FOREWORD: Worried Parents, Injured Kids: Working with Worried Parents in the Emergency Room

Medical emergencies are extremely stressful by nature, the failure of a body to function properly is understandably concerning and worrying. When children are involved, however, the factors that cause stress are multiplied. Not only are the medical professionals and patient undergoing a potentially stressful experience, but the parents of the child involved also understandably experience a significant amount of stress: their child is in the hospital after all. An overabundance of stress, especially when life or death scenarios could happen at any moment, is dangerous and detrimental to the overall process of emergency medicine. To properly understand and analyze the stress that applies to the parents of a hospitalized child, one must first analyze the various stressors and difficulties in and around the emergency room. These stressors and difficulties can be experienced by anyone, from the smallest child to the most experienced physician. To better understand the mindset of the parent, we should first talk about what is done to help the child cope.

One manner in which children are often encouraged to cope with stress in the emergency room is what has been called play therapy. Children being allowed to play provides them with an anchor into the realm of familiarity. In the microcosm of a hospital, it is often easy to get lost in the unfamiliarity of sights and smells, even for adults. For children who have recently undergone not only a potentially traumatic experience but also a stay in a building that many people already find foreign and uninviting, any sort of lines of familiarity to their normal life should be welcomed and encouraged. One study found that when children were allowed to play with age appropriate items, the end result was a much happier, more confident, and overall less stressed child (Goymour, Stephenson, Goodenough, & Boulton, 2000). While this is certainly not applicable to every case, or every scenario, the lines of familiarity explicitly provided to a child oftentimes would not work for an adult.

A potential cause of stress for parents is the very reason that parents bring their children to the emergency room: perceived dangers to their child’s wellbeing. One study conducted in France found that, unsurprisingly, when parents believe that their child is in danger, they often look for the closest, best, most well-known, and fastest available way to treat their potentially ill child: the pediatric emergency department (Wong, Claudet, Sorum, & Mullet, 2015). This practice, however, can be extremely troublesome for said emergency departments, who are often rushed, and potentially have to deal with patients in much more urgent states.

While many cases of a child being brought to the emergency room are valid, warranted, and necessary, there is an issue that presents itself, especially when dealing with worried and stress parents: overutilization of the emergency room. The emergency room is for, as the name implies, emergencies. Children brought to the emergency room whose situations are not quite as bad as the parent or child believes them to be is both a common occurrence, and an exceedingly dangerous one.

In a 2011 National Health interview survey, it was found that, of parents bringing their children to the emergency department in what physicians deemed nonurgent cases, parents said 63% of the time those cases were “very or extremely urgent” (Capp, Rooks, Wiler, Zane, & Ginde, 2013). This danger of this practice is quite clear, congestion and longer wait times, potentially lower quality care, and increased stress for all parties involved, from patient, to parent, to physician.

The theme of emergency room being overutilized, especially for children, seems to be a problem in many medical systems across the world. One area this is prevalent is nontraumatic dental care. In Canada, a perceived lack of competency in dental providers, lack of monetary funds, lack of an available dentist, or cultural norms often contribute to this rising practice of utilizing the emergency room for nontraumatic injuries (Haqiqi, Bedos, & Macdonald, 2016). Stressed parents, whether the cause relates to similar reasons as those provided above, or some other unexplored topic provide the greatest threat in many cases to the proper administration and execution of the emergency medical system.

Parents are an especially unique set of individuals in regard to how medical emergencies play out. Many times, when parents bring a child to an emergency medical center, it is not their lives, or even their physical wellbeing at stake. This, however, does not to say they are completely uninterested. The child who they love, their own flesh and blood, who they have raised and cared for from the very beginning, is potentially experiencing great pain, pain which they themselves cannot remedy. The stress of the parent can determine how the entire medical experience plays out, as they have control over and responsibility for the wellbeing of their child. Management of the stressors that parents experience should not be overlooked, as caring for the caretaker of the child contributes to the overall level of care and to the recovery process.

One common cause of stress in the emergency room is the sheer volume of movement, the noise, and the controlled chaos of the whole affair. Anxiety caused by these factors can be extremely damaging, not only to the mental state of parents and children, but also to the relationship between parents and doctors, undermining a vital principle of modern medical care: the relationship between patient, guardian, and doctor. One way this stressor has been mitigated in parents is with the involvement music: calming music, played close to 60 bpm, has been shown to significantly decrease stress levels in the waiting room (Wong, Claudet, Sorum, & Mullet, 2015). Music, while a powerful tool for both relaxation in parent and child, can prove to be ineffective if the situation is extremely dire. For this reason, careful wording should be applied when speaking to both patient and parent.

Another potential issue when multiple parties are involved is the subject of communication. Negative suggestions, such as “he’s not going to feel too good after this”, even if only negative due to their phrasing oftentimes have a vast impact on the patient, or even the parent. One study found that, of 130 suggestions between patients and physicians, almost 70 percent were identified as negative. The effect of suggestion, especially in medicine, has been well documented. To phrase suggestions and statements, no matter how dire, as purely negative for a majority of the time will most certainly lead to unintended and unwanted consequences. Suggestion, both to children and parents, is a powerful tool that should be carefully analyzed and evaluated. The words which physicians use drastically influence both children and parents in the emergency room (Perry, Samuelsson, & Cyna, 2015). Communication is a vital aspect of emergency medicine, which has the potential to make or break the parent-child-physician relationship.

It is the adult, not the child, that we expect to take an interest in the overall health of the child. In many instances, it is the parent, not the child, who makes the medical decisions pertinent to the children. The clear and calm communication between parent and physician has never been more vital, especially in the modern day. With anti-medical movements such as the antivax movement (Fox, 2018) taking hold in areas, where, ironically, vaccination and proper medical care have never been more accessible, or more encouraged.

Worried parents are not medical professionals. Parents are apt to be concerned for the wellbeing of their child, and are right to do so. With so much medical misinformation floating around, an untrained person investigating an illness they perceive their child to have may cause just as much harm with their misdiagnosis as any illness their child may have in fact had. Intelligent, rational people, if misinformed, are still just people, and are still susceptible to the pitfalls and dangers of unreasonable conspiracy theories, new age medicine and the like.

As has been shown earlier, communication is a key aspect of the parent-child-physician triad. Proper, respectful, positive, and rational communication can help a patient undergoing a traumatic procedure feel better. How much more, then, could such communication help combat the pseudoscientific, and frankly, anti-child rhetoric that has usurped much of this newfound fringe “medicine”.

Moving beyond questionably held beliefs, parents are still concerned for and have a vested interest in the health of their child. While aspects of care, such as the hustle and bustle of the emergency room provide a unique and interesting stressor to the situation, the communication between parent and physician should be paramount. Parents cannot help their children in this situation, which is why they brought the child to the emergency room in the first place. Showing aggravation at the cause for bringing a child to the emergency room, or the using predominantly negatively suggestive language is detrimental, not only to parent and child’s stress level, but potentially also to the medical professional, should the parent become hostile. Worried parents can become the worst nightmare for any medical professional, or, if dealt with properly, can become their greatest ally.

The articles by Campbell and Holmes that follow focus on these issues. Medical care of children does not stop just with providing care to the afflicted child. Parental responsibility and concern should be met with medical professionalism and high-quality communication. When we take care of the youngest and weakest among us, we must remember to also provide for the worries and stress of those that watch after them, day after day.