Some Pediatric Sepsis Survivors Struggle in School
August 22, 2018
For many people, instead of January 1st or a child’s birthday, September is the new year. This is when parents see proof that their children are growing up as they set off to tackle another year of learning and activities. But school can be particularly hard for children who were seriously ill with sepsis or septic shock. These children may have difficulties trying to get back into their school routines and picking up where they left off before they became ill.
There is still a lot we don’t understand about how sepsis and septic shock affect children over the long term. Most children recover completely. But some are left with lasting issues that may affect how they perform in school and their extracurricular activities. It is important that this issue be recognized so we can help the children as much as possible as they navigate life after sepsis.
There are few studies that look at the lingering effects of sepsis and septic shock on children, but studies of adult sepsis survivors have found that many live with signs of post-sepsis syndrome (PSS), both physical and mental. While adult study findings can’t usually be applied to children, they do show that there are lasting problems for many people. Some issues are obvious, such as organ dysfunction or amputations. Others are invisible, such as chronic fatigue and pain, decreased mental functioning, and post-traumatic stress disorder (PTSD).
Two studies involving children
In 2009, a small study in the Netherlands looked at 82 children who were treated for septic shock in a pediatric intensive care unit (PICU). All the children were healthy before they developed sepsis or septic shock. The researchers contacted the children an average of 3 to 4 years after their hospitalization, when they filled out questionnaires about their quality of life, depression, anxiety, and cognitive function.
The results of the study showed that 44% of the sepsis survivors overall had problems with their cognitive function (mental work). Fourteen percent of the survivors who were in primary school and 15% who were in middle or high school attended special education schools. This is a significantly higher number than with typical Dutch students. Only 3% of children and 3.5% of teens in the general population need special education services.
Another study, this one in the United Kingdom, looked at 88 children, aged between 5 to 16 years, who were treated in a PICU. The group was divided into three subgroups, one of which was children who had sepsis. The children were followed for 3 to 6 months following their discharge from the PICU. They were tested for cognitive and intellectual function, as well as memory and attention.
The results showed that while the children treated in the PICU had an average IQ of 98.6, this was lower when compared to the average IQ of 107.23 among a control group of 100 healthy children. In addition, the researchers found that the PICU children scored worse than the control group children in tests for skills such as recognition memory, spatial working memory, working memory capacity, and visual sustained attention. The researchers wrote in the study that teachers reported that students who survived sepsis did show more problems in academic performance than their healthy peers, such as difficulties with completing school work and focusing attention.
More research is needed
It is obvious that more research needs to be conducted so we can better understand how sepsis and septic shock affect children and teens. However, indicators do point to problems affecting pediatric survivors long after hospitalization. A star athlete may not be able to return to her previous level of performance and an A+ student may find it hard to keep up with his studies. Teachers, coaches, volunteers, and parents may have to adapt their approaches to accommodate these issues when sepsis survivors are discharged from the hospital and return to school and activities.
Learn more about how sepsis can affect children here: Sepsis and Children
School nurses are invited to learn about how sepsis can have an impact on their role here: Sepsis and School Nurses