What we can do to help our kids and ourselves after a medical traumaMay 16, 2022
Medical trauma accounts for a large amount of trauma in the world.
It often goes unnoticed or dismissed because “it was just a tonsillectomy” or “it was only a couple stitches”, but the brain just isn’t wired to 'rank' trauma like that.
The body certainly doesn’t categorize our traumas as “not as bad as what Kevin went through” or “it could have been worse and we could have ended up in surgery like Janet’s kid.”
That comparative suffering thing doesn’t work ever, but especially with medical trauma. 😊
1️⃣ So that’s the first step ⬆️ ... realizing that trauma isn’t a rating system or Pain Olympics. 🏆🥇 No medals here.
What’s traumatic for you may not be for me, and what’s traumatic for me may not be for you. What we find traumatic is unique to each of us.
So have compassion on yourself and validate your child if what happened feels huge and overwhelming.
It’s ok that something relatively minor (for example not life threatening but it FELT terrifying) has upset you. That’s ok.
Be kind to yourself if you’re having flashbacks or ruminating on it. It's totally normal to feel traumatized by something others may call ‘simple’ or ‘not a big deal in the scheme of things.’ You’re not consciously deciding what to be traumatized by! Your brain overrides that and picks for you!
2️⃣ Step two is understanding the definition of trauma. Peter Levine (a guru in trauma research and trauma work) has my favorite definition of trauma: “Any situation in which you feel profoundly helpless and lose your ability to cope.” Through that lens, you can see that so many experiences we have can lead to a trauma response.
“Simple” medical procedures, dental visits, social friendship issues, marital separation, a loved one’s cancer diagnosis... lots of “normal” things can leave people traumatised because their sense of helplessness was triggered and they may have lost their ability to cope - short term or long term.
Q: So how do we know if we've been traumatized?
A: If our body exhibits a trauma response.
3️⃣ A trauma response is basically when your body goes in to Fight Flight Freeze (FFF). Sometimes it's called a stress response - it means the same thing. The body is told “Oh no! Trouble ahead! Quick! We need to FFF!” Cortisol and adrenaline are discharged rapidly to help the body mobilize : fight, flight or freeze in order to survive the threat.
4️⃣ Brain stuff 101: There is a little dude in your brain called your amygdala. (Fun fact: amygdala is Greek for ‘almond’ - because it is small and almond shaped!)
Anyway, so obviously there are a bajillion parts of the brain, but the two important ones we need to know are amygdala and cortex (aka: pre-frontal cortex). I just stick with cortex because when I’m explaining it to kids I often call them Amy and Corey to help humanize and personalize the brain 😂
So, amygdala is the oldest and most primitive part of the brain. We call it the 'lizard brain'. It's super basic and super obsessed with safety and security.
Panic attack? Thats courtesy of amygdala. Shaking, tears, rapid heart rate, shallow breathing? All amygdala. Cortisol and adrenaline running wild and feeling crazy? Amygdala again.
We call it an ‘amygdala hijack’ because the little dude is so obsessed with safety that it sometimes hijacks the show to keep us safe. It has to. Someone has to be in control and in charge upstairs right? Unfortunately, the dude who is responsible for our safety is also super primal and basic. So our physical responses to stress or trauma are from amygdala.
The cortex, however, is super sophisticated, more mature, rational and a good problem solver. It's the last part of the brain to fully develop, and the part that's responsible for forward planning, logic, reasoning, understanding consequences etc. Cortex is all thought-focused and thinking-based. Rumination, obsessive thoughts, all that annoying thinky stuff - courtesy of cortex.
Did you know that the cortex doesn’t fully develop till age 25?! This is why our kids have a hard time with emotional regulation, impulse control, sharing, patience etc. Because literally their brain isn’t fully developed to do so!
But also - with trauma - having a cortex that isn’t fully developed means the ability to process things, make sense of it, and do all that reassuring stuff like “It was an accident, it is unlikely to happen again. It’s ok amygdala, you’re safe now. It’s over ...” is hard because amygdala often overpowers cortex in trauma.
Why? Amygdala just wants us to survive. He doesn’t care about it being over and thinking “I’m safe now" - he will keep replaying the images of a situation to ensure it never happens again. What we want to do is get cortex firing as much as we can and get amygdala to relax and feel reassured.
5️⃣ Ok so that’s the brain stuff, but what does that have to do with me?
In the situation with kids and medical intervention, their brain and ours as parents will be on high alert in both areas.
Cortex will be smashing your brains with rumination and trying to plan ahead so this doesn’t happen again, re-playing the incident again and again to ensure future safety and security. I’m sure your brain has already created a highlights reel of the moment you found your child in a medical emergency, the trip to the hospital, arriving hospital etc. Little mental video snapshots are all spring from the experience.
This is all normal and it's the brain’s way of giving you a souvenir from the emotional rollercoaster so it can ensure future safety. Your brain says; THESE ARE ALL THE IMPORTANT BITS TO REMEMBER OK? SO WE DON'T EVER DO THIS AGAIN.
Amygdala will be giving you / your child physical symptoms like trembling, nausea, dizziness maybe, soreness and weird muscle spasms or muscle pain. Headaches are also common side effects from all the tension in the muscles getting ready for FFF. Weird things often happen after trauma.
Say for example, a child who gets a tooth knocked out while doing flips on the trampoline, maybe in 6 months he makes a tucking movement (like his knee getting close to his mouth again) and he may begin to cry or shake. Or maybe he accidentally bumps his mouth a year later and suddenly finds that he feels a surge of adrenaline or cortisol... he bursts into tears after a seemingly “slight” bump to his face. All of these are normal and common ways the body stores trauma and then tries to release it.
6️⃣ Why? Because trauma is stored in the body.
Yes, we have nightmares and flashbacks and mental images of trauma. But the reeeeeal vault of our trauma is the body.
We are primal beings. We forget that sometimes. Our nervous system holds it all.
So, when the traumatic event happens, the FFF response is activated, the body wants to complete the FFF response but sometimes it gets stunted or thwarted.
Examples with medical trauma:
‘I’m pinned down and can’t fight back'. 'I go into shock and my body feels paralyzed'. Or 'I am restrained or under anesthesia and can’t run away.’
All that cortisol and adrenaline gets stuck in our nervous system, wanting to get out. And sometimes in the future we can engage in a similar body movement - the same one that happened during our profound sense of helplessness - and boom - we have a panic attack or an unexplained overwhelming bout of nausea, fear, or tears.
Trauma is stored in the body and we need to help restore the body back to calm by discharging and processing the FFF response.
7️⃣ How do we discharge and process trauma stored in our body?
There are a million ways to do this ranging from trauma-informed therapy, yoga, art, exercise, running, boxing, re-connecting with our body through awareness exercises, EMDR (phenomenal and my personal fave) and a slew of other things!
Reading books to become more trauma-informed is a great place to start. Books by Peter Levine, Pat Ogden, Stephen Porges, Bruce Perry, Bessel van der Kolk, to name a few are fabulous. The Body Keeps the Score by Bessel Van Der Kolk is a must-read for those wanting to learn more about trauma.
8️⃣ But for kiddos, these are my favorite methods for helping them process trauma...
Take the example of a little boy who had his tooth knocked out on the trampoline and required dental surgery:
1) Get a small sand tray (Google 'sand tray therapy'), some figurines, a funnel, a sieve, and some stones, and create a quiet space. Explain to them that we can tell stories in the sand or we can use it to figure out how we feel. Just encourage him to play in there. It's a beautiful resource to help children regulate and process all feelings, but especially trauma (situations that don’t make sense to a little brain, and all the different sensations in his body from pain, to fear, to helplessness. It’s complex and sand tray work can help them express and organize their feelings a bit.)
2) Tell him "the story about the time he was jumping on the trampoline and his knee knocked his tooth out.”
Explain the story of what happened : “Sometimes painful things happen in life that we don’t understand until later. It makes us feel scared. Or sad. And overwhelmed. And we feel confused. That’s ok to feel all those things. I feel them too.
"There are a lot of big feelings happening right now and I want you to know you can talk to us about it anytime. Or ask us questions. Do you have any questions? You are loved. You are safe. We will get through this together ok? We can do hard things.”
That’s kinda my go-to script for navigating a scary event. For ANY age.
Even a 1-year-old. I would be narrating what’s happening in plain language, not using cutesy words, but using the same language to identify feelings and always ending with: “There are a lot of big feelings happening right now and I want you to know you can talk to me about it anytime. Or ask us questions. Do you have any questions? You are loved. You are safe. We will get through this together ok? We can do hard things.”
When a helpless situation hits, kids need to know they’re safe above all else. The feeling of helplessness and powerlessness leads us to trauma. By creating meaning out of the situation, (we learned when we do flips we have to pull our knee a bit further away from our face), naming his emotions, and validating how he feels, we are helping him name, understand and process his experience. Which is empowering and helpful to his healing heart.
The more we run narrative scripts like this (“this is what happened, this is how you felt, the doctors helped us, you’re safe now, I’m with you, we will get through this, you’re not alone”) the less likely they will be traumatized OR the less it will impact their nervous system.
And they'll also know you're all a team.
That is powerful for kids. Knowing 'I'm not alone'.
It might sound obvious and I apologize if I’m sounding preachy - I've just seen so many kiddos come through my office who have thought an accident or trauma was their fault, or they were somehow responsible.
Maybe their parents shamed them after the incident? “Why did you do that? How could you be so stupid?” Or maybe they blamed them. “Now that you’ve done this we have to go to the hospital”.
Their innocent magical thinking can sometimes make them believe things like “it’s my fault the dog died because I didn’t play with it enough” or “my mom was crying because she was mad at me”.
Their precious hearts often create their own narrative to scary stories and so we ideally intervene and TELL them the ‘but we are safe now’ honest narrative so they don’t fill in the gaps with fears or shame.
You can then ask them daily for a while and then taper off, “do you want to hear the story about the trampoline and your tooth?” (This is again true for ANY age. Even a 1-year-old, you will recite the same 3-5 sentences of what happened and always ending with ‘it’s over and you’re safe now. Mommy is with you.’
And they will sometimes say yes and sometimes no when you ask them ‘do you want to hear the story again?’ If they’re not sure, just say I’ll tell it anyway and you can tell me to stop anytime.
And if you also tell him, “you know, you can ask mama to tell you the trampoline tooth story anytime ok?”
Children find it SOOOO reassuring to hear ‘what happened’. Even good stories. Any kind of big experience or big moment explained. Feelings labeled. The story is told in a complete narrative, for example, “The trampoline flipping practice was so fun and you were excited.
"You were practicing and working so hard. You are learning how to do so many things with your body and it’s so cool! But sometimes as we learn new things we have accidents along the way. And that day your knee and tooth had an accident. And you didn’t understand what happened right away. And we were all so worried, scared and we cried. And mama came outside and we went and saw the dentist and he fixed your tooth. And mama was crying because it made her sad to see you in so much pain.
"I was sad for your tooth too. And it was a long time sitting in the chair. And it hurt a lot. Your mouth and head are still very sore. It’s ok if you still feel like you want to cry about it. That’s normal. That’s your body’s way of healing. That’s your body’s way of releasing alllllll those big feelings that came out when it happened.”
Please try to avoid labels of being 'brave' or 'tough'. Use ‘brave’ labels for jumping off the diving board or trying a new food, NOT around medical intervention or things like separation anxiety - moments where being upset and ‘not brave’ is totally appropriate and a normal brain response (to cry and protest.)
Why? Because we don’t want to teach our children that not crying is 'brave' or that suppressing emotion is praised, which is what we inadvertently do when our kids go through pain or medical trauma.
Saying things like “you waited so patiently in the chair while the dentist worked” or “you cried when it hurt and you let your feelings out as you needed to” is more ideal to say than “you were brave” - does that make sense?
Also - if other kids or siblings were around when it all went down you can do the same “Do you want me to tell you the story of Ryan’s tooth?" But really, for anyone (even ourselves!), I would tell them the story too. It helps kids of all ages to process.
Children I’ve worked with have sometimes asked their parents to tell them ‘the trampoline tooth story’ years later. Children process through play and imagination and so providing a story that helps him make sense of it, that is delivered by you, is an awesome way to help them work through their feelings and not bottle them up.
Also: gear up for behavior (from the child or the others) that may not make sense. All behavior is communication so it’s very possible that they will regress (‘mama can you feed me?’ Or ‘I need help putting my shoes on’) or have more tantrums or angry outbursts.
❌❌Anger after a medical incident is super normal!!❌❌
Rage or irritability is normal - it’s the fight response in action! - and ideally it's met with loving compassion. Boundaries are ok (“I won’t let you bite me or hit me, but I can see you’re angry. I’m here.”)
Their brain took over and implemented the fight / flight response and the rage is a by-product of that!
They are trying to get connection / feel safe / reassured and may seek it out in surprising ways.
All are normal ways that our little people process their big feelings❤️❤️❤️
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