Preliminary evidence for the effects of morphine on posttraumatic stress disorder symptoms in one- to four-year-olds with burns
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Published on: September 29, 2021
Frederick J Stoddard1, Erica A Sorrentino, T Atilla Ceranoglu
1Shriners Hospitals for Children and Harvard Medical School at Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Insights
Higher morphine doses for acute burns in young children may reduce later posttraumatic stress symptoms, particularly arousal issues. This finding supports pain management strategies for pediatric trauma patients.
Area of Science:
- Pediatric medicine
- Trauma care
- Pain management
Background:
- Burns and trauma are frequent in very young children.
- Previous research on pain management and PTSD in pediatric trauma focused on older children.
- The impact of morphine dosage on posttraumatic symptoms in toddlers is understudied.
Purpose of the Study:
- To test if higher morphine doses for acute burns in very young children correlate with decreased posttraumatic symptoms later.
- To investigate the relationship between morphine administration and symptom reduction in pediatric burn patients.
- To extend previous findings on pain management and PTSD in older children to a younger age group.
Main Methods:
- Seventy children aged 12-48 months with acute burns participated.
- Parents were interviewed at hospitalization, 1 month, and 3-6 months post-discharge.
- Child Stress Disorders Checklist - Burn Version (CSDC-B) and morphine dosage data were collected.
Main Results:
- A correlation (r = -0.32) between average morphine dose and decreased PTSD symptoms was similar to older children.
- A significant correlation (r = -0.63, P < .05) was found between morphine dose and reduced arousal symptoms.
- Higher morphine doses were associated with fewer posttraumatic stress disorder symptoms, especially arousal, in the months following trauma.
Conclusions:
- Higher morphine doses in very young children with acute burns may be linked to a reduction in posttraumatic stress disorder symptoms.
- Pain management with adequate morphine may positively influence long-term psychological outcomes in pediatric burn survivors.
- Findings support the hypothesis that effective pain management is crucial for mitigating trauma-related psychological distress in toddlers.
Abstract:
This study tested the hypothesis that very young children who received more morphine for acute burns would have larger decreases in posttraumatic symptoms 3 to 6 months later. This has never before been studied in very young children, despite the high frequency of burns and trauma in this age group. Seventy 12- to 48-month-old nonvented children with acute burns admitted to a major pediatric burn center and their parents participated. Parents were interviewed at three time points: during their child's hospitalization, 1 month, and 3 to 6 months after discharge. Measures included the Child Stress Disorders Checklist - Burn Version (CSDC-B). Chart reviews were conducted to obtain children's morphine dosages during hospitalization. Mean equivalency dosages of morphine (mg/kg/d) were calculated to combine oral and intravenous administrations. Eleven participants had complete 3 to 6-month data on the CSDC. The correlation between average morphine dose and amount of decrease in posttraumatic stress disorder symptoms on the CSDC (r = -0.32) was similar to that found in studies with older children. The correlation between morphine dose and amount of decrease in symptoms on the arousal cluster of the CSDC was significant (r = -0.63, P < .05). Findings from the current study suggest that, for young children, management of pain with higher doses of morphine may be associated with a decreasing number of posttraumatic stress disorder symptoms, especially those of arousal, in the months after major trauma. This extends, with very young children, the previous findings with 6- to 16-year olds.
