Children in hospital: a guide for family and carers

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

The three little “P’s” - Playgroup and Peppa Pig

Children were excited when Peppa Pig Goes to Hospital was the story of the day at one Sydney play group. There were about 15 children, mainly two year olds and pre-schoolers, who sat on the story time mat. During playtime they couldn't wait to put bandages on their dolls or teddies and one boy carefully bandaged his dinosaur’s tail. Craft was a lot of fun with Humpty Dumpty, both before and after the accident, some children preferred the ambulance craft. It was a bustling morning but there was time for children to select a book from our display and have a quiet read. A few did this.  There were over twenty books to browse or borrow and several parents commented about the range of books available.

Before the story, children were told, ‘When we go to see a doctor or nurse we can take a special toy or book and we will have our mum or dad or person who cares with us’. Peppa pig’s hospital room had a bright rainbow and after the story I commented, ‘We can always play and draw pictures when visiting the doctors or in hospital’.

The playgroup was well equipped with hospital play kits including stethoscopes, bandages and toy thermometers. If any toy was short of a bandage, a box of bandaids was within reach. One little girl showed me green dots all over her baby’s head. She and her mother had carefully placed bandaids over the middle of the baby’s head covering the ‘dots’. This was clearly a topic the kids related to.

I was the first of several visitors for term three with the theme, 'people who care for us'. The playgroup leader introduced the topic talking about doctors and nurses and the children sang several action songs about being sick, including ‘humpty dumpty’.

When the doll, teddy and dinosaur play began a brochure was handed out, ‘Hospital preparation for pre-schoolers – time well spent’. In amongst the fun I was hoping to convey to the children that when we are sick or hurt, it is not because of something we have done. Also if we are sick, doctors and nurses are there to help us get better and Mums, dads or the person caring for us will be there to give us a hug.

Whilst the children played, parents were reminded that fear of the unknown is an issue for young children and that pre-schoolers need reassurance. When we think of going to hospital, we think about the role of health professionals and may not stop to think about the role of parents. My take home message for parents was that their role is really important too. Parents and carers help their children cope with fear by being calm. Playgroup parents laughed at this point, recognising this is something easier said than done. I showed them two books Help! My child is in hospital and Everybody stay calm.

Before my voice faded into the general hubbub, my final point was that it is important to be informed and not to be afraid to ask if something is not clear. Parents can ask the hospital what resources are available to help prepare. The AWCH website and Dr Angela MacKenzie have many helpful links for parents and carers who want to prepare their children in different medical situations. A special mention was given of the wonderful free app designed for and with young children, “Okee in medical imaging”.

A chat with staff at a local pre-school followed. It was not long after I had arrived when a teacher pointed out the hospital corner, put together because of a child's recent hospital stay. The staff borrowed books to read to their classes and enquired about books for children with special health needs or those who have sick parents.

 One of the most poignant reasons for preparing children for hospital came from a playgroup mum. She shared an experience as a three year old child. She recalled how her parents said she was going on holidays. It was devastating to find this was misheard and that instead, her parents had said she was going to hospital. This became a traumatic experience and hard to get over. I finished the morning with a greater certainty that preparation is time well spent*.

Perhaps the three little ‘ps’ stand for – preparation, playgroup and Peppa pig.

Jillian Rattray

AWCH librarian
http://Library.awch.org.au
July 2015

*Dr Angela MacKenzie encourages parents to do their “homework” and be prepared.

Help! My Child's in Hospital!

Help! My Child’s in Hospital: A parent’s survival guide. Practical advice for parents on preparing your child and caring for them in hospital.
By Becky Wauchope ~ Illustrations by Kaitlyn Miller

“Help! My Child’s in Hospital” is a great read if you are looking for something positive to prepare your child and family for hospital. Written in a warm, personal and easy-to-read style, Becky Wauchope describes what it is like to be in hospital and how to cope with anything from an emergency visit to a long stay and repeated visits. Her experiences with son Gus in over three years of repeated visits to hospital, have resulted in a practical and creative book. Lots of tips throughout provide starting points for children and parents to encourage coping and reduce fear. There are ideas to help keep life as normal as possible with play and some fun. The easy to follow ideas are particularly good for families with young children, Becky has many years experience as an early childhood worker. There are great tips and creative ideas to assist children and families with hospital preparation, daily life in hospital, tests and procedures, anaesthesia and surgery, medication, support and recovery.

This is a stressful time, so parents who are time poor can dip into the book and read on a topic, such as “Having an operation” and read about how to prepare and cope with fasting. Reading the book cover to cover is also a great way to gain an overview.

The book emphasises communication for parents, who know their child best, to work with health professionals for the best care. Honest conversation with your child providing the right amount of information is also a positive step. Parents can read about how to be child advocates, there are examples of steps for being prepared when talking with health professionals. Parents are encouraged to know their limits and if not able to help reduce a child’s fear or confusion then they are empowered to ask for help. Parents are a reassuring presence.

Some variations of what you may expect to find in different hospitals are covered. Parents will feel more aware and strengthened by both the information and supportive ideas. "Help! My Child’s in Hospital" highlights why preparing yourself and your child for the hospital experience is so important.

Find checklists at the back, with what to pack including Surprise packs that offer distraction. With cute illustrations, helpful layout and available for a reasonable price, this book would be a great addition to a Kindy library, hospital waiting room or public library. Copies are available for loan from the Association for the Wellbeing of Children in Healthcare (AWCH) Library and can be purchased via Becky’s website.

About the author:
The Wauchope family were about to emigrate to Australia from the UK, when Gus, the youngest of four developed severe breathing problems. This was the beginning of a three year journey through hospital readmissions in the UK and then Australia. Gus is now well and Becky has made numerous speaking engagements, run support groups and encourages people to share their stories. Find her website at: www.helpmychildisinhospital.com

Keywords:  Anaesthesia; Child; Child, Preschool; Communication; Hospital preparation; Hospitalization; Medication; Parent information; Preparation for anaesthesia; Preparation for medical and surgical procedures; Routines; School children


Jillian Rattray
AWCH Librarian
July, 2013