What You Need to Know When Your Child is in the Hospital

One of the most stressful events that can happen during parenthood is for a child to be admitted to a hospital for illness, surgery, or an accident. It is particularly stressful when the hospital stay is unplanned. This can be very frightening for the child and the parents. The following information has been compiled to help alleviate confusion that can cause more stress and fear and to answer some of the questions that parents have when their child is in the hospital.

Getting There

Whether your child is being admitted to the hospital from your doctor's office, from the emergency room, or from surgery, the most important thing you can do for your child is to stay with him or her as much as possible on the way to the child's hospital room to provide reassurance that he/she is not being abandoned and will not be alone in this strange new place. If your child is having surgery that is planned, you may be able to tour the hospital a few days beforehand. This will help you and your child know some of what to expect. If your child has to have emergency surgery before being admitted to a room, ask the staff to allow you to be with your child as much as possible before and after the surgery. You won't be allowed in the operating room but depending on the hospital's rules and your child's condition, you may be allowed to stay with him until the anesthesia takes effect. Reassure your child that you will be together as soon as the surgery is over. Many hospitals now allow a parent to be with the child in the recovery room. Once your child awakens and the recovery room staff determines it is safe to release him, then he will be moved to a room. If your child is being admitted from the emergency room, you will be escorted by an orderly to the child's room. If he is being admitted directly from the doctor's office, the doctor will either accompany you to the child's room or will instruct you where to take your child and will call the nurse with the admission orders so they will be expecting your child.

Patient Care Team

Your child's nurse and nurse's aide will get your child settled into the room and will set up any necessary equipment (IV's, monitors, etc.). The nurse will assess your child's condition when he is admitted and again approximately every two hours or more frequently if necessary. She will carry out the doctor's orders regarding medications, IV fluids, monitoring, etc. The nurse's aide or patient care aide (P.C.A.) will check your child's vital signs (blood pressure, pulse, respiratory rate, and temperature) as often as the doctor has ordered. She will also track his intake and output (more on that later), change the bed linen, assist your child to the bathroom if needed, deliver meal trays, etc. The nurse and nurse's aide can answer any questions that you have or can direct you to the appropriate resources. Your child may have the same nurse for 8 to 12 hours depending on the shifts. At shift change, your child's nurse will brief the oncoming nurse about your child's condition and treatment.

Keep in mind that nurses and nurse's aides usually care for several patients at a time so they will not be in the room every minute of the day. When you need the nurse or nurse's aide, use the call light and tell the unit or ward clerk what you need the nurse or aide to do or to bring to you. Then try to be as patient as you can. The nurse or aide will be there as soon as she possibly can. If there is a true emergency, use the emergency light (usually located in the bathroom) which will bring the staff running. But only use it if there truly is an emergency, not just to get the nurse to "hurry up". It is easy to get impatient and frustrated when your child is suffering. Realize that these reactions to such stress are normal but try to control them. If you are concerned that your child's needs are not being met appropriately by the nursing staff, ask to speak with the head nurse who will address your concerns to ensure that your child receives the care he needs.

Doctors usually see their patients either early in the morning before office hours or on their lunch break or after their office hours. Unless your child's condition is very serious, expect to see the doctor only about once each day. If you wish to speak with the doctor at other times, let the nurse know and she can contact him or her for you. Your child may be seen by the doctor's associates on your doctor's day off. The associate will have been briefed on your child's condition and can give orders for treatment. Your child may also be examined by a specialist if your doctor has asked for a consultation.

In addition to the doctor and the nursing staff, you may encounter other hospital personnel during your child's hospitalization including: chaplains, social workers, patient case managers, attending physicians, residents, interns, and both medical and nursing students, respiratory therapists, physical therapists, occupational therapists, phlebotomists (lab techs), x-ray technicians, and anesthesiologists, and more. So many people and so many different titles can be confusing. All hospital staff should have some visible form of identification but if not, don't hesitate to ask to see some identification if you are unsure about who a person is and why they are coming into your child's hospital room.

Parents on the Patient Care Team

You may have questions regarding your child's condition and treatment. If the nurse has not already discussed the doctor's orders with you, ask her to do so. If you still have questions or don't understand something, ask her to clarify. The more informed you are about your child's condition and the plan for treating him, the better you can work with the staff in helping your child. Parents are very important members of the child's "patient care team" and can greatly help in their child's treatment plan. For example, if the doctor has ordered a restricted diet (such as, "clear liquids only") or has ordered that the child be NPO (nothing by mouth), you can help by making sure your child is not given food or drink that isn't allowed. You can also assist with keeping track of your child's intake of fluids and output of urine and bowel movements. The nurse aide will either ask you to inform her each time your child uses the bathroom or will show you how to measure the urine in a special "potty hat" that sits inside the toilet. She will also ask how much the child has had to drink during that shift (unless your child is NPO). This information is very important for your child's doctor to know when determining such things as the amount of IV fluids to order, whether or not your child is dehydrated, etc.

Another way to help is to keep your child from removing his IV or any monitors if he has them. If an IV pump or monitor sounds an alarm, let the nurse know right away. Don't try to adjust it or fix it yourself. Also, never, ever give your child any medicines, herbs, or vitamins during the hospital stay without prior approval from the doctor. Only medication that has been ordered by the doctor can be given and only by the nurse or medication aide. If your child is on any medication at home then the doctor will order it to be given by the nurse if he wants your child to continue taking it while in the hospital so don't give any to him yourself. This rule is for your child's safety so that he or she does not receive an overdose of medication and also so the staff knows exactly what medications have been given in the exact amount and at the exact times that they were given. If you are unsure of what medication has been ordered by the doctor, ask the nurse.

Dealing with Needles (and other unpleasant things)

If your child needs an IV (to give fluids and medicine directly into a vein) and does not already have one from the emergency room or surgery, the nurse will start one. This can be done either in the child's room or in a special treatment room. If the child needs blood drawn for lab tests, the nurse will usually try to do that at the same time to avoid sticking the child more than necessary. If your child is very young, it may be necessary to use a "papoose board" to hold him still enough to insert the I.V. The nurse will look for the best vein to place the I.V. Depending on your child's veins and age, it may be placed in the hand, arm, foot, or the scalp (usually for infants). The needle is removed after the intravenous catheter has been placed and the site will be protected with a special bandage dressing. The fluids that your child needs will be connected to the catheter and will usually be regulated by a pump on a rolling stand. The pump will alarm when the bag is empty or if there is a problem with the I.V.

You may ask to stay with your child during the procedure if you feel that you can handle it. Keep in mind that the nurse may not be successful on the first try and if your child is dehydrated or has veins that are difficult, it could take several tries. If you know that you cannot bear to watch or if you are overly anxious about the thought of it, then it would be better to leave the room after reassuring your child that you will return as soon as the nurse is done. Your child may want you to stay but he doesn't need to see you pass out or get angry at the nurses because it would only frighten him even more. Whichever you choose, be sure to comfort your child before and after the IV and explain that it provides special medicine to help the child get well.

Comforting and Helping Your Child

You may be tempted to call the nurse or lab technicians "mean" or "bad" while comforting your child after painful procedures, but if you do, he may begin to wonder why you let these "mean people" hurt him. That could cause him to stop trusting that you will protect and care for him. If your child is old enough to understand, explain to him that the doctors, nurses, and lab techs are the "good guys" that are doing what they have to do to help him get well so he can go home. If he likes a certain superhero, you could say that the staff is fighting the "bad germs" (or whatever your child is in the hospital for) just like the hero fights the villains. The medicines, IV's, and other things are what they use to fight with instead of lasers, swords, or whatever his favorite hero uses. The important thing is that your child feels safe and knows that the staff is there to help him.

Another thing that your child may wonder is if he is being punished for something. Reassure him that being in the hospital and having to endure IV's and lab tests is not punishment. Explain to him that all of these things are being done to help him get well and that he has done nothing wrong. (Of course, if your child is in the hospital for an injury that happened as a result of something he did, you do need to address the accident and the injury, however, reassure him that these things are not punishment for what he did).

Getting Comfortable (as much as possible)

After your child has been settled in, continue to stay with him/her as much as possible for the duration of the hospital stay. Most hospitals encourage parents to stay with their child and even provide a bed or cot for a parent to spend the night. This is usually the case on most pediatric wards because research has shown that children generally recover better and more quickly when a parent is with them throughout the hospital stay. Many hospitals have a pediatric ward which is especially designed to care for children up to the age of 18 or 21. Some hospitals do not have a pediatric ward and have to place children in the medical-surgical ward of the hospital along with adult patients. In either case, most hospitals will have a place for at least one parent to stay with the child. If your child is in the intensive care unit, you probably won't be allowed to spend the night in the child's room (there is usually limited space) but there may be a parent's sleep area that you may use. Ask the staff what is available.

You will also need to find out information about the hospital such as, visiting hours and rules, where the cafeteria is located and it's hours, whether or not a parent can have a tray sent with the patient's tray for meals, etc. There should be a patient guide to the hospital providing this type of information but if you have not received one then ask the nurse's aide (sometimes called a "patient care aide") who should be able to answer these questions or find out the answers for you. You should also be told about any amenities the hospital provides for their pediatric patients, such as, a playroom, video games, a DVD player or VCR and movies, or other activities. Also, ask what is available for parents to use, such as, a telephone, a shower room, a kitchen or snack room with ice, pop, coffee, or vending machines.

One more way to help your child is to ask the nurse if any of your child's belongings from home can be brought to make him feel more comfortable and secure. If allowed, bring a favorite stuffed animal or blanket for a young child. A doll or stuffed animal can be a great comfort, especially if the doll or animal "shares" the child's experience. For example, when my daughter had surgery on her feet, she had to wear casts for four months after the surgery. I put "casts" made out of white first aid bandage tape on the legs of her sock monkey. When her casts were removed, we made a big production out of removing the monkey's casts too. She enjoyed sharing her experience with her "friend". Other parents have had their child pretend to give a doll medicine when the child has to take medicine. Others have put band aids on a doll or stuffed animal in the same places that their child has an IV or has had a shot or blood drawn. A doll can also be used to help a child understand tests and treatments, and are often used to explain surgery to young children. An older child or teenager may prefer to have books, an mp3 or CD player, video games, or other favorite items that he/she enjoys. Ask your child what would make him or her feel more "at home" and comfortable. Whatever you decide to bring, keep the number of belongings to a reasonable limit because space will be limited and you will eventually have to pack everything up to go home. Also, don't bring valuables to the hospital as things sometimes get lost or stolen.

Taking Care of Yourself

Let's face it; sitting in a hospital room day after day is anything but fun. And watching your child endure tests, needles, and other procedures is very stressful. Not to mention how little sleep you get in a strange, noisy environment. All this together leads to boredom, exhaustion, and feelings of being overwhelmed which makes it even more difficult to help your child. That is why you must take care of yourself during your child's stay. To do this you need to recruit some help.

Ask another family member or friend to bring you books, magazines, or other form of entertainment or activity that you can do while your child is sleeping or otherwise occupied. If possible, take turns with your child's other parent (or a grandparent or other close relative) staying overnight so that you can get some sleep at home. This is especially important if your child is going to have an extended stay. On the nights you do stay, remember that you don't have to stay awake all night to tend to your child. The staff is there to take care of your child so try to get some sleep. The nurse will wake you up if they need you. During the day, take a break periodically and leave the room to go for a walk outside, to the gift shop, cafeteria, or wherever you find relaxing. A good time to do this is when your child has visitors to keep him company. Let the staff know where you will be, just in case. Don't feel guilty for not being there every second, your child needs you to be rested and able to take care of his needs. You can't do that if you are falling apart.

Family and friends can be a good source of comfort and support during stressful times so if they offer to help, let them. Talk with someone you trust about your feelings so you can vent some of the stress. If you don't have family or friends available, remember that the hospital staff can assist you in these areas as well. Chaplains and social workers can be a great source of comfort and assistance to patients and their family members so if you would like to speak with either one, let your nurse know. A strong support system will make it easier for you and your child to get through this difficult time.

Extended Hospital Stay

If your child is going to be in the hospital for an extended period of time, ask if you may decorate the room with cards, flowers, and other gifts that the child receives while in the hospital. Remember to keep it reasonable and don't go overboard. Be sure not to cover or block any outlets or equipment. Use tape or removable adhesive ("ticky-tacky") not tacks or anything that could damage the room or be permanent. As long as you are careful, most hospitals will let you decorate if your child has an extended hospital stay. (An exception would be the intensive care unit where there is limited space.) My mother decorated the space above my hospital bed when I had to spend over two weeks in the hospital as a teenager. It really helped to cheer me up to see the cards and pictures sent by friends and brightened an otherwise dreary room. As a nurse, I have had many patients whose parents decorated their hospital rooms during long stays. It helped the kids feel less homesick and a little better about their stay. If you can't decorate the room, you could get a scrapbook or memory box to hold the cards and letters and keep a journal with your child about his experiences in the hospital.

Kids who have extended stays in the hospital will miss their family and friends and feel as if they are missing out on what everyone else is doing. Find ways to keep your child in touch with friends through visits, letters, or phone calls. Visitors can give you needed breaks and entertain your child. Just be careful that your child doesn't get worn out by a constant stream of visitors. Hospitals used to be very strict about hours and minimum ages of visitors but most have relaxed the rules to allow even young children to visit patients. Find out what the hospital's rules are so you can plan accordingly.

Going Home (at last!)

Whether your child has been in the hospital for a short time or for an extended time, he will probably be very excited and relieved to be going home. You will be too, but you may also feel a little nervous about whether he is ready to go home and about having to take care of him at home while he is still recovering. This is normal. Voice any concerns or questions you have to the doctor and nurse. The doctor will tell you what you need to do at home to continue your child's care and what signs or symptoms require a call or visit to the doctor's office. He should also tell you when to schedule a follow-up appointment. After the doctor has written the discharge orders, the nurse will remove any remaining monitors or IVs and your child may dress to go home. The nurse will also explain the discharge orders to you and make sure that you understand them and anything else the doctor has told you about caring for your child at home. Make sure that you ask any questions you may have.

It is normal for a child who has been in the hospital to behave differently at home for awhile. Quite often, a child will regress to behaviors from when they were younger. A toilet- trained child may start wetting the bed. He may start sucking his thumb again. He may act defiant or aggressive as well. If your child is showing regressive behavior, remember that he is doing this as a way to cope with the stress that he has been through. Be patient and gentle but do set limits on harmful behavior. Encourage your child to talk about his feelings or to draw pictures about his experience. This phase usually passes in about two weeks after coming home from the hospital. If your child's behavior is extreme or if it does not pass after a couple of weeks, speak with your child's doctor.

Kids are pretty resilient and many bounce right back from illnesses, injuries, and surgery. As long as your doctor has not placed any restrictions on your child's activities, he can resume his normal routine at home. Then he can get back to the business of being a child with his hospital stay becoming just another memory in his busy life. Don't forget to pat yourself on the back for helping both of you get through it all!

These guidelines are of a general nature and not intended to replace the advice and supervision of your physician or healthcare provider.
Copyright 2004-2009 Tamara Walker, R.N. All Rights Reserved. May be used only with author's permission.