Researchers who study parental stress tend to reach for the oxygen-mask metaphor: if you don't breathe yourself, you aren't going to be able to take care of your child.
"Parents need to feel well enough that they can then be there for their child, their other children," said Nancy Kassam-Adams, a psychologist who is the director of the Center for Pediatric Traumatic Stress at Children's Hospital of Philadelphia. "The hardest thing is self-care."
Dr. Kassam-Adams is the lead author of a new review of post-traumatic stress in both children and parents after the children were injured, which concludes that about one in every six children, and a similar percentage of parents, experience significant, persistent symptoms. They may have intrusive and distressing memories and dreams, or continue to avoid people or places that evoke the circumstances of the injury, or struggle with mood problems, including depression. If untreated, this can damage the child's emotional and physical recovery.
Research into the effects of parental stress developed as pediatric cancer treatment claimed more and more success stories, medical victories that gave children their lives back. Clinicians and social workers — and parents themselves — began asking questions about how to help families continue on with those triumphantly recovered childhoods.
It helped, in part, to tell parents that they'd been enlisted in a war, said Anne E. Kazak, a pediatric psychologist and co-director of the Center for Healthcare Delivery Science at Nemours Pediatric Health System in Wilmington, Del. Parents connected to this metaphor: "You've been part of the war on cancer, the battle fighting it," she said.
Some of the strategies and insights gained from this body of research are already visible in most children's hospitals: a place for parents to sleep, even in the intensive care unit; including parents in so-called family-centered rounds; a staff attuned to interpret a parent's extreme behavior as a cry for help, rather than a source of irritation and extra work.
But what happens after children are out of the medical danger zone? Many parents continue to experience the physical symptoms of stress — the racing pulse, the dry mouth. They continue to flash back to the moment of the cancer diagnosis, the moment of the very premature birth, the moment of the accident.
"It's my belief a parent who's traumatized is always expecting the other shoe to drop, will always be scanning the horizon," said Dr. Richard J. Shaw, a professor of psychiatry at Stanford.
Image: Mother holding infant's hand, via Shutterstock