Helping Children Cope with Health Care Experiences

The following suggestions are provided to assist you in talking with your child about health care experiences. We hope these suggestions will help you prepare your child for an upcoming hospitalization or procedure and make the child's experience a little easier. For patients using services at the Children's Medical Center in Worcester, you may find child life specialists helpful.

Preparing a Child for Hospitalization

• Adults should become prepared first. By obtaining accurate information, a parent can better prepare the child.
• Ask the child's doctor any questions or concerns regarding hospitalization.
• Talk honestly with the child about the hospital in terms he/she understands and that are nonthreatening. Remember that children have active imaginations and if they do not have enough information, they make up stories to fill in the gaps.
• Explain to the child why he/she is coming to the hospital and what will happen while he/she is here. Younger children should be told about hospitalizations no more than two to three days before they are to occur, whereas older school age children or adolescents can be told up to two to four weeks prior to their visit.
• Play is an excellent way to prepare a child for the hospital and health care experiences. Provide him/her with medical equipment (play medical kit for younger children) so he/she becomes familiar with these items. Encourage the child to use the medical equipment on a stuffed animal or doll. As he/she are interacting with the materials, look for opportunities to ask the child about how he/she feels or what he/she thinks about the equipment and pending health care experience so any misconceptions can be cleared up.
• Reassure the child. Make sure he/she knows that going to the hospital is not a punishment and everyone is there to help him/her.
• Help the child express his/her feelings by allowing him/her the opportunity to ask questions and talk about the experience.
• Read books about going to the hospital with the child. There are many books about illness and hospitalization that can be found at your local library.

What to Bring to the Hospital for an Overnight Stay

Please bring special and/or familiar objects from home into the hospital. Parents should bring items that will help make the stay more comfortable. Suggestions:

• Books and/or magazines
• Favorite blanket and/or pillow
• Preferred toothpaste/hair brush
• Favorite stuffed animal or doll
• Pacifier or sippy cup
• Pajamas, robe, slippers or other comfortable clothing
• Special pictures of family and friends
• Special toys, game or videos

During the Hospital Stay

• Allow the child to have choices and feel in control whenever possible (for example, what to wear, what activity to do, choice of movie to watch or music to listen to, etc.).
• Gather information from the child's doctor and the health care team.
• Many parents find that writing down questions for doctors or nurses in a journal or notebook is helpful.
• Spending time with the child is a great source of comfort for him/her, but adults need to take time for themselves to eat, sleep and relax. Parents need to maintain energy in order to provide love and support to the child.
• Parents should let the child know when they are leaving the hospital and when they are returning to the hospital.
• Maintain normal family limits and avoid excessive gifts. Establish and maintain routines and limits when the child is in the hospital.

Helping Your Child Cope with Medical Tests

During a child's medical care, he/she may experience unfamiliar medical tests and procedures. Often, with preparation and support from the nurse, a child life specialist, and/or parent, these tests and procedures can be less stressful for the child. The following are suggestions to help a child cope with procedures. These techniques can be used with any procedure that causes fear. Please bring items from home that are especially helpful or comforting to the child.

General Suggestions:

• Encourage the child to express his/her feelings about his/her health care experience. This can be done in a safe way by writing a story, engaging in pretend play or drawing a picture.
• During stressful times, physical touch can offer a child warmth and security. Examples of physical touch include swaddling and/or rocking your infant, and stroking and cuddling children of all ages.
• Please reassure the child and let him/her know that is it all right to cry.
• Praise the child for what he/she is doing well. For example, if the child is holding still during a procedure, it is important to tell him/her what a wonderful job holding still he/she is doing.

Infants (newborn to two years old)

• One of the most helpful ways to prepare a young child for a procedure is for the parent to be prepared for the experience. If the parent feels at ease, then the child senses this and responds in a similar manner.
• Diversional items/activities during procedures that are developmentally appropriate for infants and toddlers include: bubbles, cause and effect toys (such as pop-up toys), toys that light up and play different sounds and/or songs, playing peek-a-boo, and oral stimulation through the use of a bottle or pacifier.
• The use of a soft, comforting voice, soft music, a gentle touch, and comfortably positioning your child in your arms or lap during medical tests, when appropriate, can be very reassuring and supportive.
• Preparation for a procedure can include demonstrating the procedure on the child's favorite stuffed animal or doll before the procedure is administered. For example, if a child is fearful of having their blood pressure taken, try demonstrating this procedure on a doll or stuffed animal. Allow him/her the opportunity to perform the procedure on the doll themselves.

Preschoolers (two to five years old)

• Children this age need to be provided with truthful and simple explanations of what is going to happen, so that they do not misinterpret or develop unrealistic fears of the procedure. Remember that they have very active imaginations at this age and will make up their own explanations if not provided appropriate information.
• Diversional activities during procedures may include blowing bubbles or a pinwheel, singing a song, acting out a story or sharing a special experience.
• Relaxation techniques such as storytelling, talking about a favorite activity, listening to calming music, dimming the lights and comfortably positioning the child on your lap can help calm the child.
• Children this age see themselves as the cause of all events. It is important to reassure him/her that he/she did nothing to "cause" the illness or injury, and that the painful procedure or hospitalization is not a punishment for bad behavior.
• Visual aids are wonderful tools when teaching children about medical tests and procedures.
• Whenever possible give the child choices but be clear that he/she does not have a choice about getting the procedure done. For example, let him/her choose what arm he/she would like to have his/her blood pressure taken or if he/she would like to watch or not watch a procedure. When appropriate, allow the child to choose favorite activities or games to play after a procedure.
• Stickers and/or incentive charts work well for this age, not necessarily as a reward for good behavior, but as a way of helping establish routines for medical procedures that occur frequently with your child's hospitalization.

School Age (5 to 12 years old)

• Diversional activities during procedures can include the use of search and find books (i.e., I Spy, Where's Waldo?), pop-up books, glitter wands, music (i.e., listening to favorite music on headphones during stressful times).
• Relaxation techniques include deep breathing, using bubbles, blowing a pinwheel or listening to a favorite story.
• Encourage your child to ask questions and express feelings about the hospital/diagnosis. Answer questions honestly, and help him/her work through his/her feelings.
• Validate his/her feelings, reassure him/her that it is OK to feel mad or frustrated, and when your child is frustrated with their illness or injury, ask him/her, "What can I do to make today better for you?"

Adolescents (12 years and up)

• Allow and encourage the teen's participation in his/her health care and decisions.
• Encourage peer interactions and visits from friends when appropriate.
• Relaxation techniques during tests and procedures may include the use of music, deep breathing, imagining a favorite or comfortable place or activity.
• Provide the reason for a procedure and describe exactly what is going to happen.
• Although adolescents are becoming more independent, they still need the support and supervision of their parents/guardians. Make sure that you continue to support and encourage your adolescent. Remember to talk to him/her often, and offer help, encouragement and positive reinforcement.

Helping Siblings Cope with the Heath Care Experience

Siblings of a child who is receiving medical care have a great need for information. Although parents may want to protect a child from this information, what the sibling may be imagining about their hospitalized brother or sister could be far more frightening than the reality.

Parents know how a child copes with change and should decide how much information share. Keep communication open and honest. Provide opportunities for them to ask questions.

Before a sister or brother visits the hospital for the first time it is helpful to check if he/she has a clear understanding of what the hospital is and the role of nurses and doctors. It is also helpful to explain some of the medical equipment they will see in a way that they can understand. Children's storybooks about the hospital are also helpful in explaining the hospital.

When siblings are unable to visit the hospital, it is important for them to remain connected to their brother or sister. Some ways they can maintain communication are: making regular telephone calls, and sending drawings, letters, photos and home videos.

Maintain a normal routine as much as possible. Encourage the sibling to go to school and participate in normal activities. It is important for both parents and siblings to spend time together away from the hospital.

Siblings often experience many different feelings and emotions when a brother or sister is hospitalized. As a parent, it is important to know that these reactions are common and a normal part of a sibling's adjustment to their brother's/sister's illness or injury.

Some of the common reactions siblings may experience include:

• Guilt - Often siblings feel responsible for the hospitalization. They think that something they did or said caused the illness/injury to happen.
• Fear - Siblings worry that their brother's or sister's illness or injury will happen to them.
• Jealousy - Siblings may feel left out when the hospitalized child receives more care and attention (also gifts) from other family members.
• Anger - Siblings may be angry or upset about the changes at home and in their normal daily routine that the hospitalization has created.
• Neglect - Siblings may feel that their parent/guardian no longer loves or cares for them when more time is spent with the hospitalized child.