1. The psychological impact of
childhood meningococcal
septicaemia
Dr Natalie Holman, Clinical Psychologist
Psychological Services (Paediatrics)
Alder Hey Children’s NHS Foundation Trust
31st
May 2013

2. Psychological impact
• Emotional & behavioural difficulties, including traumatic
stress symptoms
• Adjustment to changed appearance
• Adjustment to change in cognitive ability, hearing, or sight
• Managing acute & ongoing hospital treatment
• Impact on the whole family
• These can be influenced by:
– Age & developmental stage
– Severity of illness & admission to intensive care
– Experience of hospital, treatment, pain & length of admission

4. Normal reactions to a very
frightening event
– Nightmares or sleep disturbance
– Memories of the event
unexpectedly popping into the
mind
– Appetite change
– Clingy behaviour, not wanting
to be left alone
– Temporarily losing skills (such as
walking, toileting)
– Being more jumpy & on the
lookout for danger
– Seeming to be in a daze,
withdrawn, anxious, fearful
– Avoiding reminders of the event
& not wanting to talk about it
– Playing or drawing about the
event
– Problems at school & difficulty
concentrating
– Getting angry or upset more
easily
– Changes in behaviour, eg.
increased temper tantrums

5. Reactions to a traumatic event
• For all ages, it is quite normal to experience these symptoms, even for
quite a while, after a frightening event
• Parents, siblings & other family members can experience traumatic stress
symptoms too
• Importantly, these symptoms can occur at any point after a traumatic
event; some children may show an immediate emotional response while
others may not do so for some time
• Children will worry less if people around them can help them to see that
these reactions are normal and understandable
• With help & support from those around them, most children can recover
from these fairly quickly, usually within a few weeks

6. What helps?
• Try and make things as normal as possible
– Ensure children feel safe. They may need lots of
reassurance (eg “Yes, you were hurt but you’re in hospital
now & you’re safe/getting better, etc”)
– Children feel safer when they know what to expect.
Sticking to normal routines where possible and letting
children know what is going to happen will help
– Make sure that parents & family members understand
what is happening so they are able to support & reassure
the child

7. What helps?
• Help children to understand what has happened
– Children need honest explanations of what happened to
them that are age appropriate
– Even young children can really benefit from being given an
explanation
– Helps the child to make sense of the event and can reduce
unpleasant feelings, eg. fear
– Can correct misunderstandings, eg. some children may
incorrectly think that it was their fault
– Helps prepare children for answering other people’s
questions

8. What helps?
• Letting children talk when they are ready to
– Be ready to listen if a child wants to talk about what
happened – no need to ask questions, just show you’re
listening
– Sometimes people avoid talking about what happened so
that they don’t upset the child. However, research shows
that children are really likely to benefit from talking about
frightening events
– Talking needs to be done sensitively and when the child is
ready. It can be useful to provide opportunities for the
child to talk without forcing them to. Some children may
prefer to use dolls or draw instead of talking
– Talking can help the child feel more in control of the
memory and less afraid of it

9. Adjusting to a changed appearance
• Factors that affect adjustment include
– age & developmental stage of child
– views about appearance before illness
– permanent reminder of meningitis, eg. scars
– expectations for future recovery, treatment &
healing

11. What helps?
• Helping children improve their:
– Self-confidence
– Self-esteem
– Social competence
All help build resilience & adaptive coping
strategies

12. Building positive self-esteem
• Notice your child when they do well and give them specific
praise
• Help your child to notice and remember the good things
other people say about them
• Make time to sit down and talk to your child – encourage
them to discuss their ideas and feelings
• Encourage your child to do something they are particularly
good at
• Help them celebrate their achievements
• Increase body confidence, eg. through sport
• Peer support & meeting others in a similar situation

13. Helping your child with friendships
• Encourage your child to have contact with friends
outside school
– e.g. Inviting other children to play/tea, activities such as
youth clubs/sports
• Help your child stay in touch with friends
– e.g. arranging to meet up/telephoning them/text
messages/msn messenger
• Help your child with social skills
– e.g. what to say when they meet someone new

14. Managing others’ reactions
• Does your child know what happened to them?
• Benefits of having a ‘ready–prepared’ answer to curious
questions – age-appropriate
• Talk to your child about their operations & hospital
admissions
• Use photographs
• EXPLAIN – REASSURE – DISTRACT technique to manage
curious questions – taking control of the situation
– eg. “It’s just a scar(EXPLAIN). It’s lumpy & red but it doesn’t hurt
(REASSURE). Are you playing football at lunchtime? (DISTRACT)”
• Lots of advice on Changing Faces website

16. Resilience & Positive adjustment
• Some survivors report positive changes following
meningococcal septicaemia
– increased empathy for others
– change in attitude towards & tolerance of difference
– re-evaluating life
– opportunity to make changes

17. Where to access support
• www.meningitis.org
• www.meningitis-trust.org
• www.limbless-association.org
• www.changingfaces.org.uk (for support with appearance
concerns)
• www.youngminds.org.uk (support for young people around
emotional wellbeing & mental health)
• www.mind.org.uk (as above but for adults)
• Or, see your GP for a referral to local counselling or mental
health services (eg. Child & Adolescent Mental Health Service
– CAMHS)