The document discusses the hospital environment for sick children and its impact. It notes that the hospital environment can be stressful for children and their families. It presents different strategies for preparing the hospital environment based on a child's age and developmental stage, from infancy to adolescence. The document also outlines common reactions children may have to hospitalization at different ages and the role of nurses in helping children and families cope with the hospital experience.

1. HOSPITAL ENVIRONMENT
FOR A SICK CHILD
BY –JUHI S.SHARMA

2. INTRODUCTION-
 Sick usually means physically ill, but it can sometimes be used to mean
mentally ill .
 The sick children need hospitalization.
 It is a stressful environment for both children and their families.
 Hospitalization leads to interruption of the child’s active growth and
development.

3. HOSPITAL ENVIRONMENT FOR SICK CHILD
1. SOCIAL ENVIRONMENT :- it means the people around in the hospital which
includes member of health team and other patients and relatives of their
family. This is a strange social environment for the child.
2. PHYSICAL ENVIRONMENT :- it means the setting or place and the things
around which include the ward or room, machines , equipments . These are
stressful for the child.
3. CHANGE IN ROUTINE:- children may have to undergo various diagnostic and
therapeutic procedures which are stressful for both the children and their
family. It leads to altered nutritional and sleep pattern and reduce appetite
and may cause anxiety in the child.

4. PREPARATION OF HOSPITAL
ENVIRONMENT FOR THE CHILD -
INFANTS :-
 Bring your child's favorite toy, blanket or stuffed animal.
 Nursing staff should know about the baby schedule.
 Patients remain calm.
 Bring music that helps relax your baby.
 Keep routines as normal as possible.
TODDLER –
 Use simple words that your child will understand.
 Tell truth.
 Allow your child to choose his or her favorite things to bring to the hospital.
 Read books about going to the hospital.
 Encourage your child to use play medical kits and dolls to act out his or her understanding
of the experience.

5. PRE-SCHOOL AGE-
 Use simple words without too many details.
 Help your preschooler understand that he or she did not do anything to cause
the hospitalization, procedure or surgery.
 Encourage your preschooler to talk about his or her feelings.
 Give your preschooler the opportunity to ask questions.
 Read books with pictures of medical equipment.
 Use play medical kits to allow expression of feelings.
. SCHOOL-AGE –
 Let your child know that you will answer any of his or her questions.
 Talk about your child's fears and questions openly and honestly.
 Help your child understand exactly why he or she needs a certain procedure
or to be hospitalized.
 Encourage child’s friends to visit
 Continuous school work

6. ADOLESCENT –
 Include your adolescent in any discussions and decisions about his
or her healthcare experience.
 Encourage your adolescent to ask questions about hospital care,
procedures and schedules.
 Allow and support your adolescent's privacy.
 Provide journal and read books
 Be patient with mood swings
 Leave alone

7. IMPACT OF HOSPITALIZATION ON CHILD AND FAMILY
A. IMPACT ON PARENTS /RESPONSE OF PARENTS-
 Lack of information and knowledge related to child’s illness.
 Fear of procedures and treatment of child
 Fear of unknown that what will happen to child in future .
 Fear of financial burden on family
B. IMPACT OF HOSPITALIZATION ON CHILD –
IT DEPENDS UPON THEIR AGE AND STAGE DEVELOPMENT –
 Infants reaction are mainly separation anxiety and disturbance of
development of basic trust , when the infant is separated from mother and
when illness and hospitalisation .
 Emotional withdrawal and depression are found in the infants of 4 to 8
months of age , interference of growth and delayed developments also found.
 Older infants 8 to 12 months of age may have limited tolerance due to
separation anxiety which is found as fear of strangers , excessive crying ,
clinging and overdependence on mother

8. REACTIONS OF TODDLERS -
 The toddlers PROTESTS by frequent crying , rejecting nurses attention ,
urgent desire to find mother and showing signs of distrust with anger and
tears ,especially when with mothers.
 In DESPAIR , the toddler becomes hopeless , apathetic , anorectic ,looks sad ,
cry continuously or intermittently and use comfort measures like thumb
sucking , fingering lip and tightly clutching a toy.
 In DENIAL ,the child reacts by accepting care without protest and represses
all feelings. The child does not cry in the absence of mothers and may seem
more attached to nurses.

9. REACTIONS OF PRESCHOOL CHILD -
 The preschool children adopt various mental mechanisms (defence
mechanisms) to adjust with the stressful experiences of hospitalization and
prolonged illness.
 They react by exhibiting regression ,projection , replacement , identification
, aggression , denial , withdrawal and fantasy .
 The stage of PROTEST in preschool children is usually regression.

10. REACTIONS OF SCHOOL AGED
CHILDREN’S-
 THE SCHOOL AGE CHILDREN ARE CONCERNED WITH FEAR , WORRY ,FANTASIES ,
MODESTY , AND PRIVACY.
 THEY REACT WITH DEFENCE MECHANISMS LIKE REGRESSION , SEPARATION ANXIETY
, NEGATIVISM , DEPRESSION , PHOBIA , UNREALISTIC FEAR , SUPPRESSION OR
DENIAL OF SYMPTOMS AND CONSCIOUS ATTEMPTS OF MATURE BEHAVIOUR.
REACTIONS OF ADOLESCENTS –
 Adolescents are concerned with lack of privacy , separation from peers or
family and school , interference with body image or independence or self concept
and sexuality.
 They react with anxiety related to loss of control and insecurity in strange
environment .
 They may show anger and demanding or un co- operative behaviour or increased
dependency on mothers and staff.
 They may adopt mental mechanism like intellectualization about disease ,
rejection of treatment , depression ,denial or withdrawal.

11. EFFECTS OF HOSPITALISATION ON THE
FAMILY-
 Break in the unity of family.
 Separation from the children.
 Feeling of inadequacy as others care for their children .
 They feel anxiety, anger, fear, disappointment , self blame, and possible guilt
feeling due to lack of confidence and competence for caring the child in
illness and wellness.
 Parental anxiety
 Strange environment in the hospital.
 Society will look upon the illness as a reflection of something wrong with the
parents.

12. ROLE OF NURSE TO HELP TO COPE
WITH HOSPITALISATION OF CHILDREN
 The nurse should earn sufficient confidence to develop positive relationship with the children
and their parents .
 Nurse should have patience, tenderness and emotional strength in times of stress.
 Provide family centred care with different approach to specific age group.
IN NEONATE:
 rooming in and sensory motor stimulation
IN INFANTS :
 encourage mother to balance her responsibilities and minimize separation , mother can be
allowed during procedure , providing toys to relieve tension.
IN SCHOOLCHILDREN :
 Help the parent to prepare child for elective hospitalisation , provide privacy , thorough nursing
history should be obtained for plan of care , explain the procedures and its purpose , encourage
play , self care and continue schoolwork, ensure parents to cope with their own anxieties,
introduce to other parents in the same unit and consistent visiting pattern.
IN ADOLESCENTS:
 Prepare the parents for planned hospital admission , available hospital facilities should be
explained soon after admission, respect the personal preference on selfcare and food habit ,
explain all procedure, provide opportunities for recreation , peer relationships, interaction with
other adolescent patients and expression of feelings.