Receiving health care can be stressful/traumatic, ACEs

Matt, I think you are spot on!  Interestingly, this is the 3rd time this week that this issue has come up in conversation. Even outside of the intensity of an ICU setting - when a trusting relationship is not established with a healthcare provider - being asked difficult questions can be traumatizing or retraumatizing.  The importance of patience voice was a recurring theme across all the discussions. Patient voice needs to be at the center of trauma informed practices. Utilizing universal precautions ensures that all patients (and staff) are treated in a way that supports their autonomy and recognizes that lived experiences shape who we are and who we become. Thanks for bringing up such an important topic! Karen

An interesting question, to be sure! Using Karen's point of a trusting relationship and patient voice, I think that there might be a shift in culture because as a child, was I not there really as a commodity? The Doc didn't ever address me, he addressed my mom. She talked about me, but never to me. Never was my fear addressed until it proved resistant, and then some level of force was used. Or in the case of circumcisions, a paralytic. No pain killer. In infancy and childhood then, yes, there can be that experience, but being assumed as a "trusting" relationship, we discount the patient voice and experience and I would surmise that little research is conducted at all on this issue.

Somewhat relative is the fact that the #3 killer in the USA is medical error, John Hopkins reported. Yet that never shows up in official data. Why? One reason is underlying assumptions, such as mentioned above. Another could the pedastalizing of medical professions/als that we do in the US, and a third might be the cost of doing business. The data is therefore not reported. I think we see this in the current pandemic.

Hi Matt,

I just spent some time on pub med and gathered a list of articles, which helps with my own research interests in the role of early adversity as a risk factor for chronic illness (I write about the science on my blog Chronic Illness Trauma Studies).

I'm attaching some articles I found.

Included is a short list with some of the 9 most relevant articles that includes abstracts and links. These include a journal article I published this summer on the role of adverse babyhood experiences (ABEs), a term I've coined for effects of prenatal and perinatal events, including complications for the baby during and after birth until the 3rd birthday. ABEs include incubator care, hospitalization, invasive medical procedures, circumcision. I also pull together research on how these early events are risk factors for later effects of trauma (similar to ACEs) and also how events that are potentially traumatic for the mother also impact the baby, to also influence outcomes for both. I've attached a copy of my journal article.

I am also attaching a full list of 60 articles I found. I haven't read them and some will be more relevant than others. I can send you the list with the abstracts if you like.

Your question also helped me discover a national group that focuses on prevention of trauma in medical settings:

Take a look here:

cpts@email.chop.edu

The National Child Traumatic Stress Network

https://www.nctsn.org/what-is-...types/medical-trauma

https://www.nctsn.org/sites/de...h_care_providers.pdf

https://www.nctsn.org/sites/de...h_care_providers.pdf

When I was in medical training 20 years ago, the hospital where I trained had a program to help prepare children for surgery. I don' t know if they specifically referred to it as preventing risk of trauma but they invested a great deal in it (McMaster University in Hamilton, Ontario). The work above looks very similar.

Also find a video here talking about somatic experiencing as a way of working with medical trauma in childhood, as another form of validation for the importance of and effects of medical trauma. Includes interviews with the founder of SE, with Robert Scaer and MD who describes his own medical trauma in a reference in the short list; and Ana DoValle who worked with the child in the example:

Thank you for the replies thus far including the extensive resources Veronique, I will sort through these!

Early traumas are known to have lifelong, negative consequences, and so are easily considered ACEs, but also quickly dismissed by many because of the victim's age. Here are links to four articles I've written that cover this topic. They all look at a specific, but commonplace traumatic healthcare procedure—newborn male genital cutting (aka circumcision).

Child Genital Cutting as an Adverse Childhood Experience
Normal versus Cut - Final Psychological score 100-0
Adding Insult to Injury: Acquisition of Erectile Dysfunction from Circumcision
Seven Stages of Healing Foreskin Loss

Here is a preprint of a study I did involving ACEs and a very common early surgical procedure. https://www.researchgate.net/p...lds_and_Circumcision

@Matt Erb posted:

Dear community,

I feel that it is somewhat obvious to state that the receipt of health care, under certain conditions, can be an ACE, especially when in childhood/developmental stages. I have been searching Google Scholar and PubMed for any direct references/papers that speak to this. In particular, can anyone point me to published academic/peer-reviewed references that describe how needing medical care/having medical problems as a child can be classifiable as an ACE? I know response to stress exposure is highly individualized. I did find some material about how ICU care often leads to PTSD but that is not ACE specific. I have seen (and included myself) the idea that medical issues / medical care in childhood can be a possible ACE on "expanded ACE lists" but want to reference it more thoroughly if possible. Thank you for any leads.

Matt Erb, PT, Senior Faculty, The Center for Mind-Body Medicine, and Independent Scholar

Matt Erb  - The 40+ ACE questionnaire in use by the World Health Organization (the "WHO ACE International Questionnaire") had been available on the WHO website. It was used during the WHO Assessment of the World's Healthiest Children (Netherlands was #1, followed by most/if not all of Scandinavia, US was 25th, Canada 26th...)                                                As a teen, in a state youth home, having experienced an injury/'puncture' about 2 inches across, to the back of my upper right thigh - by a (2 1/2 foot tall) tree stump cut off at a sharp angle [where wood chips ended up remaining in the wound after leaving a teaching  hospital's ER, - until 3-4 years later, while I was regularly squatting on a dairy farm job...and the scar tissue swelled up, and the [prison] physician who oversaw the follow-up only wanted dry gauze used to dress the 're-punctured' scar tissue (without 'Drawing Salve')...  --requiring further 'surgery' with only local anesthetic. ...                                                                                The 'Consumer Majorities' we had under the National Health Planning and Resources Development Act of 1974 (Public Law 93-641), until the Reagan administration gutted funds for that type of 'Government-mandated Citizen Participation' ... might have availed children an opportunity to tell their own story, or at least advocate for themselves, or have a forum such as you are trying to address... -Robert Olcott

Hi Robert, thank you for your response. I don't believe the WHO questionnaire actually asks about medical trauma does it? Not that I recall, I can look it up. Your experience is a good example of this topic. I also learned that it wasn't until ~the 1970s that certain types of anesthesia were used in infants and with certain procedures, which I was horrified to learn of. I myself underwent surgical procedures at 12-18 months old and retrieved the records and gathered as much information as I could and learned that the procedures done were likely not even necessary. I hope the medical system can continue to learn about trauma-informed care... and not just in context of respecting existing trauma but in terms of understanding that the way in which  present day care is delivered may be experienced as traumatic. Blessings to all who have navigated such experiences.