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Arch Dis Child. 2018 Jan;103(1):14-18. doi: 10.1136/archdischild-2017-313544. Epub 2017 Aug 18.

Impact of child death on paediatric trainees.

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Paediatric Intensive Care Unit, Southampton Children's Hospital, Southampton, UK.
Child and Adolescent Mental Health Service, London, UK.
Hull York Medical School, Center for Medical Education, York, Heslington, UK.



To assess the prevalence of symptoms of acute stress reactions (ASR) and post-traumatic stress disorder (PTSD) in paediatric trainees following their involvement in child death.


A survey designed to identify trainees' previous experiences of child death combined with questions to identify features of PTSD. Quantitative interpretation was used alongside a χ2 test. A p value of <0.05 was considered significant.


604 surveys were distributed across 13 UK health education deaneries.


303/604 (50%) of trainees completed the surveys.


251/280 (90%) of trainees had been involved with the death of a child, although 190/284 (67%) had no training in child death. 118/248 (48%) of trainees were given a formal debrief session following their most recent experience. 203/251 (81%) of trainees reported one or more symptoms or behaviours that could contribute to a diagnosis of ASR/PTSD. 23/251 (9%) of trainees met the complete criteria for ASR and 13/251 (5%) for PTSD. Attending a formal debrief and reporting feelings of guilt were associated with an increase in diagnostic criteria for ASR/PTSD (p=0.036 and p<0.001, respectively).


Paediatric trainees are at risk of developing ASR and PTSD following the death of a child. The feeling of guilt should be identified and acknowledged to allow prompt signposting to further support, including psychological assessment or intervention if required. Clear recommendations need to be made about the safety of debriefing sessions as, in keeping with existing evidence, our data suggest that debrief after the death of a child may be associated with the development of symptoms suggestive of ASR/PTSD.


death; intensive care; occupational health; palliative care; psychology

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