making me stress alot i hope she will be ok:(:(:(:(:(

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  6. Anonymous11:14 pm

    I searched for this topic to see if anyone else had experienced this in their baby. My 6month old is a week out of an 11 day hospital stay (I was with her during the whole thing). It started with th ER & ended with a diagnosis & treatment for Kawasaki disease, but the process to get there involved multiple blood tests in both arms & both legs, iv lines put in & out, feeding tubes put down her nose, ENT's putting tools down her nose & throat, ECG's, three X-rays, 2 ultrasounds & an echocardiogram, machines attached to iv's beeping every 2/3hours (if not more) to deliver or flush the lines, which followed with a new nurse almost three times daily to come in & poke & prod, a heart rate monitor which alarmed every time her oxygen levels fell or rate went up over 200 (which was every hour or so for the entire 9 data prior to treatment for Kawasaki). And then there's the lumbar puncture test ;(. Poor & uncomfortable furniture for nursing & changing an infant, I sufficiently healthy food to keep me going as her carer.

    We have escaped to a coast location to hear waves & silence & be relaxed as a family but our little girl is terrified to be on her own, screams when put on her back (is not as strong as before the event so not as independently sitting or rolling) for changing or simply dressing or playing, terrified of strangers, won't stay asleep in her cot & has night terrors & startles awake, we are now sleeping with her as it makes us so sad to hear her distress.

    We were so scared in hospital that our little girl would not return, she has but she has collected so much baggage from this experience I fear for long term effects.

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  7. Anonymous11:45 am

    I was very interested to read the above experiences. My little boy is now 10 months but underwent open heart surgery at 4 months old. He is not crawling yet and hates being placed on his tummy. I have been placing him with a childminder over the last month to ease him in for my return to work but this has not been successful, he was getting worse instead of better becoming so distressed that he would not eat. I was wondering if this could be linked to his stressful time as prior to putting him to the childminder his hospital stay is the only other time I have had to be away from him as I was not allowed to stay in intensive care or the high dependency unit after his op?...

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    Replies
    1. Anonymous12:17 pm

      I also meant to say his sleep patter has now completely changed. Up till January I could put him in his cot awake at 8pm, he would send himself off to sleep quite happily and sleep through till 7.30 am. Since January he wakes frequently through the night screaming and a cuddle will not always sooth him straight away, though he is screaming his eyes are still closed, are these night terrors. Had put down to teething initially but really am beginning to wonder if more to it especially now with such distress at going to a childminder. In her 8 years of childcare she has never come across a baby who was this extreme. Needless to say now not returning to work as can't see him this way. At home through the day he is a happy laughing boy who hardly ever cries, seems only to be through night or when left.

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    2. Anonymous7:10 am

      I had surgery when I was just a few days old and my life has always been shit because of it. Beware, parents !

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  8. My daughter experienced trauma at 6months when her father (not in right mind and I later found had taken street drugs) tried to snatch and take off with her one night and I had to fight to keep her safe. Up until this point, she slept soundly and peacefully all night. She has not slept through the night since. Its been nearly 8 months. The nights for following 3-4,months were as if she was having night terrors. Happy baby when awake, but when she was in between sleep and awake, she would freak out and be unconsolable. Trying to throw herself out of my arms, arching back, hitting, scratching my face, pulling my hair, screaming and crying. Only thing that would stop her is nursing or waking her up all the way. Once awake, even at 3am, she would be all smiles and want to play. It was terrifing to see her act that way and broke my heart that she didn't feel safe or peaceful at night anymore. She lost her ability to self sooth immediately after traumatic event (stopped sucking thumb, which she used to do all the time before), nursing became the only way to sooth her and then she wanted to nurse all night long. The only time she would sleep good was when sun started coming up until about 8-9am. (Event happened at night around her bed time, so I think she attributes night with feelings of anxiety) I have kept her father away for several months to protect her, but the damage was already done. I have tried EVERYTHING to get her back to a normal sleep schedule. She is seeing a pediatric sleep disorder doctor and she has improved, only wakes 2-4 times a night at 13.5 months old and I can usually get her back to sleep with in 10-30mins), where she used to wake 8-12+ times a night and sometimes take 2hrs to get to sleep. Its still very difficult without getting sound sleep, haven't slept good in nearly 8 months. My heart goes out to all suffering children and their parents who are trying to help their child through this difficulty. Sleep deprivation if very difficult. It does get better, but in babysteps and takes a lot of patients. Blessings to you all!

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