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Institute for Public Service Reporting – Memphis

Health Care

Healing a child’s hidden wounds a breath at a time

Dr. Kiersten Hawes (left), the BRAIN Center’s Clinical Director of Trauma Services for Le Bonheur, consults with Abigail Blackford on trauma care. (Lisa Buser/Courtesy Le Bonheur Children’s Hospital)
Bonheur, consults with Abigail Blackford on trauma care. (Lisa Buser/Courtesy Le Bonheur Children’s Hospital)

“What’s your favorite color flower?” the counselor asked the 8-year-old girl who was sitting in her hospital bed.

“Red,” said the girl, one of 141 burn victims treated last year at Le Bonheur Children’s Hospital.

“What’s your favorite flavor of cake?” asked Dr. Kiersten Hawes, clinical director of the BRAIN Center Trauma Counseling Services at Le Bonheur. Hawes supervises other counselors who are graduate students from the clinical mental health counseling program at the University of Memphis.

“Chocolate,” said the girl.

Le Bonheur provides free, trauma-informed mental and behavioral health services to all children admitted to the hospital for gunshot wounds, burns, injuries from motor vehicle crashes, falls, and other unintentional traumatic injuries.

“Whenever you are in pain or nervous,” Hawes told the girl, “breathe in through your nose and smell the beautiful, red flower. Then breathe out and blow out the candles on your yummy chocolate cake. Can you give it a try?”

The girl nodded.

The Le Bonheur program is called Hurt-2-Healing. It’s the nation’s first integrated behavioral health model specifically designed for pediatric trauma patients.

“Breathe in and smell the flower,” Hawes said.

The girl took a deep breath filling her little lungs with oxygen-rich air, replenishing the blood vessels that flow through her body and brain.

“Breath out and blow out the candle,” the counselor instructed.

The girl exhaled deeply through her mouth, expelling dangerous carbon dioxide from her blood stream, and restoring the finely-tuned balance of her nervous system that connects her brain and body.

Hurt2Healing counselors treat their young patients with deep breathing, play therapy, and other therapeutic interventions that can literally calm a trauma victim’s nerves.

“How do you feel?” Hawes asked.

“I feel better,” the girl said with a smile that released more happy hormones into her bloodstream.

Le Bonheur’s emergency department treats about 2,000 injured children every year. More than a quarter of those cases involve falls or sports injuries.

“A lot of injuries are just kids being kids,” said Dr. Trey Eubanks, a pediatric surgeon and former trauma medical director who was named Le Bonheur’s president last year.

Over the past five years, Le Bonheur’s ER has treated nearly 3,000 fall victims.
Kids fall off bikes or out of trees. Kids jump off balconies or roofs. Kids get hurt playing football or soccer. Kids pull pots off a stovetop, spill boiling water on themselves, or fall into fireplaces or fire pits.

Any injury can be traumatic for a child. But injuries sustained by gunshots, physical abuse, and car crashes tend to be the most traumatizing.

Over the past five years, Le Bonheur’s ER has treated 710 children injured by gunshots, 536 by abuse, and 1,825 by motor vehicle crashes.

Two-thirds of them show symptoms of acute stress disorder. Left undiagnosed and untreated, acute stress often leads to post-traumatic stress disorder and long-term, life-changing consequences.

Those consequences can include impaired brain development and academic performance, and increased risk for chronic physical and mental health problems, behavior issues including criminal actions, and addictions.

“Because children who have experienced traumatic stress may seem restless, fidgety, or have trouble paying attention and staying organized, the symptoms of traumatic stress can be confused with symptoms of attention-deficit/hyperactivity disorder (ADHD),” explains the American Psychiatric Association.

“What do you remember about the accident?” Hawes asked the 10-year-old girl sitting in a hospital bed.

The girl, one of 118 kids brought to Le Bonheur last year with ATV-related injuries, remembered that she was driving the ATV. She also remembered that her 10-year-old friend was sitting behind her.

The girl didn’t know her friend had been killed in the accident. The counselor was there to tell her.

The girl began to weep. The horrible news compounded the trauma of the accident itself, reinforcing the self-defense stress hormones coursing through her brain and body, preparing her body again to fight or flee.

“You may have big feelings like shock, anger, confusion, anxiety, or sadness at this time,” the counselor told the girl. “It is OK to cry and feel all these feelings.”

Left untended, grief can lock the brain into a permanent stress response, impairing memories, heightening emotions, and inhibiting the ability of the brain to regulate and calm the body.

Healthy grieving can unlock and stengthen parts of the brain-body connection that help children and others process injury, illness, loss and other life-altering traumatic events.

“Would you like to do an activity that will honor and remember your friend?” Hawes asked the girl. “I have a memory box with me. Would you like to paint the box with me and tell me about your favorite memories with your friend?”

The girl shared memories of her friend as she painted the box. Art therapy can help younger children express their deepest fears and hopes.

“Although your friend is no longer here with you physically, they will always be in your heart,” the counselor told the girl. “You can put pictures or any valuables in this memory box to remind you of that when you miss them. You can even write letters to them and place them in your memory box.”

The girl carefully opened the box and smiled.

Children who develop acute stress disorder show several symptoms for three to 30 days after a traumatic injury.

Among them:

Recurring, uncontrollable and intrusive distressing memories of the event

Recurring distressing dreams of the event
Feelings that the traumatic event is recurring — for example, in flashbacks

Intense psychological or physical distress when reminded of the event (for example, by entering a similar location or by sounds similar to those heard during the event)

A persistent inability to experience positive emotions (such as happiness, satisfaction or loving feelings)

An altered sense of reality (for example, feeling in a daze or as if time has slowed)

Memory loss for an important part of the traumatic event

Efforts to avoid distressing memories, thoughts or feelings associated with the event

Efforts to avoid external reminders (people, places, conversations, activities, objects and situations) associated with the event

Disturbed sleep

Irritability or angry outbursts

Excessive attention to the possibility of danger (hypervigilance)

Difficulty concentrating

An exaggerated response to loud noises, sudden movements or other stimuli (startle response)

The symptoms must cause significant distress or significantly impair functioning.

“So many children in our community, in our society, are among the walking wounded,” Hawes said. “We can’t see their wounds, but we can treat them. We shouldn’t just discharge them and let them go back to their lives untreated.”

“You have been through a lot,” Hawes told the 8-year-old girl, one of 347 car-crash victims brought to the hospital in 2023.

The child had sustained significant injuries in a car crash in Arkansas and was airlifted to Le Bonheur.

Her parents and younger siblings live several hours away, and couldn’t be with her every day. The girl was going to miss her little sister’s birthday.

“I hear that you are happy that your sister is going to have such a fun birthday, but also upset and sad that you won’t be able to be there for her,” the counselor said.

The girl nodded and began to cry.

“It is okay and normal to have some hard feelings during this time when you’re having to heal,” the counselor said.

Trauma can disrupt a child’s brain and body. It also can damage the psyche’s social engagement system, especially a survivor’s sense of safety and agency.

“For our physiology to calm, heal and grow, we need a visceral feeling of safety,” Dr. Bessel Van Der Kolk wrote in “The Body Keeps the Score,” a seminal work on healing trauma.

Hawes spoke slowly and softly. She held the little girl’s hand.

“You may not be able to be there for your sister physically, but there are some ways that you can show her love from here,” the counselor said. “Let’s create a birthday card for your sister with some of your favorite memories and let her know all the things you are looking forward to doing with her once you are healed.”

The girl’s face brightened. Her mood lightened. She smiled and let go of the counselor’s hand. They spent the next half hour making a birthday card.

“Trauma survivors often experience a loss of control,” Hawes said. “So allowing them to feel safe and to collaborate with their treatment is therapeutic for them.”

The Institute for Public Service reporting is part of the Mental Health Parity Collaborative, a group of newsrooms that are covering stories on mental health care access and inequities in the U.S. The partners on this project include The Carter Center, The Center for Public Integrity, and newsrooms in select states across the country.

Written By

David Waters is Distinguished Journalist in Residence and assistant director of the Institute for Public Service Reporting at the University of Memphis.

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