When and how do I inform my child?


Childrens perceptions of health and illness as well as of how the human body functions depend on age and developmental level. Even medical fears are associated with development and coincide with the general fears that are common at different ages. The individual childs reaction to a certain situation depends as well on past experiences of health care, parental perspective and reactions as well as cultural influences.

The child who is prepared for a hospital stay can generally handle the experience better than one who is not prepared. Information can assist in decreasing the stress level and help the child achieve a sense of security.

Childrens need for information changes with age. Generally true is that the information should be given honestly and with language appropriate for the childs age and maturity. It is also important that the information be of appropriate length and given at the most opportune time. A good opportunity is when the child is well rested, calm and relaxed, or at a moment when he/she reveals curiosity about or interest in information. Be attentive to questions, facial expressions and other signals that reveal the childs feelings and needs.

Children with previous hospital experience are not protected from fear. On the contrary, past experience may increase anxiety as the child knows what is in store. It is therefore important that even these patients receive the same information as a child preparing for his first visit.

It is difficult for children to predict how they will react to a new and stressful situation. To ease the preparation it might be helpful to discuss how they could feel or react in different situations reinforce for them that reactions are allowed!

Inform your child that no questions are silly or wrong. If you cant answer all questions encourage your child to write down or draw concerns and questions and take them with you to the hospital.

Its not only important that your child receive information it is also important that the timing for when the information is given be appropriate. The younger the child the shorter should be the interval between preparation and the actual procedure or examination. Children do not have long attention spans. It is important to provide information in reasonable amounts and continuously.

The following sections provide tips for how to inform children of different ages. Remember that these are simply recommendations. The advice may need to be adjusted to meet the needs of the individual childs developmental level and medical condition.

Children up to three years

Parents to small children preparing for anesthesia may often be the ones most anxious. This is quite normal. Remember also that small children, up to two months of age, can commonly be separated from parents and be comforted by those caring for them.

Small children are often described as people of routine, as repetition, routine, familiarity and predictability contribute to an environment of security. Between eight months and two years many children undergo developmental periods of fear for strangers. Parental presence and usual routines convey security to your child.

For this age group it is usually sufficient with a short and simple explanation about what is to happen. Avoid detailed explanations about what different body parts look like and what will be done to them small children will generally not understand such detail. Instead, for example, tell a story about a doll who has become ill and has to go to the hospital. Illustrate with the doll and then explain that the same things might happen to them.

Children under three years dont have a well developed sense of time and shouldnt be informed too far in advance. For children who have started to communicate verbally, information can be given the same day or one day prior to coming to the hospital.

Pre-schoolers and younger school age children, 3 - 6 years

Pre-schoolers live in a world of rich fantasies and imagination. Their thought processes can combine and associate events and they can at times confuse cause and effect, which can affect the way they interpret and experience illness and be confusing. There may be difficulties in separating inner and exterior realities. For example, pain can be experienced as something associated with external events.

Information to pre-schoolers should be short and simple. They learn through play, which makes this form of communication preferable. They may often be more at ease communicating the feelings of a doll than their own, so that a doll and a doctors bag are useful aids. Information is applied to the doll at the same time the child is involved in the process in a way that he/she understands that the same things will happen to them.

Children in this age group will often have a general idea of what the body consists of. They are aware that different body parts are vulnerable and fear injury. It is important to discuss which body parts are involved and which are not. It is important to remove any possible feelings of guilt that may be associated with the illness or situation.Fear of the unknown, including ghosts, goblins and frightening masks, is common up until school age. Children can react with fear when they encounter hospital staff wearing caps and sometimes surgical masks.

Pre-schoolers also have a limited temporal concept. Information should therefore be spread out over several days, e.g. a week, such that details are provided one or two days before the procedure or operation.

Children 6-12 years

From pre-occupation with a world of fantasy, school-age children begin to separate fantasy from reality. The body is divided up into constituent parts. Structure can be separated from function. At this age children can understand that illness can occur from inner processes as well as outer trauma. Being sick is not the result of magic spells or punishment but can be explained by factors such as bacteria and viruses. However, in very stressful situations, magical explanations can still occur.

Body awareness is more pronounced than earlier. Procedures or treatments can be seen as mutilating and there can be concerns about the way the body is being changed. Just as for the younger child, it is important to be clear about which body part is involved.

Children in this age group can be intimidated by the technical equipment they meet in an operating room environment. It is also in this age that concerns or fears about death emerge. Sleep and death are associated and it is understandable that many children are anxious about not waking up after anesthesia.

Children in this age group can verbalize feelings. They can understand the reasons for and the consequences of an examination. Compared to younger children they often show more interest in what is going to happen, and information should spring from their questions. Information given by play with dolls can be perceived as childish, dolls should be used instead as instructional material. Pictures and drawings can however be used to help express thoughts and concerns. Information can be given appropriately a week in advance.

Teenagers/Adolescents

Adolescence is a dramatic period, marked by important physical and psychological changes. Worries about not being normal, not developing or having an acceptable appearance are common. Teenagers are often concerned about being in control of their bodies. Changes that are made to their body or being dependent on help due to an illness can be experienced as a violation of their integrity.

Teenagers tend at times to see themselves as the center of attention. They might experience what they go through as completely unique and not understand that anyone could empathize with what they may feel. Adolescence is a time of liberation and desire to make ones own decisions. Teenagers may have a strong need for privacy and may clearly mark their integrity by maintaining distance from their surroundings.

Adolescents wish often to be considered almost equal to adults. Information should be given almost as if to an adult. Teenagers may have enough understanding of biology to understand how organs and body functions work, and can also think abstractly, draw conclusions from given information and calculate the consequences of planned actions. They are therefore not completely satisfied with only knowing what will happen or be done during a procedure or treatment. They may be interested in the whole hospital course, and may desire information on why certain examinations or treatments are planned and what may result from them. Teenagers should be encouraged to ask questions and be included in discussions, decisions and plans. Information should be given enough in advance to allow for reflection and consideration. Emphasize for your teenager the importance of writing down questions and concerns and bringing them to the hospital.

There are often concerns in this age group about waking-up during the procedure or operation, or not waking-up at all following anesthesia. There are also concerns about being out of it, losing control, making embarrassing remarks or losing bladder or bowel control.

References

Bischofberger, E., Dahlquist, G., Edwinson-Månsson, M., Tingberg, B. & Ygge, B. (2004). Barnet i vården. Stockholm: Liber.

Jylli, L., Olsson, G. (2005). Smärta hos barn och ungdomar. Lund: Studentlitteratur.

Tamm, M. (2004) Barn och rädsla. Lund: Studentlitteratur.

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