Helping Infants and Preschoolers Cope With Medical Procedures, Illness, and Hospitalization

Almost all children will experience medical procedures (e.g. lumbar puncture, injection) during childhood and some experience related medical stress.

  • Most receive at least 10 preventive injections by age 5
  • 5 million children undergo treatment or diagnostic medical procedures yearly
  • More than 2 million children under 15 hospitalized yearly
  • About 12.6 children will experience chronic illnesses

Helping children in adapting to medical stress is important for childhood and later adult functioning. Childhood experiences with medical events may influence anxiety, pain, and coping with medical issues

  • Research suggests that as many as 54% of children exhibit behavioral changes following outpatient surgery
  • 11% of children experience relatively severe behavior problems within 2 weeks of surgery

Common Illness Reactions:

  • Regression to old behaviors (e.g. loss of toilet training, increased dependence)
  • Development of new behaviors- hitting, yelling, crying
  • Questions
  • Seeking comfort
  • Avoidance (e.g. playing, not talking, etc.)
  • Attempt at control by trying to prevent procedures/events
  • Withdrawal
  • Attention seeking behaviors

 Reactions to Hospitalization:

Infants-

Major Fears

  • Separation
  • Abandonment
  • Pain
  • Strange People
  • Strange Objects
  • Loud Noises

Behavior Reactions

  • Crying
  • Screaming
  • Searching for parents
  • Clinging
  • Physical resistance (older infants)

Toddlers-

Major Fear

  • Loss of Control
  • Restrictions
  • Confinement
  • Dependency
  • Bodily Injury
  • Shame
  • Doubt
  • Separation
  • Loss of routine
  • Strange People
  • Being left alone
  • Loud noises
  • The dark

Behavior Reactions

  • Temper tantrums
  • Physical resistance
  • Aggression
  • Negativism
  • Regression- soiling, thumb sucking
  • Bad dreams

Preschoolers-

Major Fears

  • Same as toddlers
  • Guilt

Behavior Reactions

  • Similar to toddlers
  • Magical thinking
  • Manipulation- get out of things, get things

Primary Goals to Promote Coping with Medical Stress:

1) Encourage trusting relationships

  • Give honest information
  • Allow and encourage questions and open communication
  • Encourage expression of feelings
  • Children sense when parents’ are upset and hiding information

2) Provide emotional support

  • Be genuine with own emotions
  • Provide affection and soothing

3) Give developmentally appropriate information

  • Can use stories or videos
  • Modeling- through exposure to actual sights, sounds, equipment, and techniques for procedures at hospital or doctor’s office

Language To Use When Talking to Kids:

Avoid                                                  Use Instead

Hurt                                                       Uncomfortable, different

Pinch, sting, “ouie”

Sore, ache

Shot, injection, needle                   Poke

Stretcher (stretch her)                   Special bed on wheels

Put to sleep, anesthesia                 Special sleep, help to sleep

Cut open, incision, make hole     Small opening

Dye (“die”)                                           Medicine to help Dr. see

X ray, CT scan, MRI                          Picture, special camera

ICU (“I see you”)                               special care

OR table                                                 Bed

Funny smell/taste                             different smell/taste

Suggestions to Promote Coping with Medical Stress:

  • Distraction- toys, video, bubbles, stories, parent presence, rocking, singing, patting, item to hold (blanket, stuffed animal), encourage counting or saying alphabet
  • Maintain matter-of-fact tone, stay calm
  • Parents should have a job to feel helpful- distract child, hold hand
  • Give limited choices/control
    • Best to use before and after procedure-e.g. injection site, whether to be held or hold hand, numbing cream
    • What to wear, eat, play
  • Recognize and praise child for bravery, sitting still, etc.
  • Attempt to have a routine during hospitalizations (library, hospital school, playroom)
  • Keep routine as close to home routine as possible
  • Utilize sticker charts- for taking shots, medicine, etc.
  • Have a visual schedule- can include photos of activities, family, nurses, docs
  • Encourage activity and exercise as possible- e.g. walking laps, going outside
  • Pacifier for infants- especially when unable to eat
  • Bring familiar items, pictures, foods, decorations, toys
  • Maintain usual approach to guidance and discipline- promotes security and consistent expectations
  • Request consistent nurses/staff and introduce child to them
  • EMLA- “numby” cream for shots
  • Massage
  • Provide many options for stimulating play- especially when physically limited
  • Relaxation techniques- breathing, imagery
  • Hypnosis