Age-Specific Tips
Child Life specialists at Cincinnati Children's Hospital Medical Center form special bonds with the patients they work with, helping them through their fears and stresses of being in the hospital. Here are some age-specific tips from Child Life to help you soothe and calm your child during hospitalization.
Infants: 0-12 Months | Toddlers: 1-3 Years | Preschoolers: 3-5 Years l School Age: 6-12 Years l Adolescents
Infants: 0-12 Months
Issues
- Development is supported by sensory and motor experiences
- Minimal expressive language; uses facial expressions, body posture and crying
- Infant is extension of parents
- Sensitive to changes in caregiving schedules
- Beginning of stranger anxiety
Fears, Stresses of Hospitalization
- Separation from parents
- Disruption of routines
- Loss of normal stimulation
- Sensitivity to abnormal stimulation (bright lights, loud noises, multiple caregivers)
- Loss of security
- Impaired basic trust
- Disruption of attachment, bonding with parents
- Parents' fear of medical environment and loss of normal parental role
Interventions
- Primary caregiving
- Encourage visiting, holding, parental involvement; discuss and show parents how to assist in care and play
- Limit abnormal stimulation
- Lower lighting; balance day and night lighting
- Incorporate home routines
- Cluster intrusive procedures
- Offer soft music
- Offer stimulation during awake, alert state (calm, rhythmic movement)
- Speak to child in a gentle soothing manner
- Use tactile stimulation to comfort child
- Observe and respond to child's cues and behaviors
- Provide familiar objects (blanket, stuffed animal, toys, music)
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Toddlers: 1-3 Years
Issues
- Motor skills developing at a rapid pace
- Egocentric (can't see something from another point of view)
- Receptive language more advanced than expressive language
- Assertive will
- Beginning to make choices or show preferences
- Rituals important; concerned about change
- Beginning of security object (e.g., blanket, toy)
Fears, Stresses of Hospitalization
- Separation from parents and familiar environment
- Fear of the dark and loud noises
- Loss of autonomy
- Restriction of movement
- Regression, loss of newly acquired skills
Interventions
- Primary caregiving
- Incorporate routines and familiar objects
- Involve parents in caregiving decision and tasks
- Provide child with brief details about sensory information (room will be dark with one bright light)
- Allow opportunity for medical play
- Provide developmentally appropriate activities
- Minimize excessive restraint or allow some movement (one foot or hand)
- Offer child support during a procedure (e.g., bubbles, music)
- Allow child to manipulate equipment before it is used (e.g., stethoscope)
- Observe and respond to child's cues and behavior
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Preschoolers: 3-5 Years
Issues
- Rapid language development, although limited
- Egocentric
- Active imagination
- Minimal distinction between fantasy and reality
- Magical thinking (belief that thoughts can cause actual events)
- Little / minimal concept of time
- Literal interpretation of language
- Transductive reasoning (two events related because they happened at the same time)
Fears, Stresses of Hospitalization
- Long separation and abandonment
- Medical procedures can be seen as punishment
- Fear of castration, mutilation of body parts
- Loss of control and newly acquired skills
- Death, Boogieman, scary superheroes
- Loss of appropriate sensory, motor stimulation
- Fear of blood, unknown events
- Regression
Interventions
- Continuity of care
- Provide access to favorite toy or object
- Allow participation in own care
- Reassure child that he / she is not to blame for illness and on other body part was harmed
- Be honest about what will hurt
- Use concrete explanations and concrete markers for time (TV show)
- Allow for medical play
- Involve parents and opportunities for choices patient family
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School Age: 6-12 Years
Issues
- Want to earn recognition and be successful
- Has some understand of body function and structure
- Able to reason and compare
- Increasingly modest
- Increased understanding of time
- Understands cause and effect
- Separation from parents is easier
- Peers influence increasing
Fears, Stresses of Hospitalization
- Altered body image
- Disgrace, loss of competence
- Invasion of privacy
- Loss of status in school or peer group
- Death and disability
- Hesitant to reveal fears
- Loss of bodily control and enforced dependence
Interventions
- Participate in own cadre and encourage verbalization of feelings
- Respect, do not minimize fears, and explain procedures
- Promote a sense of responsibility and open communication
- Continuity of care and be honest about what will hurt
- Offer self-expressive art opportunities
- Protect privacy, especially with removal of clothing
- Offer support during procedure (medical imagery)
- Encourage classmates to send cards, letters, and visit
- Observe and respond to child's cues and behavior
- Encourage socialization with other patients
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Adolescents
Issues
- Wants / doesn't want parent close by
- Seeking a separate identity
- Decision making
- Peer approval important
- Realistic view of death
- Conflict with dependence versus independence
- Prone to extremes in behavior, mood swings
- Capable of abstract thinking
- Interest in sexuality
Fears, Stresses of Hospitalization
- Altered body image
- Loss of control
- Fear of anesthesia
- Enforced dependency
- Perception of illness is distorted
- Threat to body competence, future competence and level of activity
- Loss of peer acceptance
- Fear of failure in school
- Death
- Denial, non-compliance with medications, restrictions, or treatments
- Hides confusion and lack of understanding of condition
Interventions
- Facilitate choices and control; include in care plan
- Encourage peer interaction
- Respect autonomy, protect privacy (draw curtain or discussion with parent absent)
- Honest explanations
- Provide opportunities to write answer to caregivers' questions
- Offer support during a procedure
- Listen to patient to understand meaning of experience
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