How Patients React to Hospital Care

Common reactions to illness and hospital care

When your child or teen is in the hospital, their daily routine changes. They may be sad, angry, fearful, and feel a loss of control. These are normal feelings.

How they react to these feelings depends on their age, stage of development, and personality. Also, some medications may make them feel different. It is common for children and teens to react in 3 ways:

• Regression
  
• Aggression
  
• Withdrawal

Regression, aggression, and withdrawal are usually temporary reactions. These behaviors often decrease or stop when they feel more secure and adjust.

Regression means going back to an earlier stage of life to cope with a new situation. Your child may act younger than their age if they:

• Wet the bed, even if potty-trained or used the toilet for awhile
• Comfort themselves by thumb-sucking or clinging to a parent
• Complain more after coming to the hospital
• Use "baby talk" or limit their communication

Aggression

In the hospital, health care providers and parents make many decisions that affect patients. Your child or teen might feel like they have no control over what happens to them. They may be angry, fearful, and act out (misbehave) in aggressive ways such as:

• Crying or yelling
• Kicking or using physical resistance (grabbing, pushing)
• Acting irritable or “snapping” at others without a known cause (acting rude, yelling)

Withdrawal

Some children and teens react by avoiding normal activities. They may:

• Lose interest in activities they enjoyed
• Sleep more
• Talk less, quieter
• Eat less
• Not make eye contact with others

Your child’s reactions will vary daily. Watch for changes in their behavior and emotions, especially if that last for several days to weeks at a time. Also watch to see if these behaviors happen only when they are at the hospital. Or if they continue when your child transitions to your home and goes back to school. Tell your health care team about any concerns.

Support your child or teen in the hospital

Child life specialists, psychologists, social workers, and chaplains can help you interact with your child or teen. They have experience and are ready to assist. Do not be afraid to reach out and ask for help if you need it.

Help your child or teen find healthy ways to manage their emotions and share their fears:

• Express your feelings in a positive way, stay calm, and show good coping skills. By watching you, your child or teen will learn the right way to handle their emotions.
• If you cry or become frustrated, that is OK. It will validate those same feelings that your child or teen may also be having. Explain that parents feel sad when their child is sick. When you are sad, it is not their fault.
• Do not force them to talk. Wait until they are ready. Children and teens may show they are ready by asking questions when unprompted.
• Create a safe space for them to share. Let them know you take their feelings, concerns, and fears seriously.

When they are ready, encourage your child or teen to talk about how they feel and not hide their emotions. If they start asking questions, let your child guide the type of questions or concerns they wish to talk about. This can be a clue that your child is ready to talk about their illness and learn more.

• Ask your care team for help if you are unsure what information to share.
• Share age-appropriate information and only what they need to know at that time.
• Follow their lead. If they ask questions, answer them honestly as appropriate. Use simple words they can understand. Honesty builds trust.
• Children need to feel loved and surrounded by people who want to help them.
• Explain who will be with them during treatment.

Please see Talking to Your Child about Cancer for more important tips on how to talk with your child.

Take care of your emotional health and that of other family members too.

Talk with other parents going through the same thing.

Managing emotions in the hospital

Help your child or teen find better ways to let out their feelings instead of hiding them or acting out. They can:

• Hold a comforting object when they are fearful or upset or do an activity to distract them (hold your hand, play a game, sing a song).
• Hit a pillow when they are angry instead of hitting others.
• Make a list of what they like and do not like about the hospital.
• Express their feelings through art, music, photography, playing “pretend” games, or other activities.
• Practice deep breathing.
• Keep a journal (write, draw, video).

Setting rules and consistent limits in the hospital

Set rules and keep consistent limits for your child or teen at the hospital. Keeping a routine helps them feel secure. Some tips are:

• Whenever possible, keep the same rules and limits at the hospital as before their diagnosis.
• Give them clear instructions. Tell them what to do instead of what not to do.
• Praise them for things done well (getting through a hard procedure or treatment, waiting patiently).
• Praise them for taking their medicines.
• If they are upset, stay calm and recognize their feelings. Do not allow your child to use meltdowns or outbursts to gain control so they don’t have to follow rules. Set clear limits and act on them with consistent follow-through.
• Avoid harsh punishment and physical discipline.

Getting a sense of control and connection

If there are options, let your child or teen choose to give them a sense of control. If something must happen, then do not offer it as a choice.

• Let them schedule their play or free time. As appropriate, they can decide the activity and how long. Let them do it without interruptions.
• They can pack their favorite items to use while waiting for appointments.
• Ask them what they want to share with others about their illness.
• Let them plan visits and communicate with others. (FaceTime, text messages, videos, or phone calls).
• Help them make new friends at the hospital.

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