Mummy, what’s hostable?

It’s a telephone call that is made several times a week from school to parent – Johnny has hurt himself in the schoolyard scrum.

When Kelly’s mother took the call she wasn’t too concerned, recalling guiltily, ‘I didn’t realise that her teacher thought that it might be a broken arm. I think I said something like, is she bad enough to come home, or can she go to the sick room!’ Enlightened, mother and daughter were inducted into the emergency procedures of the nearest hospital.

Says Kelly’s mother, ‘I guess I was surprised at just how scared she was, given that she is normally a very self-possessed little girl. The shock of the fall and the pain she was in, meant that everything was a threat, from the jab in the backside for pain relief, to the sight of the X-ray machine.’

‘She couldn’t understand why she wasn’t allowed to have a drink of water and by the time she was finally sent to surgery many hours later, she was very worked up’

‘You can never predict when you’ll end up in a hospital with one of your kids, and most of the time you can’t prepare them for it.’

Statistics from the Royal Children’s Hospital in Melbourne show approximately 26,000 children are treated there every year, with an average stay of 2.3 days. Unlike their parents’ day, the ‘Children’s’ is no longer the only place for treatment. 

And sooner or later, many children end up at a local hospital; often as a result of accident, or for treatment of a variety of common children’s illnesses - hernias, ear grommets, tonsillectomies and the like. These days, such procedures are now day surgery, or at most an overnight stay.

You’re the parent of a healthy child, so how do you prepare your child for a short hospital stay?

Leanne Hallowell, Chief Educational Play Therapist at the Royal Melbourne Children’s Hospital, says that play therapy is an important part of the treatment process. The role of the educational play therapy department is to make going to hospital a positive experience, not only for the child who is there for a one-off procedure, but also for the chronically or long term ill. The department provides normal ‘play’ for hospitalized children and medical play to help them work through any fears or misconceptions about medical procedures.

‘Most children won’t tell you what’s wrong with them and why would they? If you have a sore tummy and you tell the doctor, then you might get an injection!’ ‘By using medical play and watching them, the therapist can gain an idea of what’s concerning them. If the oxygen mask is the fear, then you can guarantee that the oxygen mask will be going on and off the doll.

‘And if they’re injecting the doll’s toes, when they’re about to have a tonsillectomy, then it’s a fair assumption that they have no idea at all about what’s happening!’
At the Melbourne Children’s Hospital, the usual procedure is for parents to receive information about play therapy when they receive their pre-admission information.

At that stage they can book an appointment with the Play Therapy department, where the therapist will use play to teach a child about what will happen, show the process and in what order and what can be done to make that process easier.

‘We show them the X-ray machine, show them the pre-op, show them where they’re going to wake up afterwards. And especially we show them where Mum or Dad will wait while they’re having the operation, because for some children, that’s really scary.’

Having said that, Leanne goes on to say, ‘We work on the theory that you don’t need to know anymore you must, so a child will know about the pre-op room and induction room (where anesthesia is given) and they know that their parents will be with them up to the point at which they go under, but they don’t need to know what happens in the actual surgery or what it looks like.’

(And it’s not called going to sleep - too many connotations of the family pet! Young patients are told that they will be given a special medicine so that they won’t feel or hear anything during the operation. And when the medicine is stopped - they wake up.) Once a child’s in the recovery room, their parents are paged before they come to – the child never knows that Mum and Dad weren’t there all along.

Leanne stresses that medical staff fully understand that parents themselves are under a great deal of stress. As she says, ‘It’s a fine line – as parents, you don’t want anything to hurt your child, but you know that if they have an IV line put in, for example, it will cause pain. ‘Yet if they don’t have it done, then they don’t get well. Children trust their parents to not let them get hurt and there they are handing them over to someone who is going to give them an injection!’

Play therapy is also of tremendous value where the parent is of a non- English speaking background; an interpreter can be present at the information session. Inevitably too, there will be some parents who become terribly distressed themselves. Leanne candidly admits, ’It can be dreadful. If Mum and Dad are collapsing, then their child obviously won’t cope.’

‘Play therapy can help break the cycle before it comes to that. Medical play with both parents and child means that maybe the child won’t get it all, but Mum and Dad will and if Mum and Dad are more confident and feeling in control, then so will their child.’ ‘And when it comes time for the procedure to happen, they’ve already gone through it on the dolls.

‘Parents can say to their child, remember when we did this on the doll and this is what happens next. They can keep reminding them where they are in the process – there’s light at the end of the tunnel; we practiced it before and now there’s just the bandage and we’re finished’.’

Leanne stresses that it’s important to be completely honest with young patients. A child may not understand all that is happening at the time, but when they’re recovering, they have time to reflect on their experiences. If they’ve been given facts appropriate to their age, then over time a child can make sense of the whole experience in a positive way.

Kelly’s mother agrees. Once the pain of the break had subsided, her daughter talked a lot about her hospital stay, remembering minor details and asking questions. For that reason, a lot of medical play is done afterwards, to help in the debriefing process.

As well, it’s a tempting incentive to get out of bed and go along to the playroom and often a welcome diversion from pain. If a child isn’t well enough, then activities are brought to the bedside.

And as for the reaction of siblings, Leanne feels that the same approach works best. ‘Be open and honest with them, as you do with a patient, because otherwise what will happen is their brother or sister will come up with their own storylines, depending on what they’ve seen or heard elsewhere.

‘And those storylines are not going to match reality. They need to be involved, need to know what will happen and what their sibling will feel. And that there’ll be some disruption to normal life, dinner may not be on the table at the usual time, for example.

‘One thing, though, I definitely wouldn’t go down the road of coming in every day with presents, because suddenly that’s when being sick becomes attractive.  ‘Keep things as normal as possible; a visit after school, or even email or fax instead.’

The play therapy team has good advice to help families make the adjustment to their home life. Once discharged, children often show adverse behaviour for a few days after they go home. Parents should expect that it may take a little while for life to return to normal.

The team can give parents follow-up information and some skills and are available if needed, but as Leanne says, ’at the end of the day, parents are really better at it than us – they know their child and being home is the best medicine!’

Hospital visits can be stressful for all. Managed carefully, they become just another part of the fabric of childhood. For Kelly, the emergency trip to the hospital has faded to a not unpleasant memory, and even a source of pride. Back at school, the traditional honour badge of the arm plaster helped ease the pain.

And the stuffed bear given to her for comfort takes pride of place on her bed!

Checklist – Things to Do

With your child

• Talk honestly about the visit to hospital.
• Listen to your child’s questions – your answers depend on their age and level of understanding.
• Make an “All About Me” board to hang on the hospital bed. Include favourite toys and games, brothers and sisters, pets and friends. It gives the hospital staff things to talk about with your child.
• Read books about going to hospital.
• Write a story together – ‘Susie Goes To Hospital’
• Play games – Give teddy an injection, bandage dolly’s arm.
• Draw me sick in bed.
• Build a hospital with Lego.
• Pack a bag together with favourite soft toy, book, family photo, pyjamas, toothbrush and so on.

Some questions to ask the hospital

• Can I visit the hospital with my child before admission?
• Is there a special area set-aside for children?
• Do they have play and school programs available?
• Can parents be with children during painful procedures?
• Can parents be present - In the pre-op room? While anesthesia is administered? In the recovery room?
• How long will the operation last?
• How many days stay?

By Jennifer Kernahan

Source – pamphlet produced by the Association for the Welfare of Child Health (AWCH Victoria)

Resources

Kids Health website - Bright, user-friendly site set up by the Nemours Foundation in the US – it has categories for kids, teenagers and parents (and also is a terrific site for school projects on the Human Body).

The information provided in this article is intended as a guide only. Always consult your doctor if you or your child is suffering any medical complaint. Any websites referred to by Australian Family contain information moderated by government and medical institutions or organisations.

This article was first published in Australian Family Magazine, May 2001. Updated July 2009.