"Am I here because I've been bad?"
"Is it going to hurt?"
"Am I going to look different?"
"If my stitches open will everything pop out?"
"Will I wake up during the operation?"
"Where will you be? Are you coming back?"
Fears commonly heard from hospitalizes children.
Up until 10 to 15 years ago, a child who was hospitalized was allowed to see his parents only one or two hours a day, and at many hospitals, only certain days of the week. Those frustrating, limited visits often would end with the raising and clanging of bed-rails, followed by the disturbing sound of children crying into the night.
The psycho-social problems that developed from this ridiculous but true separation routine finally proved to professionals that a hospitalized child does need his parents, and in a very special way.
According to recent surveys -- although many with pediatric departments have extended parental visiting hours -- many hospitals do not have the appropriate facililties, support programs, or skilled staffs to maximize the benefit of parent involvement. Child health-car professionals emphasize that "simply allowing parents to visit is not enough."
"The first place where the parent can make a difference is in the selection of the physician and hospital," advises Beverley Johnson, executive director of the Association for the Care of Children's Health (ACCH). "Parents need to look very carefully at the philosophy of the physician's practice. Is the physician concerned with both the physical and emotional parts of the family . . . then check his hospital and make sure it has a pediatric unit that also meets these needs.
"When you're taking your child to the doctor for well child care, talk about what this all means . . . the weighing . . . measuring . . . taking blood pressure, and explain why it's important to see the doctor."
This early exposure to routine medical care gives the child a base of information, should he or she be hospitalized.
A trip to the emergency room -- whether it be for stitches or a concussion -- can be upsetting for parents and child alike. The unfamiliar sounds, smells, sights, the sudden exposure to so many new (sometimes strangely dressed) people going in and out of the treatment room, asking questions, setting up equipment and touching the child (often where it hurts) is usually described by children in one word: "scary."
"It's hard to prepare families for the emergency room," says Johnson, who also works closely with special projects at Children's Hospital. "A child needs continued contact with the parent. Explanations are needed as to what's happening and parents can help to give that.
"A lot of professionals differ on this, but I'd like to see as many parents as (emergency room) participants as possible. This doesn't mean the child's not going to be upset, or not going to cry by the parents being there, but he won't feel abandoned."
After an emergency-room experience, a child may need to work out anxious and angry feelings for as long as "several weeks or months."
"He may not be able to verbalize (anxieties) at all," says Johnson, "but you can watch the intensity with which he plays . . . how hard he bangs the playdough . . . what he does with his teddy bear and toys."
Children often regress in development after hospitalization. Four-year-olds go back to the bottle, 6-year-olds wet the bed, others may step up their temper tantrums or hit their little sister one time too many. Again, ACCH's advice is for parents to be patient and gradually help the child return to normal behavior.
ACCH, which represents about 1,000 health-car and education institutions, recommends preparing children for hospitalization through preadmission programs "which give simple, truthful explanations."
At Holy Cross Hospital in Silver Spring, the colorful mural-filled pediatric ward of 34 beds is far from "scary," thanks to a successful pre-op program conducted by child-life play-therapist Briget Barr.
"I think it's better for the child to see the real thing," says Barr, who every Wednesday evening takes a group of children (age 2 to 10) and their parents through a step-by-step procedure of their upcoming hospitalization.
As parents watch, the children see and touch syringes, masks, rubber gloves. They are shown where they'll sleep and play, the operating room, recovery room and even the room "where Mom and Dad will be waiting" during their operation. "The whole pre-op process helps the parent's anxiety level just as much as the child's" says Barr, who is trained to work (children call it "play") with them throughout their hospitalization.
If a parent is anzious, more than likely the child will sense that anxiety and make it his own.
A parent needs to "identify positive or negative feelings about hospitals," says Johnson, who suggests that parents ask themselves questions like: How many times have I been a patient, and in one word how would I describe my hospital experience? Do I like to visit sick relatives or friends at the hospital? If the answers show negative feelilngs, she advises parents to talk it out with someone before their child needs to rely on them for emotional support.
Other recommendations from Johnson and ACCH:
If you have to leave, be sure to tell your child where you are and when you'll return.
Find out if your child can wear his own pajamas or even street clothes in the hospital.
Pack favorite toys and photographs of the family.
If the patient is school age, notify the child's teacher about the hospitalization. "Together, as partners, parents and teachers can help the child make the adjustment, not only with that child, but with the other children in the classroom."
Explain the situation to siblings, who may feel left out or guilty. "Siblings need explanations just like the patient. It used to be that hospitals feared infection from siblings, but the professionals have learned the psycho-social risks are much greater. So the system is changing, and hospitals like Children's (and Holy Cross) have flexible visiting hours for siblings.
Might parents tell their child and siblings too much? "A parents knows his child best," says Johnson. "Some need a lot of time, some need more information than others, others don't want it. Age is another factor. Young children need brief information, older children need more details.
"And when the child returns from the hospital, listen and watch what he does when he plays. He may express to this toys, and not to you, a total distortion of what happened. Then you can step in and make it clear what really happened."