Key Takeaways
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- After a cardiac arrest, children can have permanent changes in their physical health, their emotions, the way they think and learn, and the way they interact with friends and family.
- It is common for family members to also experience changes in their emotions, relationships, routines, and ability to take care of themselves.
- Children and families can experience a sense of grief or loss even if they survive a cardiac arrest.
- There is a road to recovery! Talk with your healthcare team about how to manage these symptoms.
How to understand and manage the aftermath?
Recovering from cardiac arrest can take a long time. Some of that recovery happens in the hospital or a rehabilitation (rehab) facility, but most people will still have symptoms even after leaving the hospital. Some of these symptoms may get better with time. Here are some things you can watch out for and discuss with your child’s doctor.
Symptoms of the body
A cardiac arrest and a stay in the hospital puts a lot of stress on the body and mind. Children may experience symptoms that last even after leaving the hospital. Some of these may include:
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- Their muscles may be weak and sore, especially if they need a breathing tube, a ventilator, and/or sedation.
- Their chest may have pain, especially if they got CPR.
- They may have injuries to their hands or feet from not getting enough blood flow.
- They may not be able to breathe, swallow, or eat on their own. They may need machines to live, like a ventilator or a feeding tube.
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- They may tire out easily when doing activities that were normal for them before their cardiac arrest.
- They may have pain or muscle cramps from brain or nerve injury.
- They may not be able to care for themselves or perform routine activities like going to the bathroom independently. They may need help with toileting or require diapers even if they were toilet-trained before the cardiac arrest.
Physical Therapy (PT) and Occupational Therapy (OT) can help your child build up as much strength as possible. These therapies usually start in the hospital. After leaving the hospital, the therapists will meet with you in an office or your home, if your child requires continued therapy. Usually, they will give you exercises to practice at home.
If your child has new machines and treatments, like a ventilator or a feeding tube, nurses may be able to come to your home to help.
Getting the treatments they need is a big part of your child’s recovery. Families can feel overwhelmed by the number of appointments and therapies their child needs. Please talk to your doctor or healthcare team if you feel like you need more support.
Action plan
Physical symptoms can change with time. You can talk with your healthcare team about symptoms they could expect to develop. Ask your healthcare team for a list of phone numbers to call if you are worried.
If you are worried about your child’s symptoms, you should seek medical attention. You should discuss new symptoms with your child’s pediatrician. In an emergency, you should call 911 or go to the nearest emergency room.
Symptoms of the mind
Being in the hospital is stressful for anyone. This is especially true for a child who experienced a life-threatening illness like cardiac arrest. After a cardiac arrest, you and your child can have changes in your mental health.
Many children will have feelings of joy or gratitude that they have survived. Sometimes, children can develop anxiety, depression, or post-traumatic stress disorder (PTSD). Anxiety is a feeling of intense worry. Depression is an experience of sadness and heaviness. PTSD is a response to an event that threatens someone’s safety. All of these can make it hard for children to live their lives and thrive.
Anxiety, depression, and PTSD can look different in different people. Here are some symptoms to look out for:
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- Acting out more, having more behavioral outbursts
- Trouble sleeping, having more nightmares
- Returning to things they used to do when they were younger (thumb sucking, being more clingy or attached to you)
- Showing more fear, being less willing to try new things
- Making more risky choices (substance use). This is especially true in older children.
- Re-enacting the experience during playtime
It can help to reassure children that they are safe. It can also help to make space for them to talk about their feelings with you or a mental health professional. Above all, you should talk to your doctor or healthcare team if you notice that your child has these symptoms. There are treatments for these mental health changes.
Changes in thinking and learning
After cardiac arrest, your child’s body and brain might be injured from lack of oxygen and nutrients. These injuries, and the medications used to treat their symptoms, can affect how your child thinks and learns.
Serious brain injury can also cause your child to have seizures. Seizures can be treated with medicines that can cause extra sleepiness.
After serious brain injury, your child may lose skills that they previously had – including talking, following directions, reading, writing, and studying. Your child may be unable to talk or understand communication in the same way before the cardiac arrest.
Even if your child does not suffer a serious brain injury, they can have changes in how they think and learn. Just being in the pediatric intensive care unit, even for a short time, can be life-changing. It is common for children to have memory and attention problems after being in the hospital. This can make it harder for them to stay focused at home or school. It may be harder for your child to keep up with school assignments or home chores.
Therapy can be important for changes in thinking and learning (not just for physical or mental health changes). Ask your doctor and therapists about whether your child would benefit from a special kind of therapy called “cognitive rehab.” Your child may benefit from being evaluated by a neuropsychologist to determine if your child has cognitive difficulties as a result of the cardiac arrest. It can also help to partner with your child’s school to see what formal supports and services might be available.
Changes in friendships and relationships
A hospital stay can have a big impact on your child’s relationships and routines. Your child may be less able to participate in normal routines, especially if they have ongoing medical needs. Challenges can include:
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- Missing days of school
- Being unable to take part in sports or other activities
- Having new physical, mental, or emotional disabilities
- Needing new medical equipment
Changes in routines can be stressful, especially for children. Consider working with your child’s teachers and coaches to help find ways for your child to be included in activities with modifications. You should also work with your doctor to decide which activities are safe for your child.
Your child’s relationships and friendships may be affected, too. Your child’s friends may worry about how your child is recovering after a cardiac arrest. They may also have questions about what happened, when they will be able to play together again, and whether something like this could happen to them. It can help to talk with your child’s friends’ families to answer questions.
It affects the whole family!
A hospital stay can affect your whole family, including YOU! Just like your child’s feelings of stress, depression, anxiety, or PTSD, your child’s friends and your family can have these feelings too. It is normal to have feelings of joy and gratitude that your child has survived AND feelings of sadness and fear. Many families find it helpful to use counseling, therapy, or support groups to help them adjust after their child has had a cardiac arrest. You can reach out to your doctor to ask for resources. Reach out to your pediatrician to discuss what support might be available for the other children in your family.
Many families struggle with changes in their routines. If your child has a long hospital stay or has new medical needs, it may be difficult to go to work, school, or other activities. It may also be harder to make last-minute plans because of your child’s healthcare needs. If you are unable to work, you can reach out to your doctor to discuss Family and Medical Leave Act (FMLA) resources. Make sure that more than one caregiver is trained to take care of your child – especially if they have new healthcare needs. This way, you can care for yourself if you become tired or sick.
A word on grief
After a serious medical illness like cardiac arrest, it is normal to feel feelings of grief and loss. Even if your child survives cardiac arrest, such a life-changing experience can be challenging for everyone. For both you and your child, these feelings can come and go, grow stronger, or lessen with time. They are often more intense around important times – for example, the anniversary of the event or an important event like a graduation or a birthday. It can help to create space to talk about these feelings with your child and your family. Do not hesitate to ask your doctor or healthcare team for help.
Sources
American Heart Association. (2024). What is recovery like after a cardiac arrest? https://www.heart.org/-/media/Files/Health-Topics/Answers-by-Heart/Cardiac-Arrest-Recovery.pdf
Manning, J. C., Pinto, N. P., Rennick, J. E., Colville, G., & Curley, M. A. Q. (2018). Conceptualizing post intensive care syndrome in children-The PICS-p framework. Pediatric Critical Care Medicine, 19(4), 298–300. https://doi.org/10.1097/PCC.0000000000001476
Resources for children and families following a critical illness. (n.d.). Retrieved from http://www.afterpicu.com/
Schonfeld, D. J., Demaria, T., Nasir, A., Kumar, S., Committee on Psychosocial Aspects of Child and Family Health, & Council on Children and Disasters. (2024). Supporting the grieving child and family: Clinical report. Pediatrics, 154(1), e2024067212. https://doi.org/10.1542/peds.2024-067212
United States Department of Labor. (n.d.). Family and medical leave act. https://www.dol.gov/agencies/whd/fmla
Thank you to our contributors
Annie Gula & Neethi Pinto
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