When we talk about children and hospital, we can say that admission to hospital will be a distressing for everyone, especially the children and their parents. Small child, especially those under 5 years old may be frightened by a lot of things including the illness itself. Painful procedures like intravenous infusions and blood tests can be very terrifying. However, separation from family and being to an alien place can be the most upsetting to these children. This is the reason why it is very important that someone close to the child to stay together in the hospital. These people not only will help with nursing like feeding and toileting, but they may comfort the small child, which is the most important task of all.
In my experience in pediatrics ward, some parents can be very wonderful, but some can be very annoying (sad but truth). I am sure they are very worried about their child however it will be a great help if they understand that we doctors and paramedics are trying very hard to make things better for their children. However, most of the relatives are very helpful and understanding, which I do respect and appreciate. Parents, siblings and other relatives on the ward often add to the work of the staff because they naturally expect to ask questions about tests and treatment they see. I don’t have any trouble at all to entertain those as long as I have enough spare time to do so. In my experience in pediatrics department, the staffs are usually willing to spend time with the children and parents as long as they have opportunity to do so. Even so, their presence in the ward helps all the staff to care for the child better, and makes stay in the hospital less fearsome. A controlled trial has shown that after effects, such as nightmares, clinging and recurrence of enuresis were less common in children whose mothers stayed with them in the hospital.
A good children hospital will provide a space for playing and schooling which are essential for the children, especially when they have been in ward for a long period of time. Play will allow the children to bear the strain of the hospital admission and separation from family. This often reveals information about their physical and emotional problems. Furthermore, it is very important that a long illness do not interrupt their school work.
Over the last 50 years, children health care has change a lot. The good thing is that pediatrics departments in many centre is now applying the policy and try to keep hospital admission as short as possible and tends to discharge patients as soon as they recover. Every effort is made to minimize the child’s stay in hospital. Many medical and surgical procedures are done as daycare cases where parents are actively involved in their children’s care. Outreach nursing teams and day assessment units significantly reduce the need for hospital admission. Neonatal care also makes increasingly heavy demands on resources. My own practice is try not to admit the children if possible (if the illness is mild and the care takers and their transportation is reliable should the child deteriorates at home). However, I will arrange for a near appointment for follow up if necessary.
Hospitals are not a risk free place. The children are exposed for cross infection. Long unnecessary hospital stay will lead to other social problems, school refusal, etc. One may not realize that the mother-child bonding has been broken (especially 1-4 year olds) and need to be rebuilds. At this age, the children are old enough to grieve over the separation from their mother but still very young to understand the reason and the separation are only for a brief period. For these toddlers, tomorrow has no meaning at all and what they care is “now”.
A toddler that has to be separated from mother will usually undergo 3 important stages; protest, withdrawal and denial. Initially they will protest and cries for the mother. The withdrawal stage involves emotional deprivation when this child may losses interest in food and play. They may refuse to communicate and choose to stay alone on their bed. The worse stage is denial where they seem to be happy and making indiscriminate friendships with people around them. One might thought that the child has settled but the truth is the mother-child relationship has been broken and like I’ve told earlier, it need to be rebuilds. Once they return home this child may exhibit tantrums, enuresis, etc. These problems can be avoided or minimized by prevent or reduce hospital stay and arrange for parents to stay with them in the ward or arrange for frequent visit if the parents cannot stay with them.
I have got colleagues that ends up come to the hospital every day, including weekends and may stay late throughout the night before going home each day. I did that myself when I was in the pediatrics department. I keep wondering what it feels like to do the same thing each and every day for the entire life and ends up ignore our own children and family at home. No need to say that they need us as well. Hmm… that is why I am very proud of my colleagues that willing to dedicate their life to the unfortunate children. I am sure that Allah will repay what you have done (and will do) for these kids.
Reference:
- Simon J Newell et al. Lecture notes Paediatrics. 8th edition. 2008. Blackwell Publishing.
- Paediatrics Colour Guide. Mosby Elvisier.
