Hospitalization is admittance to the hospital as a patient.
Patients are admitted to the hospital for a variety of reasons, including scheduled tests, procedures, or surgery; emergency medical treatment; administration of medication; or to stabilize or monitor an existing condition.
Because no one can predict when a child may face an emergency hospital stay, it is a good idea for all parents to spend some time talking to their children about hospitals. Even though the information presented here is geared toward a planned hospitalization, the communication tips will also prove helpful to parents when their child's hospitalization is emergent.
Parents should describe and explain, as honestly and thoroughly as possible, what will happen to the child in the hospital. Parents should tell their child as much of the truth as he or she can understand. A toy doctor kit can help prepare a child for the experience. There are children's books about hospitalization, written for all age levels, that parents can read to their child before the hospital stay. Parents need to reassure young children, with their limited concept of time, that the hospital stay will be temporary. They can plan a party afterward or read a storybook part way through and mark the place where it will be resumed once the child comes home.
For preschool children, explanations should be simple and concrete. It will not ease the child's anxiety to try to explain that he or she will undergo a series of tests or will spend three weeks in the hospital. Instead, the parent might indicate the part or parts of the body that are to be "fixed," using a doll or stuffed animal.
By the time children reach five or six years of age, they can understand hospitalization on a more sophisticated level. They will be familiar with some medical instruments and concepts, and better able to grasp the time frame involved. Children of this age may feel they are going to the hospital because they have done something wrong, and parents need to reassure their child that hospitalization is not a punishment.
Teens should be given an honest explanation of what to expect during their hospital stay. They should be included in the discussions about their care. They also should be encouraged to ask their health care providers questions.
Overall, the best reassurance parents can give children of any age is the promise that they will be there to help them through the experience, even if they cannot be physically present during the entire ordeal. Parents should encourage their child to ask questions and talk about their feelings.
LEARNING ABOUT THE HOSPITAL Many hospitals allow parents and children to tour the pediatric facilities before the hospital stay, further reassuring the child. Children may be shown rooms similar to that in which they will stay. The tour may include a visit to the unit's playroom, a chance to meet the nursing staff, and the opportunity to become familiar with some of the hospital equipment. It is best for parents to be present during these tours, so the child can see that they approve of the facilities and trust the care providers.
Most hospitals provide information to the parents in advance of a planned hospital stay. This information may include directions to the hospital, parking information, and other services available. Parents should take advantage of the services offered during their child's hospital stay, especially support groups or educational classes that provide more information about the child's condition.
For a planned hospital stay, the parents need to contact their insurance company, if insured, to determine if the hospital is covered by their insurance plan. Once a hospitalization date is confirmed, the parents are required to notify the insurance company. If the hospital admission was emergent, the parents should notify the insurance company as soon as possible. Parents also need to review the credentials of the health care providers and hospital, gather information about the hospital, including services offered and specific policies (especially the visitation, boarding, and rooming-in policies), schedule the hospital stay, take the child to complete pre-admission testing, and receive and follow all of the appropriate pre-admission instructions. If certain medications need to be discontinued before the hospital stay, the hospital staff will notify the parents or send a complete list of medications to avoid.
MAKING SURE THE CHILD IS HEALTHY It is important for the child to be as healthy as possible before a planned hospitalization. The child should eat healthy foods, and rest and exercise as normal, unless given other instructions. The child needs to get extra sleep before the hospitalization, since his or her normal sleep patterns will likely be disrupted during the hospital stay. If the child has a fever, cough, or cold, the parents should call the child's doctor to determine if the hospitalization should be delayed.
PACKING FOR THE HOSPITAL STAY The child should help the parent pack items for the hospital stay. It
Children should not bring latex (rubber) balloons to the hospital, as they can be a serious safety hazard, as well as a health hazard for children with a latex allergy. Shiny, metallic balloons (Mylar) are usually permitted. Parents should check the hospital's policies before packing any electronic items, such as video games or hair dryers. Some items may cause interference with the hospital equipment. Also, parents should check the specific unit's policy for bringing fresh flowers or plants. In most cases, bringing food from home is not permitted since certain foods may be restricted and the child's specific dietary intake may need to be recorded.
The parents should bring a complete list of the child's medications, medical conditions, and any known allergies. The child's medications should remain at home; all necessary medications will be provided in the hospital.
SELECTING A FAMILY SPOKESPERSON Because of privacy regulations established by the Health Insurance Portability and Accountability Act (HIPAA), some hospitals require families to select one spokesperson to communicate with health care providers. The spokesperson helps maintain the patient's privacy and also improves communication with the health care providers. The family spokesperson should be responsible for communicating information about the child's health to outside family members. Families and friends who call the child's nursing unit will not be able to obtain information about the patient, due to privacy regulations.
Before the child leaves the hospital, the health care providers will review discharge instructions with the child and parents. These instructions include incision care, signs of infection or complications to watch for, information on when to call the doctor, medication guidelines, activity guidelines, dietary restrictions, information about when the child may return to work or school, a follow-up appointment schedule, and other specific instructions as applicable to the patient's condition. Follow-up appointments may be scheduled, and the necessary prescriptions will be given to the parents.
If the child weighs less than 40 lbs (18 kg) or is under four years of age, he or she is required by most state laws to ride home in a safety seat. Parents should remember to bring the car seat with them on the day of the child's hospital discharge.
If health care services will be needed at home (home care), they can be arranged by a social worker or the nursing staff.
The risks of hospitalization are related to the type of treatment or procedure the child will be having. Every procedure has risks, which the parents should discuss with the child's doctor and health care team. Parents should make sure they understand the potential risks of any procedure prior to signing the informed consent form.
For planned hospitalizations, the parents register their child at the hospital registration or admitting area. For emergency hospital admissions, the parents register their child in the emergency department. The parents are required to complete paperwork and show an insurance card, if insured. Often, a pre-registration process performed before a planned hospitalization makes the registration process on the day of admission run smoothly.
A health care provider will review an informed consent form with the parents, and they will be asked to sign it. Informed consent is an educational process between health care providers and patients or their guardians. Parents are encouraged to ask questions. Before signing the form, the parents should understand the nature and purpose of the child's hospital stay and medical treatment, the risks and benefits, and alternatives, including the option of not proceeding with the medical treatment. Signing the informed consent form indicates that the parents permit a treatment to be administered to their child.
Upon admission, an identification bracelet that includes the patient's name and doctor's name will be placed on the child's wrist. The child may wear his or her own pajamas, or a hospital gown, depending on the hospital and nursing unit's policy. A nurse usually consults with the parents to learn about the child's dietary restrictions or preferences. Daily menu choices are available.
Usually, the child will share a room with one or more other children, unless a private room was requested or is required for health reasons. A typical feature of children's hospitals or children's hospital units is a playroom where children can interact with others who are undergoing similar experiences.
Most non-intensive care wards allow parents to stay overnight, at least initially, either in a special nearby unit or on a cot or chair in the child's room.
Health care team
Children's units in many hospitals are staffed by at least some nurses who specialize in caring for infants and children and understand their special needs. A children's activities specialist, also called a child life specialist, is usually on staff. This specialist has a background in child development and therapeutic play.
A variety of physicians, specialists, nurses, and teachers may make up the child's health care team. Parents should make sure they know who is providing care for their child during the hospital stay.
The child's daily hospital experience will likely vary each day. The first day may be consumed by tests to determine the proper course of treatment. The health care team will discuss with the parents the anticipated length of stay in the hospital, based on the child's diagnosis.
Some of the typical hospital routines may be as follows: the nurse checks the child's vital signs (blood pressure, temperature, and heart rate) several times throughout the day and night; the attending physician and medical team usually visit in the morning (medical rounds); medications are administered; tests are performed; and meals are provided three times a day. During the entire hospital stay, the child will be made as comfortable as possible. The health care team will provide the parents with as much information as possible about the child's condition, care, and treatment throughout the hospital stay. Parents are encouraged to ask questions.
Most hospitals have designated visiting hours. The hospital staff is usually accommodating to close family members who want to visit at other times. Each hospital has its own visitation policy that should be investigated before the child's hospitalization. Parents should inquire about sibling visitation guidelines. Usually, only the child's parent or guardian may stay in the room with the child after a certain time in the evening. In some cases, the health care team may ask visitors to wait outside the patient's room during a procedure or treatment.
Depending on the reason for the hospital stay, certain medications may be prescribed or restricted. The health care team will provide specific guidelines and provide all necessary medications during the child's hospital stay.
Many children's hospitals will assign a teacher to any child able to do some assignments. Social workers can help arrange home-schooling as needed after the child is discharged from the hospital.
Resources for families
Educational classes may be available for family members to learn more about the child's condition and what to expect during the child's recovery at home.
Most hospitals have on-site pharmacies where family members can fill the patient's prescriptions; gift shops; and a cafeteria. Usually a list of on-site and off-site dining options can be obtained from the hospital's information desk or social work department.
Before they can reassure their children, parents need to deal with their own fears about the impending experience. It may be easy for parents to unintentionally communicate these fears to the child. The parents should learn all they can about their child's condition and about the hospital, the child's health care team, and available services.
Even with preparation and support, it is normal for children to experience certain fears when they are hospitalized. The most common fear is separation anxiety. The hospital is a frightening place full of unfamiliar sights, sounds, and people, and the child's primary source of security and reassurance is a parent. Many young children have never spent even a single night away from their parents, and if the parents leave for the night, especially at the beginning of a hospital stay, a child can easily fear that they will never return. Even a parent's short absence during the day can prove upsetting to a child. Once the child has become familiar with the hospital environment and personnel, the parents can encourage attachments to particular staff members or playmates to prevent the child from feeling abandoned during periods when the parents must be away.
In addition to separation anxiety, it is common for hospitalized children to fear injury or even death. Children may or may not verbalize these fears. Besides comforting their children simply by their presence, parents can also help them cope by trying as much as possible to help the child feel he or she has some control over things, such as what toys to play with, or what to eat or wear. Parents should answer their child's questions as honestly and thoroughly as possible.
Children may cope with their emotions by being withdrawn or aggressive, or they may have an unnatural
Anesthesiologist—A medical specialist who has special training and expertise in the delivery of anesthetics.
Attending physician—The doctor who is in charge of the patient's overall care and treatment in the hospital. This doctor may or may not be the child's primary physician.
Case manager—A professional who designs and monitors implementation of comprehensive care plans (i.e., services addressing medical, financial, housing, psychiatric, vocational, social needs) for individuals seeking mental health or social services.
Clinical nurse specialist—A nurse with advanced training as well as a master's degree.
Discharge planner—A health care professional who helps parents arrange for health and home care needs after their child goes home from the hospital.
Electrocardiagram (ECG, EKG)—A record of the electrical activity of the heart, with each wave being labeled as P, Q, R, S, and T waves. It is often used in the diagnosis of cases of abnormal cardiac rhythm and myocardial damage.
Financial counselor—Professional who can provide assistance with financial matters associated with the patient's hospital stay. The financial counselor can help families evaluate their insurance plan's hospitalization coverage, determine a payment plan for medical expenses that are not covered, and discuss possible sources of financial aid.
General anesthesia—Deep sleep induced by a combination of medicines that allows surgery to be performed.
Home care—Health care services provided in the patient's home. If home health services will be needed after the patient is discharged, they can be arranged by the social worker or nursing staff.
Inpatient surgery—Surgery that requires an over-night stay of one or more days in the hospital. The number of days spent in the hospital after surgery depends on the type of procedure performed.
Local anesthesia—Pain-relieving medication used to numb an area while the patient remains awake. Also see general anesthesia.
Nursing unit—The floor or section of the hospital where patient rooms are located.
Outpatient surgery—Also called same-day or ambulatory surgery. The patient arrives for surgery and returns home on the same day. Outpatient surgery can take place in a hospital, surgical center, or outpatient clinic.
Patient education—Instruction and information that helps patients prepare for a procedure, learn about a disease, or manage their health. Patient education may include one-on-one instruction from a health care provider, educational sessions in a group setting, or self-guided learning videos or modules. Informative and instructional handouts are usually provided to explain specific medications, tests, or procedures.
Patient rights and responsibilities—Every hospital has an established list of patient rights and responsibilities, established by the American Hospital Association. They are usually posted throughout the hospital.
Pediatric intensivist—A physician who completed a three-year residency in pediatrics after medical school and an additional subspecialty fellowship training in intensive care.
Regional anesthesia—Blocking of specific nerve pathways through the injection of an anesthetic agent into a specific area of the body.
Registered nurses—Specially trained nurses who provide care during the patient's hospital stay. Registered nurses provide health care, administer medications, monitor the patient's condition, and educate the patient.
Social worker—Health care professional available to help patients and families manage the changes that may occur as a result of the patient's hospitalization. Socials workers provide referrals to community resources and can help the family make arrangements for care in the home as necessary after the patient is discharged from the hospital.
degree of obedience stemming from the fear that if they are "bad," worse things will happen. All of these emotions are normal and generally transient reactions that do not cause any long-lasting emotional harm.
It is common for children to experience some developmental regression in response to being hospitalized, either during the experience or after they come home. Often, they temporarily lose a recent advance, such as staying dry at night or overcoming certain fears. It can be helpful for children to cope with their feelings about hospitalization once they are home by playing with dolls and other toys. A doctor kit, selected to help prepare for the hospitalization, is sometimes very helpful in replaying children's reactions once they return home.
Whether planned or on an emergency basis, hospitalization causes disruption in the life of any child. However, with the special accommodations that hospitals usually make for children and their parents, a stay in the hospital need not be a traumatic event. If children receive proper support from family members and the hospital staff, hospitalization can even make them feel proud for having successfully negotiated a challenge to their maturity, self-discipline, and courage.
BOOKS FOR CHILDREN
Bridwell, Norman. Clifford Visits the Hospital. For children ages four to eight years. New York: Cartwheel Books/Scholastic, 2000.
Jennings, Sharon, et al. Franklin Goes to the Hospital. New York: Scholastic, 2000.
Rey, Margaret, and H.A. Rey. Curious George Goes to the Hospital. New York: Scholastic, 1974.
Rogers, Fred, and Jim Judkis. Going to the Hospital. Itasca, Illinois: Putnam Publishing Group, Reprint Edition, 1997.
BOOKS FOR PARENTS
"Planning a hospital stay." In The Gale Encyclopedia of Surgery. Detroit: Gale Group, 2003.
"Preoperative Care." In Mosby's Medical, Nursing and Allied Health Dictionary. 5 (1998): 7033.
Schaefer, Charles E., and Theresa Foy DiGeronimo. How to Talk to Your Kids About Really Important Things: Specific Questions and Answers and Useful Things to Say. 1st ed. Indianapolis, Indiana: Jossey-Bass, 1999.
Agency for Health Care Policy and Research (AHCPR). Publications Clearinghouse P.O. Box 8547, Silver Spring, MD 20907. (800) 358-9295. Web site: <www/ahcpr.gov>.
American Hospital Association One North Franklin, Chicago, IL 60606. (312) 422-3000. Web site: <www.hospitalconnect.com>.
Association for the Care of Children's Health. 7910 Woodmont Ave., Suite 300, Bethesda, MD 20814. (301) 654-6549.
Joint Commission on Accreditation of Healthcare Organizations (JCAHO) One Renaissance Boulevard, Oakbrook Terrace, IL 60181. (630) 792-5800. Web site: <www.jcaho.org>.
KidsHealth. Available online at: <www.kidshealth.org>.
Salo, David, M.D., Ph.D. "Hospital Admissions." Emedicine Consumer Health. 2003. Available online at: <www.emedicinehealth.com/fulltext/11983.htm>.
Angela M. Costello