Coming into hospital can be a daunting experience for children and families. Even before surgery, your child will likely undergo numerous tests, procedures or interventions which can be difficult for them to understand and may result in feelings of fear and anxiety.
As Child Life Therapists, we have supported countless children to help prepare them in the lead up to surgery or medical appointments. These are our top 5 strategies for promoting familiarisation, preparation, choice and control and a sense of mastery over medical interventions.
Medical Play
Providing children with the opportunity to engage in medical play gives them the chance to become familiar with real or toy medical equipment, in a relaxed situation in their own space and time. Research suggests that children benefit more from medical play when given time to play with the equipment and then process any emotional responses related to the experience. If you don’t have a kit at home, you might like to consider purchasing one or borrowing one from a friend in the weeks leading up to your child’s admission.
Talking to your child
How and when to talk to your little person about their heart surgery can be a difficult decision. For older children (6 and up), talking to them about a week before their appointment or surgery is usually a good amount of time to help them understand, process what is happening, address misconceptions and answer questions. For younger children, telling them 1-2 days prior is usually a good time frame. Try and have the conversation in the morning or during the day. Talking about these things just before bed can lead to little minds worrying without time to process. You know your child best and when you feel it is the right time to have these conversations, however, it is always important to have honest discussions with your child before they arrive at the hospital. If your child has lots of questions or worries, you can get a special notebook and encourage them to write them down or draw them. You are not expected to be able to answer all their questions! Your child can then bring their special book to the hospital and ask the doctors or nurses to help answer them. It gives them a sense of control and a place to put down their worries.
Access Resources
Research has shown that, with developmentally appropriate preparation, children can demonstrate increased coping and decreased distress during procedures. There are so many amazing resources available to families to help your child understand what is expected of them and familiarise them with procedures and interventions. The Royal Children’s Hospital has produced videos which can be accessed through their website called: ‘A Child’s Guide to Hospital’. They are short videos which explain different procedures such as ECHO’s, ECG’s, chest x-ray, bloods tests and even coming in for surgery. It can be extremely helpful to see another child having similar experiences and helps your child feel more prepared and comfortable with what is expected of them.
Comfort Items
When it is time to come into the hospital, involve your child. If it is for an outpatient appointment, let them pack a bag for the day with their favourite toys or activities. Having a routine around coming to the hospital for regular appointments can increase a child’s feeling of safety when they know what is coming next. Consider creating routines around:
- Bringing a particular toy with them to the hospital
- Visiting particular attractions at the hospital or going to a nearby playground
- Having a treat after the appointment
- Getting your child to choose a special activity that they do on the way home
If they are coming in to stay, encourage them to pack their suitcase with all their special things. Pillows, blankies, teddy bears, trucks, superhero figurines, photos – whatever is going to make them feel more comfortable and promote a sense of safety. It is also a good idea to get them to help you pack your own bag. This reassures them that you will be present and you are going to do this together.
Create a coping tool kit
Developing your child’s coping tool kit is so individual and you get to be as creative as you like! It might be putting together a list of things that help them when they feel worried, such as having a hug, taking some deep breaths or watching their favourite TV show. Creating this list allows the child to reflect on what makes them feel good and they can draw on it when times are more challenging. It might be gathering some sensory toys that provide a sense of calm when stressed. It might be creating a play list of their favourite music or setting up FaceTime calls with family and friends. When any of us are in pain, tired or anxious, it is a lot harder to draw on those strategies; but if you have your coping tool kit ready to go, your child can choose what feels right for them at the time. This will promote a sense of control and allow them to tap into known effective strategies.
Kate Strickland has a background in Occupational Therapy and Education and has been a Child Life Therapist working with infants, children and young people in the cardiac space for many years at the Royal Children’s Hospital. Seeing the gap in service provision pre and post hospital, she started the organisation Healing Hearts Beyond to provide a community-based Child Life Therapy service to support infants and children along with their families in managing the stresses associated with procedures, hospitalisations and medical trauma.
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