Hospitalization Issues Listed by Stages of Development

INFANTS

Basic Fears: Loss of support, loud noises, strangers; Sudden unexpected and looming objects; Separation from parents

Responses to Hospital: Unable to communite verbally; Separation distress, irritability; Increased crying, decreased play; Schedule is upset; Tactile hyersensitivity; Lethargy

Supportive Care: Swaddle, hold, rock, speak with a soothing voice; Play soothing music and comfort infant when distressed; Verbally label everything you do and talk to child before touching infant when distressed

TODDLERS

Basic Fears: Loud stimuli, dark rooms; Large objects or machines; Changes in personal environment; Masks

Response to Hospital: May view hospital as punishment; Increased cryng, decreased play; Decreased appetite; Beginning to verbally communicate pain, irritable; Temper tantrums; Refusal to eat

Supportive Care: Provide toys, play activities; Sing favorite songs; Rocking, stroking; Blow bubbles, read books; Tell stories with puppets; Avoid interrupting regular schedule; Whenever possible, allow safe expression of anger with pounding toys, toys that can be squeezed or manipulated

PRE-SCHOOL

Basic Fears:  Separation from parents; Dark rooms, noises; Unfamiliar places; Strangers, "bad" people; Bodily harm

Response to Hospital: May view hospital as punishment; Regression (baby talk, diapers); Aggressive behavior; Can verbalize pain; Nightmares, misconceptions of treatment

Supportive Care:  Deep breathing, bubble blowing; Toys that capture their attention; Glitter wands, view finder, books; Create a pretend place and describe; Needs opportunities for expressive play and mobility; Allow safe expression of anger by providing pounding toys, tactile substances such as playdoh or paint, outlets and books describing feelings

SCHOOL AGE

Basic Fears:  Supernatural beings (ghosts, monsters); Bodily injury; Physical appearance; Thunder, lightning, dark; Sleeping or staying alone; Separation from parents; Death

Response to Hospital:  Regression; Aggressive behavior; Will test authority; May withdraw, deny favorite activities; May virtualize pain, but may not report if anticipates a "shot"; Withdrawal

Supportive Care:  Encourage peer interactions; Games: electronics, video, board; Search and find books; Favorite music, computer games; Deep breathing, relaxation tapes; Counting games and pretend stories; Conversation involving their interests; Provide choices when appropriate; Allow safe expression of anger through expressive toys, and art activities, physical activites/outlets, writing about feelings, and providing books about feelings

ADOLESCENT

Basic Fears:  Social performance; Sexuality; Loss of independence; Fear: of rejection/criticism; Fear internal/external; Body changes or injury

Response to Hospital:  Can understand invisible body changes; May withdraw socially and emotionally; May test limits; body image concerns, Sleep disturbance, withdrawal or depression

Supportive Care:  Provide privacy; Allow independence and choices; encourage peer interactions; Provide activities such as: computers, video/board games; Favorite music; Teach relaxation techniques; Allow safe expression of anger through journal writing, sharing experiences with peers, drawing, and conversation