At this stage, infants learn through their senses and are very attached to their primary caregivers. During hospitalizations, stressors include: separation from parents, stranger anxiety, and impaired soothing needs. These can lead to crying and irritability. To help this age range cope, parental presence is essential. We empower parents to hold infants and reassure them that they will not hurt their baby with the IV line and pulse oximeter. Talk to the baby before touching and limit the number of caregivers in the room. Distraction tools to use are: light up and pop up toys, music, touch, and singing.
As children develop in this age range, mobility increases greatly, language starts to develop, and attention spans are short. Hospital stressors include: stranger anxiety, loss of control and mobility, back-laying (feeling vulnerable), loud noises and sudden movement.
At this age, children do not have a strong sense of time. When you are scheduled to visit the hospital, it is not necessary to tell him/her weeks in advance. You can start to read basic books about the hospital a few days in advance (see recommended reading). Giving them control is helpful; have them pick out a stuffed animal or favorite toy to bring with them.
Use soft words to describe the experience. You can say “the soft squishy mask will help make you feel sleepy or take a nap so nothing hurts. After the Doctor looks in your mouth you will feel better.”
To help them cope in the hospital allow for them to walk or move around, parental involvement and presence, and use simple explanations. Light up toys, music, videos, bubbles, and books are helpful for comforting your child. It is normal for children this age to resist treatment. Sitting up or lap sitting is reassuring for children in the OR. Talk to them as they go to sleep and hold them to reassure everything will be okay.
Children in this age range become very egocentric. Their language becomes strong and they have magical thinking. The concept of time is still limited, and misconceptions develop from lack of understanding. In the hospital setting, they will cling to parents or loved ones in fear of separation. They become more aware and fearful of the environment and medical equipment. It is normal to see their behavior regress; they may choose a baby toy and speak like a baby. They can get irritable, throw tantrums, and become angry. Reassure them they have done nothing wrong to avoid guilt. Start to read hospital books a few days in advance (see recommended books). Tell them they are coming to the hospital to help them feel better. Use soft language when describing things and be realistic and truthful. Avoid words like cut, bleed, or shot and correct any misconceptions. Allow for manipulation of equipment and explain in concrete terms (touch, smell, taste, sound and sight). Have them bring a favorite item from home. Keep them busy and distracted through play, movies, and music. When going into the OR, allow them to play with the anesthesia mask if interested. They can pick their scent to breathe and stickers to decorate to make it their own. Explain, “this squishy mask will help them feel sleepy or take a nap so nothing hurts.” They can walk into the OR and you can suggest sitting so they don’t feel so threatened in the room. Continue to use distraction by talking, singing, watching movies or listening to music. Let them choose which distraction. At this age, role play may begin to develop. For frequent patients, we can offer common medical equipment such as a mask, pulse oximeter, hospital PJs, hats, gloves, band aids, and gauze to take home with them. They can use the objects in a fun manner at home with stuffed animals and dolls. This will desensitize the equipment and encourages them to control it in play. Encourage this play close to coming back for surgery. This may open questions to help ease their concerns.
Children in this age range have developed good friends and are very involved in school. They develop concrete thinking and are active learners. They understand their body and increased participation in their self-care. In the hospital setting, they are fearful of loss of bodily control, loss of competence, fears of pain, death, and anesthesia. Often times their behavior can become withdrawn, regressed, depressed, or acting out. It is important to talk to them about why they are going to the hospital. Ask if they have any questions or concerns. Reassure them it’s normal to feel nervous or uneasy. Allow for them to bring a favorite hand held game, movie, book, or craft activity. We will also offer these interventions during their stay. Many times anesthesia is a stressor for this age. Children don’t like to feel loss of control. It is important the anesthesia techniques are explained to them so they won’t feel surprised. For example, “the anesthesia gas is strong smelling.” Talk about coping techniques. Would it be best to take 10 deep breaths, close your eyes, listen to music, or play a game while breathing the mask? Include them in participating in their care. The discussion of having an IV before going to sleep may start depending on the age and weight of your child. In this case, education and preparation is important before starting that. To help ease their anxiety, use humor/jokes, games, movies, or deep breathing; all of these can help. For future visits, we can ask what worked best or what we can do different to help their experience here.
As adolescents develop, their bodies are constantly changing. This contributes to their self-esteem and need for privacy. They are identifying their interests, strengths, and socialization is very important to them. In the hospital setting they fear loss of control and independence and restriction of activities. Adolescents may become defensive and uncooperative. Be sure to involve them in the planning of their surgery. Encourage them to write down concerns and questions they may have. They should be a part of their care plan. Talk about their fears and be very honest. Allow them to bring music devices and tablets, or they can use ours that are offered.