Pediatric concerns refers to those issues that are unique to the care of children when surgery and hospitalization are involved.
Children are not just little adults. When dealing with children medically, it is important to keep in mind the stage of their physical growth and development; their emotional development; and their maturity level. There are many different kinds of pediatric surgeries and procedures. A pediatric hospital is planned around the special needs of children and their families. All of the staff, including doctors (pediatric surgeons, pediatric anesthesiologists, pediatric radiologists), nurses, and technical support, have special training in pediatrics. Children's hospitals have specific expertise in pediatric problems and special programs for children who are ill or injured.
When parents are helping their child prepare for surgery, it is important to realize that, no matter how mature the child may act, he or she still needs to be treated differently than adults. Some children find it comforting to know exactly what will happen, when, and how, all in great detail. Others do not want much detail. They may need just an overview of what to expect, keeping just one step ahead of what will be done to them. The particular level of a child's development will determine the specific concerns.
For example, the biggest fear for infants and toddlers is being away from their parents. Parents should stay with the child as much as possible, and ensure that basic needs (such as eating, play, or sleeping) are met, both at home and in the hospital. Preschoolers also fear being away from the parents, but, additionally, they see hospitalization as a punishment and fear bodily harm. In this case, parents should, again, stay with the child as much as possible, and start talking to them at home about the coming operation to help reassure them. For the hospital stay, parents should bring the child's favorite blanket and/or toys, pictures from home, and maybe music tapes.
For school-age children, the biggest fears are needles and pain. Parents can help by giving them information about their body and how it works, and vaguely explain that the doctor will fix them, but parents should not use language like "cut, incision, open you up, make a hole, etc." To make the hospital feel more familiar, parents can bring pictures and music tapes and/or videos from home. By adolescence, children are worried about the loss of independence, being separated from their peers, and being different (i.e., a change in their appearance). For teenagers at this stage of development, it is extremely important to explain an illness or hospitalization to them in terms that they can understand, using examples to which they can relate, and allow them to be involved in decisions, if possible. The parents should encourage them to ask questions.
Being in a hospital and undergoing surgery is scary and stressful for a child. Hospitalization disrupts their normal routines. If the staff behaves in a trusting, nurturing way, the child may become comfortable enough to return to some normal behaviors. Trust is important to all ages of children. If a procedure will hurt, it is important to be honest and let them know what to expect. Children can only learn to trust the staff if the staff is honest with them and treats them with respect.
Books and videos developed for children that explain about going to the hospital can be helpful. Some hospitals provide programs for children to come and visit before hospitalization, so that children will already be familiar with the hospital environment when they are admitted. Play is a child's way of expressing emotion, especially under difficult situations. Play can serve as a distracter as well as a means by which surgery and hospitalization can be explained to children. Dolls or stuffed animals can be used to walk young children through what they will be experiencing. Hospital play areas will often have toys that represent hospital equipment, so that a procedure can be explain with the use of props. For example, there may be pretend casts and bandages that a child can put on a stuffed animal. How children play can also serve as an insight for parents and staff as to understand how their children are feeling about what is happening to them. As children express their concerns through play, parents and staff can then address those concerns. Play is therapeutic for children, helping them feel safer in an unfamiliar environment, and should be considered an essential element in preparing for a child's hospital stay. Play areas help to make a strange place feel comfortable, both for the child as well as for the parents. Play areas also provide a relaxed area for parents to be with their child, a friendly home-like environment where nurturing can take place.
Unfortunately, some surgeries are not planned. Emergency situations are always more stressful, both because they are unexpected and because they are often more serious. Children take their cue on how to behave from those around them. When parents are noticeably concerned, children's anxiety levels rise. Parents should remain as calm as possible to be fully present for their children.
Parents should expect to be able to be with their children most of the time. For most day surgeries, parents can stay with their child until he or she is asleep, and then can be waiting in the recovery room when the child is waking up after the procedure is completed. Some facilities provide pullout beds for parents to spend the night with their children, and may even have a small kitchen where they can prepare food to eat in their child's room.
Qualified staff should be available to help parents work through their concerns and anxiety. Parents with more than one child may sometimes need to leave their hospitalized child completely in the hands of hospital staff as they attend to their other children at home. Many facilities have volunteers who can stay with children when their parents need to leave the hospital.
While those hospitals designed especially for children are a wonderful resource, other hospitals that care for patients of all ages will often provide comparable care. If the surgery allows for time to select a surgeon and hospital, things to look for include:
A pediatric hospital or wing will have equipment that is smaller, better suited to the child's size. Bandages may have pictures of cartoon characters on them; there may be paintings of characters from children's movies on the walls.
Staff will usually have had special training to understand what issues are important to children at different stages of development. They should use language that is adapted to explain what is happening to the child in ways that make sense to them. For example, instead of just asking a child to blow, they may ask them to imagine that they are blowing out candles on a birthday cake. All of these techniques help to make the hospital a more familiar and friendlier place, putting the child at ease and helping to lessen anxiety.
Hautzig, Deborah, Dan Elliott, Joseph Mathieu, and Joe Mathieu. A Visit to the Sesame Street Hospital: Featuring Jim Henson's Sesame Street Muppets. London: Random House, 1985.
Rogers, Fred. Going to the Hospital. New York: Penguin Books for Young Readers, 1997.
The Nemours Foundation. http://kidshealth.org .
Esther Csapo Rastegari, RN, BSN, EdM