It is generally agreed that it is more difficult for human beings to face the unknown than the known. The child entering the hospital, especially for the first time, is facing the unknown, and his anxiety in this situation may be extreme. This paper is concerned with the role of the physician in minimizing this anxiety as he prepares his patients for hospitalization and supervises the child's care in the hospital.Over the past 20 years many studies have been conducted to determine the emotional effects of hospitalization on the child.* Observations have been made of significant changes in the behavior of the child which were not present before hospitalization, the duration of such changed behavior, and the age groups in which it has occurred. It was found that 20% of the hospitalized children showed the following significant behavior changes after hospitalization (in one study this figure reached as high as 50% )4: regressive behavior, with extremely increased dependence, loss of bowel or uri¬ nary control, loss in the ability of self-help; fears-excessive fears of hospitals, white coats, darkness, strangers, bodily harm; sleep disturbances-night terrors, difficulty in going to sleep; speech disturbancesvoice changes, refusal to talk; eating dis¬ turbances; tics and mannerisms; negativistic reactions-disobedience, temper tan¬ trums, defiance, destructive behavior.The change in behavior ranged in dura¬ tion from several months to three or four years. Approximately 50% of these children were under the age of 4 years at the time of hospitalization. From these stud¬ ies,! it was concluded that emotional trauma in the hospital experience may be pre¬ vented by (a) an adequate parent-child re¬ lationship; (b) proper preparation of both the parent and the child for the experience of admission, hospitalization, and discharge, and (c) modifying the hospital experience as much as possible to meet the endurance of the child and his parents.Modern pediatric training stresses the importance of the physician in helping par¬ ents build an adequate parent-child relation¬ ship. This point, however, is not within the scope of this paper. We are concerned here with what we as physicians can do about the preparation of the child for hos¬ pitalization and about modifying the hos¬ pital experience to meet the needs of the child and of his parents, as well as our own.
A complete family history as to the past seizures experienced by the patient or by members of his family may be revealing and helpful in establishing a diagnosis of abdominal epilepsy. In our study 19 of the 46 children revealed a past history of seizure state and 25 had experienced febrile seizures in infancy. Detailed consideration of the type of pain, its site, and allied symptoms should be evaluated carefully. Disorientation during an episode of pain followed by exhaustion and sleep is suggestive of abdominal epilepsy. Electroencephalography is usually helpful in supporting the clinical diagnosis of abdominal epilepsy. Discussion with the child and his parents, when practical and possible, in regard to the diagnosis and therapy, is recommended. Clarification and definition of the regimen and of the condition are essential, as the term "epilepsy" still carries a stigma to the lay person. Consideration of the patient and parental feelings and attitudes leads to understanding, co-operation, and ultimate success in the control of symptoms.
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