Studies indicate that medical procedures may cause post-traumatic stress (PTS) symptoms (fear, avoidance, sleep disturbances, irritability, concentration difficulties. hypervigilance). It has been suggested that administration of midazolam hydrochloride, a sedative/amnesic medication commonly used in the Pediatric Intensive Care Units (PICU), may help decrease if not prevent the development of PTS symptoms. This study examined if PTS symptoms were related to procedural invasiveness (PI) and whether midazolam had a moderating effect on the development and intensity of PTS symptoms in children. English-speaking children ages 8-16 (N=20) who had been in the PICU for at least 3 days were recruited at Loma Linda University Children’s Hospital. During the first assessment self-report measures of PTS (Trauma Symptom Checklist for Children Alternate Form and Child’s Reaction to Traumatic Events Scale) and PI (Procedural Invasiveness Rating Scale) were administered. One month later children were contacted for follow-up. 75% of children reported moderate or higher levels of traumatic memories relating to their stay in the PICU. 40% reported sub-clinical (but significant) symptomatology representative of difficulties and 25% reported clinically significant PTS symptoms. A moderate positive relationship existed between PI and level of depression (r = 0.562, p = 0.01) and PI and anger (r = 0.50, p = 0.02). The non-midazolam group demonstrated less PTS at first assessment; however, only the midazolam group demonstrated clinically significant decrease in PTS (17%), Anxiety (24%), Dissociation (28%), and Overt Dissociation (44%) at follow-up. Length of stay in the PICU was positively correlated with depression (r = 0.687, p = 0.001) and anger (r = 0.539, p = 0.014). Children in the PICU experienced PTS symptoms. Midazolam had a moderating effect on the symptoms reported one month after the first assessment. While children tended to underreport symptoms, overall results revealed strong indicators of stress. Due to small sample size, generalizability is limited. However, further investigations are warranted.

LLU Discipline





Graduate School

First Advisor

Kiti Freier

Second Advisor

Matt Riggs

Third Advisor

Daved Van Stralen

Degree Name

Master of Arts (MA)

Degree Level


Year Degree Awarded


Date (Title Page)




Library of Congress/MESH Subject Headings

Stress Disorders, Post-Traumatic -- therapy; Child; Intensive Care Units, Pediatric; Postoperative Care -- infancy & childhood.



Page Count

x; 89

Digital Format


Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.


Loma Linda University Electronic Theses and Dissertations

Collection Website



Loma Linda University. Del E. Webb Memorial Library. University Archives