Paeds Vivas · professional-practice-and-evidence
Trauma-informed paediatric care — branching viva
Viva on the SAMHSA trauma-informed care framework, the toxic-stress mechanism, ACE screening, and bedside application in paediatrics.
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Target exams
RACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
ED: a six-year-old is brought in after a witnessed domestic violence incident; the child is hypervigilant and recoils when staff approach; the mother has limited English and appears frightened; a routine cannula is needed for blood tests.
Opening (candidate)
I would approach this child using universal trauma precautions — assuming trauma is present given the domestic violence context. I would create a calm space, bring the mother close, use a trained interpreter rather than the child or a family member, explain each step before acting, and avoid forcing the cannula while the child is hypervigilant. My goal is to recognise the stress response, respond with safety and choice, and resist re-traumatising the child through restraint or powerlessness. [10] [11]
References6ShowHide
- [1]Felitti VJ Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American journal of preventive medicine, 1998.PMID 9635069
- [2]Shonkoff JP The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 2012.PMID 22201156
- [7]Kerker BD Do Pediatricians Ask About Adverse Childhood Experiences in Pediatric Primary Care? Academic pediatrics, 2016.PMID 26530850
- [10]Forkey H Trauma-Informed Care. Pediatrics, 2021.PMID 34312292
- [11]Goddard A Trauma-informed care for the pediatric nurse. Journal of pediatric nursing, 2022.PMID 34798581
- [13]Masten AS Ordinary magic. Resilience processes in development. American psychologist, 2001.PMID 11315249