Hospitalization can be stressful for children of all ages due to separation from parents and familiar routines. Younger children may experience separation anxiety while older children worry about missing school or peer activities. Providing family-centered care, frequent family visits, play activities, and explaining medical procedures can help lessen children's stress during hospitalization. Therapeutic play tailored to children's developmental stages allows them to express feelings, learn coping skills, and feel a sense of normalcy and independence despite illness.

3. MEANING OF ILLNESS AND HOSPITALIZATION TO CHILD
Infant
• Charge in familiar routine and surroundings response with global reaction.
• Separation from love object.
Toddler
• Fear of separation, desertion, separation anxiety highest in this age group.
• Relates illness to a concrete condition, circumstances or behavior
Preschool
• Fear of bodily harm or mutilation, castration, intrusive procedures.
• Separation anxiety less intense than toddlers but strong.
School Age
• Fears physical nature of illness
• Concern regarding separation from age mates and ability to maintain
position in peer group.
Adolescent
• Anxious regarding loss independence. Control, identity concern about
privacy.

4. PREPARING THE ILL CHILD AND FAMILY
FOR HOSPITALIZATION
1) Preparing the infant
2) Preparing the toddler and pre-schooler
3) Preparing school age and adolescent
4) Preparing the child of a different cultural background
5) Preparing disabled and chronically ill child

5. INDIVIDUAL RISK FACTORS
• It has also been noted that rural children exhibit significantly greater
degree of psychological upset than urban children, because urban
children are familiar with hospitals.
• The stressors of hospitalization may cause young children to
experience short and long term negative out comes.
• Supportive practices such as family centered care, and frequent
family visiting, may lessen the detrimental effect of such admissions.
• Infants may be emotionally disturbed by hospitalization
• Not only they are separated from parents but also they will have
sensory deprivation. If the nursing personal do not take the time to
provide care.
• If the child doesn’t have close physical contact with another human
being may result in emotional trauma.

6. BENEFICIAL EFFECTS OF HOSPITALIZATION
• The most obvious effect is the recovery from illness.
• Hospitalization provides an opportunity for the children
to master stress and feel competent in their coping
abilities.
• Hospital environment can provide new socialization
experience.
• Child can broaden their inter personnel relationships.
• Psychological status of child also maximized.

7. CHILDS REACTION TO HOSPITALIZATION AND PROLONGED
ILLNESS
• Illness threatens both physiological and psychological development
of children.
• Sickness causes pain, restraint of movement, long sleep less periods,
restrictions of feeds. Separation from parent home environment,
which may result emotional trauma.
• Hospitalization and prolonged illness related growth and
development and cause adverse reaction in the child based on stage
of development.
• Reactions of neonates
• Reactions of infants
• Reaction to toddler
• Reactions of pre-school child
• Reactions of school-aged
• Reaction of adolescent

8. EFFECTS OF HOSPITALIZATION IN CHILDREN AND FAMILY
1) Stressor’s of hospitalization and children’s reaction
a) Separation anxiety
• Early childhood
• Later childhood and adolescence.
b) Loss of control
• Infants
• Toddlers
• Preschoolers
• School age
• Adolescents
BODILY INJURY AND PAIN:
• Infants
• Toddlers
• Pre-schoolers
• School age

9. PLAY ACTIVITIES FOR ILL HOSPITILIZED CHILD
FUNCTIONS OF PLAY IN THE HOSPITAL:
• Provides diversion & bring about relaxation.
• Helps the child feel more secure in strange
environment
• Helps to lessen the stress of separation & the
feeling of home sickness.
• Encourages interaction & development of positive
attitude towards others.

10. Play in infancy
• Pleasure by touch & manipulation.
• 5-6 months – infant repeat activities
• 9 months – repetitive games (pat-a-cake)
• 12 month - recognition & acknowledgement of other
Play in 2nd year
• 2 to 3 year – fascination with working part of toys talking on toy
phone involve parents
Third year – child taught to share
Conflict between parents & child.
Pre-school – competition, mastery of tasks
Genders roles (House, Doctor)
School – Foot ball, basket ball.

11. NURSING CARE OF HOSPITISED CHILD AND
FAMILY (PRINCIPLES AND PRACTICE)
Preventing or minimizing separation
• Primary goal is to prevent separation particularly in children
younger than 5 years of age.
• Welcome the presence of parents at all time throughout the
child’s hospitalization.
• Many hospitals developed a system of family centered care.
• During the time of separation behavior, nurse provide support
through physical presence
• Parental visits should be frequent
• If the parents can’t room-in they can leave a favorite article from
home the children gain comfort and re-assurance from them.

12. PREVENTING OR MINIMIZING FEAR OF BODILY
INJURY
• Promoting freedom of movement during procedures can
be completed by placing child in parents lap.
• Mechanical freedom can be provided by transporting
child in wheel chairs, or beds with mechanical freedom.
• Maintaining child’s routine
• Encouraging independence
• Promoting understanding

13. PREVENTING OR MINIMIZING FEAR OF BODILY
INJURY
• Preparation of children for painful procedures decreases
their fears.
• Manipulating procedural techniques also minimizes fear
• For children, who is fear of mutilation of body parts, the
nurse repeatedly stress the reason for a procedure and
evaluate child’s understanding.
• Employ pain reduction techniques.

14. STRATEGIES TO COPING & NORMAL DEVELOPMENT
• During hospitalization care of the child focuses not only on
meeting physiologic needs, but also on meeting psychosocial and
developmental needs.
a) Child life programs
• Focus on the psychosocial need of hospitalized children.
• Professional child life specialists, para professionals, &
volunteers staff these departments.
• A child life specialist plan activities to provide age appropriate
play time for children either in playroom or child’s room.
• Child specialist & nurses formulate plan together to assist
children with particular needs.

15. b) Rooming-In
• It is the practice of having a parent stay in the child’s
hospital room & care for the hospitalized child.
• Some hospitals provide cots, others have special built-in
beds & in some institutions parent stays in a separate
room on the unit.
• Parent who is rooming in may want to perform all of the
child’s basic care or help with some of the medical care.
• Communication between nurse & parent is important so
that the parent’s desire for involvement is supported.

16. THERAPEUTIC PLAY
• Play is an important part of the childhood.
• Toddler play is important for toddler. Through play they explore the
environment & learn to identify with significant people in their lives.
• Play is also an acceptable way for toddlers to release tensions caused
by stress or aggressive impulses.
• Other developmentally appropriate toys for toddlers include familiar
objects from home such as measuring cups or spoons, wooden
puzzles, push & pull toys.
• Pre-schooler
• Pre schoolers like crayons & coloring books, puppets, felt &
magnetic boards, play dough, & recorded stories.
• School age child
• Although play begins to lose its importance in the school age years,
the nurse can still use some techniques of therapeutic play to help the
hospitalized

17. Child deal with stress.
• School age children often regress developmentally during
hospitalization, demonstrating behaviors characteristics of an
earlier state, such as separation anxiety & fear of bodily injury.
• Body outlines & occasionally dolls can be used to illustrate the
cause and treatment of the child’s illness.
• School age children enjoy collecting, organizing objects & often
ask to keep disposable equipment that has been used in their
care. They may use these items later to relive the experience with
their friends.
• Games, books, crafts, computers, provide an outlet for
aggression & increase self esteem in the school age child.
• The type of play used should promote a sense of mastery &
achievement.

18. THERAPEUTIC RECREATION
• Adolescents do need a planned re-creation program to assist them in meeting
developmental needs during hospitalization.
• Even adolescents on bed rest or in wheelchairs can play a modified form of
basket ball.
• Telling a story rather than reading draws children into emotional
involvement with it.
• Children usually select toys such as doctor, syringes with which they can
imitate the activities seen around.
• Children also enjoy play telephone because they can pretend that they are
calling home.
• Children play areas cannot be kept clean & orderly as judged by adult
standards.
• In addition, nurse is able to note their comments about home, hospitalization,
general attitudes & behavior.
• Nurse should have an opportunity to participate with children play activities.
• Water play during bath, Television-by instructing them about programs, Art.