Trauma reactions (i.e., emotional trauma) can show up in many stages of a child’s experience at the doctor’s office or hospital. These reactions may present when the child is emotionally scarred by an invasive surgery or painful physical therapy. They may occur when a child struggles with port access or needle sticks and has to be held down to receive life-saving treatments. Even navigating a large, big-city health care system can be emotionally challenging for children and families.

Pediatric traumatic stress is a child’s emotional response to pain, illness, and other aspects of medical care. Studies show that nearly one in three families may have substantial emotional health reactions to medical care. Traumatic stress reactions can be experienced by family members in addition to the child presenting for medical care.

To Meghan Marsac, PhD, associate professor of pediatrics, it is “the biggest thing in pediatric medicine that no one’s talking about.” Her goal is to help doctors and other health care professionals prepare for it to reduce patient suffering.

Dr. Marsac is associate director of the Center for Pediatric Traumatic Stress (CPTS), a national organization that just celebrated its 20th year of teaching trauma-informed pediatric care to health care professionals across the globe. CPTS, part of the National Child Traumatic Stress Network (NCTSN), brings together a unique multidisciplinary team headquartered at three institutions: Children’s Hospital of Philadelphia, Nemours Children’s Health, and UK HealthCare.

CPTS distributes evidence-based practices, screening tools, and training to help providers recognize and address traumatic stress in children, as well as resources (in English and Spanish) for patients and families. Health care teams can find information and resources such as free online courses and downloadable patient education materials at the center’s website,

“When we think about trauma reactions, we think about what kids and families are coming in with,” Dr. Marsac said. “What are some other traumas that might affect the way they interact with medical care? And then what are the things happening here within the health care system that could be potentially traumatic? And finally, what can we do as health care professionals to make it better?”

Health care professionals have the opportunity to take steps to prevent and address trauma reactions in their patients. This includes screening and identifying children who need additional support, modifying procedures, communicating properly among physicians and staff, and referring children who need extra support to other services. Meanwhile, an important component of trauma-informed care is also to consider the impact of the practice of medicine on health care professionals’ well-being including educating providers about burnout, how their personal lives may intersect with the care they provide, and how and when to seek help if they need it.

Knowing these techniques and the evidence behind them, Dr. Marsac found it imperative to help Kentucky Children’s Hospital partner with CPTS. She began her role at UK in 2016, and in 2018, CPTS expanded to UK HealthCare.

“We are extremely grateful for Dr. Marsac’s direction and orchestration in the organization, positioning us as a leader in addressing the important issue of pediatric trauma,” said Scottie B. Day, MD, chair of pediatrics and physician-in-chief of Kentucky Children’s Hospital, “Through her guidance, we have been successful in helping more and more families feel safe, comfortable, and at ease during their care.”

Dr. Marsac has witnessed the successful implementation of trauma-informed care trainings and initiatives at UK. For example, when UK HealthCare created a pediatric COVID-19 vaccine clinic, the team integrated evidence-based strategies such as strong communication about what children would expect, giving children choices about using numbing cream or distractors, and presenting information in a developmentally appropriate way. The team worked to prevent needle fears by creating a treasure hunt with prizes for children receiving vaccines. They also created a sensory room and had child life specialists available for those children who needed extra support.  

When it all comes together, and a child is cared for in the best possible way, Dr. Marsac said those moments show the difference trauma-informed care makes.

“When we can empower children to conquer their fears, and you get to be there and watch them climb, put their arm out, and just champion it, it not only minimizes trauma for the child and the nurses and the parents, but it also empowers children and teaches them that they can overcome hard things,” she said. “I think these moments that we get to celebrate with kids and families and keep me passionate about continuing to expand trauma-informed medical care.”

For more information about CPTS, visit