Abstract
Psychopathology in parents and children is increased after Paediatric Intensive Care Unit (PICU) admission; few studies have evaluated interventions to reduce this. Objective. Evaluation of the feasibility of setting up a joint paediatric and psychiatric follow-up clinic for families after PICU discharge. Design. Feasibility study offering joint follow-up with a consultant paediatric intensivist and child and adolescent psychiatrist. Setting. Paediatric outpatient clinic in a university teaching hospital with a PICU. Patients. Children and their families discharged from PICU. Interventions. Outpatient appointment focussing on physical and psychological health; psychoeducation about emotional and behavioural difficulties occurring after PICU discharge, advice for parents about supporting their child’s psychological recovery, screening for more severe psychiatric disorders, and provision of a leaflet outlining possible difficulties and management strategies. Measurements. Attendance, content of discussion, psychiatric questionnaires, and family feedback. Main Results. It proved feasible to set up follow-up appointments to address physical and psychological health concerns; 4/12(33%) eligible families attended. Children and mothers who attended all reported child difficulties including sleep disturbance, increased anxiety, and PTSD symptoms in children and parents. Conclusions. Follow-up clinics after PICU discharge are feasible to set up; take-up is poor but families attending report psychopathology which may be addressed through the intervention.
Highlights
There is accumulating evidence of increased risk of psychopathology, but not exclusively posttraumatic stress disorder (PTSD), in children and parents following Paediatric Intensive Care Unit (PICU) admission [1,2,3,4,5,6]
The meeting with the child psychiatrist included imparting information about emotional and behavioural problems that may occur after PICU admission; simple advice about managing psychological symptoms, such as gradually exposing children to anxiety-provoking situations associated with the admission that they may be trying to avoid, parents maintaining firm boundaries with regard to their child’s behavior, and keeping regular routines at home, for example, around bedtime; providing an opportunity to identify more severe psychiatric problems through history and clinical assessment and facilitating appropriate referral to local child and adolescent mental health services (CAMHS) if appropriate; families were given a leaflet about possible psychiatric presentations and management strategies
All attending mothers reported child difficulties including sleep disturbance, increased anxiety, and PTSD symptoms in both children and parents. This is in-keeping with the PICU follow-up intervention by Colville et al [10] and with studies which have documented high levels of psychiatric symptoms in children and parents following critical illness [1,2,3,4,5,6]
Summary
There is accumulating evidence of increased risk of psychopathology, but not exclusively posttraumatic stress disorder (PTSD), in children and parents following PICU admission [1,2,3,4,5,6]. Mothers favour follow-up by the PICU team to talk through the admission and believe that this may be psychologically beneficial [11]. An American randomised controlled study demonstrated the effectiveness of a combination of psychoeducation for mothers during the child’s admission and parental activities with their children to help them make sense of their experience, in improving maternal functioning and emotional wellbeing and reducing child adjustment problems/behavioural difficulties a year after discharge [12]. The findings must be interpreted in the context of over 50% attrition
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