The Child's Emotional Response to Hospitalization

Abstract

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.

Postoperative behavioral changes following anesthesia with sevoflurane

“…The reported incidence of NBC in children following surgery and hospitalization varies from 22 to 92% (11–14). In a series of studies, using the PHBQ Kain et al .…”

“…The reported incidence of NBC in children following surgery and hospitalization varies from 22 to 92% (11)(12)(13)(14). In a series of studies, using the PHBQ Kain et al reported an incidence of NBC of 23-54% persisting at 2 weeks following anesthesia and surgery (8,(15)(16)(17).…”

Marking the 50th anniversary of the Platt Report: from exclusion, to toleration and parental participation in the care of the hospitalized child

“…For working-class children, whose care was funded by charity, visiting was restricted to twice a week for two hours and mirrored that allowed in most British hospitals. Even so, within America there were those, such as Gofman et al, (1957), who drew attention to the adverse emotional effects of hospitalization on children and Gellert (1958) who also called for frequent visiting by parents to minimize these. Clearly on both sides of the Atlantic and across Europe there were those who were in favour of unrestricted visiting and those who were not.…”

Communicating With Sick and Hospitalised Children

“…She finds that studies of sick children by Beverely (1936), Richter (1943), Dubo (1950), Brazelton et al (1953), Gips (1956), Schechter (1961), Lynn et al (1962), Rutter (1969), Smith (1973) and Peters (1975) all point to the conclusion that many sick children perceive their illness as a form of punishment for their own wrong-doing. Only work by Goffman et al (1957) stands in contradiction to these conclusions. Most workers suggest that the tendency to self-blame for illness decreases with age.…”