The hidden morbidity of pediatric trauma.

In an attempt to characterize the emotional and behavioral consequences of severe multisystem injury on pediatric trauma patients and members of their immediate family, 54 former trauma patients and their families were studied at least 1 year after discharge. Of those in a home setting, 60% had residual personality changes. Physical and cognitive handicaps, often multiple, were present in 50%; and social, affective, and learning disabilities were present in like number. Only 20% of the 50 children are in a regular school class; the other 80% require special-needs education. An unexpected finding was the effect of the accident on uninjured siblings, 66% of whom were reported to have developed emotional disturbances, school problems and aggressive personality changes. Parents reported a worsening of their martial relationship in 32% of cases, and new social and financial problems in 60%. Twenty-one mothers who were previously employed have stopped working to care for their child and 20% of families have exhausted their savings or gone into debt. Although a variety of support services were available to these families, they reported little use of extended care facilities, visiting nurses, and counselors. There is a hidden morbidity in pediatric trauma. It manifests years after injury, not only as physical disability but also as changes in cognition, personality and behavior, and as family stress. Since success in pediatric trauma care is the restoration of the child as nearly as possible to his premorbid state, these data suggest that more attention and resources should be directed to the late consequences of multisystem injury in children.