Child hospitalized

Children in hospital: a guide for family & carers – review

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Children in hospital: a guide for family and carers by Richard Lansdown
Oxford University Press (Oxford Medical Press) (1996) ISBN: 0-19-262357-5

“Matching the intervention to the child”…


Children in hospital: a guide for family and carers is an information-packed book combining research and personal experience. Written by Richard Lansdown, formerly consultant Psychologist at Great Ormond St Hospital London, one of the world’s leading children’s hospitals.

Although the book is over 20 years old, families, healthcare professionals, early childhood educators and students will find a useful overview supporting children in hospital and healthcare. Researchers continue to read this book today.

 
 

Child rights

Have we come to expect child-friendly services? Lansdown writes about early hospitals and emotional aspects such as separation and the battle of early visitors, this gives a significant background. Development of child rights in hospital, saw the emergence of advocacy organisations and the Charter for children in hospitals, NAWCH 1984.

In Australia, AWCH promoted child rights and better healthcare with Health care policy relating to children and their families published 1974, revised 1999 and Charter on the rights of children and young people in healthcare services, 2010. Understanding child rights in healthcare is essential. An 11 year old girl on a children’s ward in the UK asks “aren’t we kids supposed to have a bill of rights when we are in hospital?”, Children’s hospital charter revisited.

 
 

Fear and coping

Children and families going to hospital or healthcare appointments may be fearful, Lansdown approaches the topic from a child’s perspective without being simplistic. You will find practical information about children’s understanding of health, illness and treatment. Play in hospital and play specialists (also known as child life therapists or specialists) guide children towards meeting their emotional needs.

Pain

Parents and carers can be supportive when a child is in pain and often know what techniques are likely to distract their child during medical procedures such as injections. Children turn to their parents or carers to see if it is safe and to know what to do.

The chapter on pain gives an understanding of its impact on children. Information and support are based on the child’s developmental stage and what works for them. Supportive strategies for children facing painful procedures include active distraction. This may involve reading books, toys, songs, stories, video games, mobile apps and new technologies such as video goggles. Other supportive strategies are participation, desensitization and modelling, watching a film that shows other children and mastery coping or coping models (initial anxiety then coping). Being noisy (counting out loud), guided imagery, relaxation and breathing techniques are some more options to consider.

A combination of distraction strategies might be used such as bubble blowing and guided imagery. For example, a child is asked to visualize the colour of the pain and places it on a bubble as though it was an imaginary cloud floating away. As the pain moves off, the bubble changes to the child’s favourite colour, blowing away pain and fear (p 116).

 

Talking with children

Summaries of pain assessment tools show how children rate their pain. Why ask children about pain? Adults usually explain how important a procedure is but there could be a gap in the child’s thinking. For example, a finger prick/injection to take blood may leave some children wanting information about why it is being done and what will happen next with the blood.

 
Children in hospital: a guide for family and carers reviews literature and includes bibliographical references providing a quick source of information for healthcare professionals and students. Families will find it is easy to dip into relevant sections. This book gives a valuable overview on the wellbeing of children in healthcare and also shows glimpses of what a good children’s healthcare service should look like.

More information

For more information about supporting children through medical procedures, see Needles and Needle-Related Medical Procedures links.

AWCH also holds a copy of Needles: helping to take away the fear, a booklet for parents based on information provided by Dr Richard Lansdown produced by Action for Sick Children, 1994.

 
 
 
Jillian Rattray
AWCH librarian
Email: Jillian@awch.com.au
AWCH Library
 

 

M – is for Moment of panic and Mum’s sleeping on the floor

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Moment of panic

A brown blob appeared momentarily in my peripheral vision and disappeared, I stopped. Continuing on, the motion of my swinging hair caused the reappearance of the brown blob. Standing still, I sensed a slight weight, something was there… and it was starting to move.

A moment of panic ensued and with a hasty flick, the small huntsman spider dropped to the floor, scuttling across tiles, sinking low into a groove, not daring to move. This young Huntsman with brown translucent legs, had been taken from familiar surroundings and catapulted into a strange environment – my bathroom. 


Mum’s sleeping on the floor

This reminded me of a different kind of fear, not of spiders but of fear and children in hospital. I’d just read an article written in 1982 about one parent’s experience* with her seven-year old in hospital. Her sick boy, Sam, was in a ward with other children also taken to hospital in an emergency. If I were to give her article a title I might call it, “Why I chose to camp on the hospital floor”.
 
Not long ago the expectation was that parents didn’t stay with their children in hospital and visiting hours were restricted (a paediatric nurse at a Sydney children’s hospital recalls many tears as visiting time on Sunday afternoons finished). The impact on many children, especially young children was large. Following AWCH’s recommendations, Australian hospitals began promoting family centered policies, parents were encouraged to stay. 
 
This parent’s experience is worth reading because she challenged expectations in a leading children’s hospital, her story was firstly published in the Age newspaper, then AWCH magazine, Interface*.
 

Fear and separation

The mum, Janet, gave a moving account of five nights with her son in hospital. She knew staying would be best. This was reinforced when on the first night, another child awoke screaming, a nurse rushed in and this panicked child grabbed her crying “Mummy come quick”.
The child in a bed nearby had been taken from home, was sick and separated from his family. Hospital was a strange and frightening place. He had an intravenous drip and splint attached to his arm. Later, a two year old was screaming and inconsolable, her mother had gone home. The nurse had given sedation to stop crying.

 

Poster was one of six from AWCH (SA)  issued by NAWCH, London, 1978

 

To go home or stay on the floor?

Sam’s mum, it had been suggested, should go home because her son was old enough that “he should be able to cope”. With an upright chair to sleep in, Janet stayed. At 3 am another nurse approached her with a strip of foam rubber and a towel, she “hit the floor with relief”. The next night she had a sleeping bag from home. Janet experienced some odd looks from hospital staff but she was pretty much ignored. This mum was courageous, doing what she thought was best for her child despite hospital protocol.

At home, Janet revisited scenes of children screaming for their parents. Her greatest affirmation came from Sam. Hugging her close, in a whispering voice he said: “thanks for staying with me in hospital mum”.

“thanks for staying with me in hospital mum”



AWCH helps children

AWCH “pioneers” were also courageous, working hard to change care for children and young people in hospital. They were part of a social movement, linking with international sister organisations. AWCH’s first benchmark policy, A recommended health care policy relating to children and their families, was published in Medical Journal of Australia, 1974. Your Child in Hospital (pamphlet),.a Joint effort of Division of Health Education and AWCH, was significant as the first Australian education of parents about sick children and hospital. Written between the lines was a reminder to health professionals of their role in caring for children. With great interest, ¼ million pamphlets were printed.


AWCH continues to produce policies, work with key stakeholders (CT scans – information for parents and carers), guide the provision and advocate for rights of children and young people in healthcare. 

AWCH Ward Grandparent scheme supports children and parents or carers in hospital. Volunteer grannies, recognise it isn’t possible for parents or carers to always stay with their child. 

Your comments and impressions are welcome and can be added below.

 

 

 

 

Jillian Rattray

AWCH Librarian
http://library.awch.org.au

 

October 2016

 

 

 

J is for Joking Around in Hospital

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Mention the word “hospital” to a child and chances are thoughts of fun won’t spring to mind. This is with good reason. Infants, children and teenagers in hospital or facing repeated hospital stays understand about pain and fearfulness. Sick children see hospital differently from adults. Children’s thoughts about hospital also differ depending on their age. Young children may want more than anything to have their family close and sometimes this isn’t possible. They also want lots of play and toys. School children often have many questions and need answers about what is happening. Adolescents value privacy and social and educational spaces. Young patients surveyed in a recent report Admitted children and young patients survey results 2014 indicated there was room for improvement in what is available to do in hospital (more books, games, toys).

Hospital, a friendly and healing environment?
For children and young people the hospital environment is not just about clinical care. Human needs count. An interactive, engaging and aesthetically pleasing environment and a friendly, caring welcome from the hospital community is important. Children find ways to connect with their environment, such as creating a personal bedside with pictures, photos, decorations and cards.  Children’s hospitals make their environments more child-friendly through bright colour, plants, toys, artworks, arts and craft, books, a visit to the hospital playroom, games room, multi-sensory room, healing garden, natural space or playground. Child-friendly places where family can gather, play and be together make all the difference.

Children and young people’s social and emotional needs
One study looked at the views of young children and found that children between five and seven years like “funny”, “friendly” and “happy” doctors and nurses. Being in hospital and a strange environment is challenging, particularly when children aren’t prepared for the experience.

Clown Doctors
How can “joking around” help children in hospital? Clown Doctors™ are amongst the people in hospital who help kids cope. If you have met one you will know they simply ooze fun. Their tools include a “goody bag” of gags and a fine appreciation for quirky antics and silliness. Perhaps Clown Doctors are the antithesis of all things serious in hospital but they do play a serious role. Clown Doctors take therapeutic play and art forms, such as drama, music and song, jokes and gags to hospital bedsides, emergency, preoperative rooms, wards, playrooms and other hospital spaces.

Clown Doctors understand about the feelings of sick children, their families and health professionals who they meet. Sick children have a changed body image and find themselves in a passive patient role. Clown Doctors turn things upside down using humour. The Clown Doctor, has a white doctor’s coat, with bright collar, maybe a tie and “medical equipment” but that’s where the resemblance stops. The rest is very much “clown”.


 Clown Doctors dose sick children in hospital with fun and laughter!

Clown Doctors unique dress mode suits their unique task. Using a toolbox of skills and understandings, they modify and interpret play and activities to fit with a child and family’s needs and responses. Clown Doctors help reduce anxiety and emotional responses in preoperative rooms where children and parents wait before minor operations. In some hospitals, Clown Doctors work in Emergency helping children by distracting them during painful procedures. The positive impact lasts beyond their interaction. Clown Doctors bring joy to children with serious illness, who experience extended and repeated hospital stays. Children are transported out of the medical, into the magical with humour and laughter.

Who is joking around now?
A sick child may swap roles and “become” the doctor who practises with medical play. This contrast leads a child into a stronger place. With the positive benefits of laughter children relax, have reduced muscle tension and pain and stress are taken away.  They cope with sad and hurt feelings and feel good and in control. Clown Doctors also bring humour and laughter to parents, siblings and carers as well as healthcare professionals. Happier and less anxious families and health professionals journey with children towards better health.

Clown Doctors™ is run by the Humour Foundation and does not receive government or hospital funding. They rely on community support to fund programs, visit their website to find out more.

Thank you Clown Doctors™ for contributing photographs.


Jillian Rattray
AWCH librarian
January 2016

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