Dr. Hands discusses the three phases of hospitalization that children experience. He also explains how parents should react in the different phases.
How to Deal with Children Hospitalization Probably one of the major stresses that a family ever has to face is if their child has to be hospitalized. This is especially from middle infancy throughout the pre-school years. There are three phases that go on in hospitalization. The separation anxiety that you see goes through these three phases. Phase one is a phase of protest. Phase two is a phase of despair and number three is detachment and denial. But the importance of knowing this is that parents may be upset when they visit their kids and the children react negatively to their visit. They yell, they scream, they protest, they cry loud when their parents are there. This may also cause the hospital staff to mistakenly think that the parents are causing the child’s stress and they ask the parents to leave. If separation is avoided the young children have a greater capacity to withstand other stresses. Separation anxiety is the greatest of course from six months to 30 months. The toddler stage is very different. They demonstrate more goal-directed behavior. That is if you're doing a procedure they’ll push your hand away. They’ll try to avoid procedures. They’ll resist in a goal map where the younger child will be in this phase of protest, of crying and yelling and screaming. And when his parents come there they are in this phase and so they demonstrate it more. It is not that the parents are producing it. It’s a normal phase of protest. So to minimize this we urge, we minimize separation, we minimize that the parents stay with these children, the parents be involved in their participation and involved in the strategies to minimize all the separation. Now the other thing is response to pain. Often it’s forgotten that infants do have pain. The infants cry. They have an increase heart rate and their major thing is postural changes and facial expression. It is very important that the parents as well as the physician and the hospital staff recognize that often the infant is crying, his heart rate increase, his facial expressions are all -- and he’s squirming, he’s writhing, he’s jerking. It’s not just resistant but it’s pain. Most and like medical areas have what we call pain aggress which they measure the pain of children by certain measuring facial expressions changes, body posturing and have a score which is a pain score which they can make decisions on the writhing pain, the pain medication at that time. Timers have an additional problem. They have a concept of body image problem so everything you do is intrusive to them and therefore is anxiety producing. You don’t see this in the infants as much but you do see it in the toddlers. So they react to even procedures that are very easy like looking in the mouth, looking at the ears. It’s something that everyone must understand and the parents must understand that their child is not a problem patient. He’s reacting to a body concept problem. Also, toddlers have a problem when they memorize things. They remember things. They have more emotional problems, more emotional reactions if they’re not prepared. So a toddler is helped a lot by preparing for a hospital visit often showing him where he’ll be and explain to him what’s going to happen. The other thing is you notice that we talked about the age up to 30 months basically, in the first three years of life. That’s why you try to do procedures in children before the first year or you wait after the third year towards the fifth year because the problems with separation are greatest during that time. We certainly hope none of you have this hospital stress phenomenon when you're parenting in the first years of a child’s life or if that moment at any time. But if you do, all these little hints are a hint on the what response, what the child is going through and maybe adjust and get through it better.