Preparing Your Child for a Visit to Gillette Children’s
The following are some coping strategies to help your child and your family deal with a medical environment. Children of different ages have unique physical and emotional needs:
- Infants (birth-12 months)
- Toddlers (13 months-3 1/2 years)
- Preschoolers (3-1/2 to 5 years)
- School-Age Children (6-12 years)
- Teens (13-18 years)
When a brother or sister goes to the hospital
Book Resources
For more information, please contact a child life specialist at (651) 229-3936.
Infants (birth-12 months)
Reactions to Health Care Settings or Medical Procedures:
An infants’ basic needs include trust, love and security. Human contact is the most important need, with toys as a secondary source of stimulation. An infant depends on a caregiver to respond to cues that may indicate the infant is experiencing fear, pain or discomfort. Examples may include irritability, decreased activity level, sleeping more, loss of interest in familiar materials or a decrease in appetite.
Preparing yourself and your infant:
You should ask for a complete explanation of the procedure your child will undergo and the role that you could take in consoling your infant.
Ideas for helping your infant cope:
Sensory
- Patting
- Stroking
- Sucking a pacifier
- Cuddling
- Positioning — holding on your lap or over your shoulder
- Music
- Familiar blanket to hold
- Rapid rocking
Cognitive or behavioral
- Mobiles
- Objects that change shapes, colors or positions
- Bubble blowing by an adult
- Holding a familiar toy or stuffed animal
- Mirrors
- Playing “peek-a-boo”
Toddlers (13 months-3 1/2 years)
Reactions to Health Care Settings or Medical Procedures:
Children in this age group begin to differentiate parents from other figures and react with “stranger anxiety” when confronted with unfamiliar faces. This struggle between independence and dependence leads to a show of defiance, negative attitude and/or temper tantrums. Children in this age group often perceive pain as punishment. They are more likely to actively resist during painful procedures.
Preparing yourself and your toddler:
You should ask for a complete explanation of the procedure your child will undergo and clarify the role you as a parent can take during the procedure.
Tell your child when you will be present. If you are not able to be present, remind your child that you will return. Your presence is the best source of comfort and support. With your child, talk about procedures in general terms that they can understand. If possible, use play medical kits and rehearse with a doll or stuffed animal to demonstrate procedures to your child.
Ideas for helping your toddler cope:
Sensory
- Patting
- Stroking
- Sucking on a pacifier
- Cuddling
- Positioning — holding on lap, or shoulder
- Music
- Rapid rocking
Cognitive or behavioral
- Nursery rhymes
- “Pat-a-Cake”
- Books — picture, pop-up
- Puppets/dolls
- Bubble blowing
- Singing favorite songs
- Pounding toys
Imagery
- Speaking to your child through a doll or stuffed animal
Preschoolers (3 1/2 to 5 years)
Reactions to Health Care Settings or Medical Procedures:
Children in this age group are developing imaginative and magical thinking. At this age, children often perceive pain as a punishment. They may have more difficulty in identifying the source or the location of pain. They are likely to actively resist during painful procedures and often fear permanent damage to their body. This is especially true if the doctor is going to fix something inside their bodies that they cannot see. As a result, children may exhibit behavior changes or regress to earlier childhood behavior such as tantrums, clinging, being quiet or withdrawn, anger, aggression or non-compliance.
Preparing yourself and your preschooler:
As a parent, you should ask for a complete explanation of the procedure your child will undergo and clarify the role you can take during the procedure. Encourage your child to bring a familiar toy or security object from home to offer comfort. Ask to be present during procedures. During the procedure, give your child positive messages, be honest about what will happen and what will hurt. Ask your child what will help, rehearse it before and talk about it afterward, and never use medical procedures as a threat to the child. Reassure your child that they will come home again.
Tell your child when you will be present. If you are not able to be present, remind your child when you will return. Emphasize that only certain parts of the body will be involved. Explain the purpose of the procedure. Reassure your child that no one is to blame for their illness, injury or hospitalization. Give a simple explanation of what the child will experience and why. Provide them with constant verbal support and encouragement.
Ideas for helping your preschooler cope:
Sensory
- Patting
- Stroking
- Music
- Handholding
- Movies
- Talking softly
- Squeezing a hand, putty or pillow
Cognitive or behavioral
- Deep breathing
- Blowing bubbles
- Pinwheels
- Sound books
- Counting
- Singing favorite songs
- Magic wands
- Hand-held games
Imagery
- Pretend situations:
— Trip to the park
— Blowing out candles
— Creating a fun place
— Storytelling
School-Age Children (6-12 years)
Reactions to Health Care Settings or Medical Procedures:
Children in this age group are beginning to understand and be interested in body structure and function. This can lead to many questions about what will happen in the hospital or clinic, or how they may look different after a surgery. They are developing a sense of independence and enjoy being given choices when available. They may interpret medical procedures as punishment for past mistakes or bad deeds, and worry about pain or even death. Concrete explanations of procedures or surgeries in terms that your child can understand will help clarify misconceptions.
Preparing yourself and your school-age child:
You should ask for a complete explanation of the procedure your child will undergo and the role that you can take in consoling your child. If possible, allow your child opportunities to make choices in the health care setting; for example, which arm to choose for a blood test, or whether to swallow or chew medicine.
Tell your child:
- What they will experience (sensations, duration, what will or won’t hurt)
- When you will be present
- How they might look or feel afterward
- That they can ask questions and actively participate in making some choices
- That they can bring familiar items for comfort (favorite toys, books or music)
- That it is okay to feel scared, upset or angry
Ideas for helping your school-age child cope:
Sensory
- Music
- Handholding
- Movies
- Squeezing a hand, putty or pillow
- Talking softly
Cognitive or behavioral
- Deep breathing
- Blowing bubbles
- Magic wands
- Counting
- Singing favorite songs
- Hand-held games
Imagery
- Stories
- Conversation about a fun topic
- Plans for after the procedure
- Go on a pretend trip
Teens (13-18 years)
Reactions to Health Care Settings or Medical Procedures:
Teens are developing an increasing sense of self-identity and need for privacy. They struggle with conflicts between dependence and independence. They desire information about their health care needs and should be talked to directly about their concerns. Validation of fears or concerns about medical procedures will assist in promoting a sense of self-esteem. Increasing changes in their bodies lead to concern about body image, and a need for peer contact and acceptance. Changes in behavior may occur with hospitalization such as aggression, isolation, opposition to authority, withdrawal and fatigue.
Preparing yourself and your teen:
As a parent, you should ask for a complete explanation of the procedure your child will undergo and the role that you could take in supporting your teen. Ask your teen what they understand, and clarify any misconceptions. Offer your child the opportunity to talk to health care professionals alone. Allowing your teen to discuss concerns about health issues privately will promote self-confidence and a greater comfort level with professionals.
Tell your teen:
- It’s important to ask questions
- About any physical changes that may be visible after a surgery (stitches, bandages, casts or orthopaedic devices)
- What choices may be available
- How they can maintain contact with other family members and peers during their hospital stay (phone calls, visits, mail, etc.)
Ideas for helping your teen cope:
Sensory
- Music
- Handholding
- Movies
- Squeezing a hand, putty or pillow
- Support from a friend
Cognitive or behavioral
- Deep breathing
- Hand-held games
- Magazines/books
- Drawing or journal writing
Imagery
- Going on a trip
- Conversation about a fun topic
- Visualize a favorite place or activity
When a brother or sister goes to the hospital
When a child goes to the hospital, the experience can be as frightening for the brother and sister as it is for the patient.
Finding themselves separated from their parents, the brother and sister may feel abandoned, rejected and angry that their parents let the other child become sick in the first place. Or the brother and sister may feel responsible for the illness, and feel guilty for having angry thoughts about the hospitalized child. They may be afraid of being sent to the hospital themselves. If they have been sent to stay with relatives, finding themselves in an unfamiliar setting with unfamiliar routines could make the problems worse.
How siblings react to the hospitalization of a brother or sister is affected by:
- Age(s) of the child(ren) at home
- Length of the child’s hospital stay
- Seriousness of the hospitalized child’s illness or disability
- Amount of time the siblings are separated from their parents
- Quality of explanations and answers to the siblings’ questions about hospitalization
- Attention that is given to the siblings’ feelings
- Nature of past experiences with hospitals
- Nature of past experiences of separation from parents
What to expect:
Children often supplement incomplete information with fantasies that are worse than the real situation. Children may express feelings about a brother or sister’s hospitalization by:
- Eating or talking less
- Withdrawing
- Acting in a way that gets more attention
- Displaying stored-up feelings, particularly related to anger, fear or feeling left out
- Returning to behaviors from an earlier age (bed-wetting, thumb-sucking, carrying a security blanket or toy, eating with fingers)
How to help children cope:
- Give honest answers to questions about hospitalization that are appropriate for the child’s age level. Allow the child to ask questions and express feelings.
- Preparing and helping to plan are as important for the healthy child as for the hospitalized child.
- If an emergency hospitalization occurs, explain it to the healthy child as soon as possible.
- Allow brothers and sisters to take the hospital tour with the sibling, if possible.
- Act out hospital experiences with people, dolls or puppets. Using puppets is a good way for children to express feelings they may be uncomfortable saying otherwise.
- Read stories or provide coloring books about hospitals, or let the child make their own story or picture book about what it is like to have a sibling go to the hospital.
- Allow the siblings to visit the hospitalized child, if possible. This may help clear up misunderstandings or fears they may have and it provides them with valuable information.
If you must be away from home with the hospitalized child, attempt to have daily contact with the child at home. Here are some activities that may help both the parent and the hospitalized child stay involved with other brothers and sisters:
- Write or tape-record “letters” or phone the siblings as often as you can. It’s OK if a young child cries when hearing your voice. This is how they say they miss you, and they will feel better knowing that you know.
- Videotape or tape-record bedtime stories, or read them over the phone.
- Send a new piece of a puzzle every day.
- Send home unused trinkets from the hospital, such as plastic tableware, seasoning packets, straws and other safe, disposable items.
Book Resources
Reading together is a great way for you and your child to learn more about the hospital stay. For ideas, talk to your local librarian and use the following reading list:
Toddlers and preschoolers:
- Hautzig, D. and M. A Visit to the Sesame Street Hospital. Random House, 1985.
- Rogers, F. Going to the Hospital. Putnam, 1988.
School-age children:
- Banks, A. Hospital Journey, A Kids Guide to a Strange Place. Puffin Books, 1989.
- Hogan, P. and K. The Hospital Scares Me. Raintree Publications, 1980.
- Howe, J. The Hospital Book. Beech Tree, 1994.
- Reit, S. Jenny’s in the Hospital. Golden Book, 1984.
Adolescents:
- Richter, E. The Teenage Hospital Experience.
- Coward, M. and G. You Can Handle It. 1982.
Siblings:
- Becky’s Story. Bethesda, MD: Association for the Care of Children’s Health, 1981.
- Duncan, D. When Molly was in the Hospital: A Book for Brothers & Sisters of Hospitalized Children. Rayve Productions, Inc., 1994.
- Rogers, F. Going to the Hospital. New York: Putnam, 1988.
- Peterkin, A. What about Me? When Brothers and Sisters get Sick. Magination Press, 1992.
- Walkden, M. and Congdon, B. Special Gift for Mike. Houston: Texas Children’s Hospital, 1988.
Videos that may be helpful:
- My Brother is Sick. Kids Corner. Timonium, Md.: Milner Fenwick, Inc. Focuses on the emotional response of a well sibling to the hospitalization or her brother.
Books for parents:
- Going to the Hospital. Bethesda, MD: Association for the Care of Children’s Health, 1986.
