Hospitalisation always involves for the child, regardless of age, drastic changes in daily life and its rhythms, such as detachment from objects and people considered points of reference. Children react to hospitalisation in different ways depending on their age, the level of development achieved and the emotional relationships established. However, some aspects are transversal to the different phases of growth, and it is important to know the mechanisms underlying certain behaviours, in order to manage them with greater awareness and offer more effective support.
The morbid event causes, first of all, a substantial change in the routine and habits of life, hindering the conduction of an autonomous life. In fact, the child is forced to suspend relations with the external environment, witnesses a decrease in his or her possibilities of movement, is restricted in his or her diet and is totally dependent on the adult (Lima & Santos, 2015). These restrictions are relevant at a psychological level as they cause a return to previous stages of development and to more childish behaviours belonging to the past. Therefore, slowdowns, arrests or alterations to the normal growth process can occur and the younger the child is the more negative the consequences are. It can also happen that the child concentrates too much on himself or herself, on his or her diseased organ/limb or its compromised function. This causes a kind of narcissistic regression, i.e. a return to a condition of egocentricity (the tendency to take an interest in oneself and be insensitive to the problems of others) and emotional dependence on the adult.
Hospitalization also involves the loss of an active role of the child, who finds himself immobilized by the condition of the patient. Inactivity may consist of:
1. use of mobile phone, tablet and television as anaesthetics,
2. excessive demand for attention,
3. loss of most of the autonomies acquired,
4. inability to tolerate minor frustrations,
5. eating disorders,
6. poor cooperation during examinations and/or therapy.
It is important to know that for the child there is a close relationship between illness and punishment: he/she can be convinced that the illness does not have an organic or external cause, but is rather generated by his/her own guilt and therefore represents a "just punishment" for having violated his parents. This conviction can provoke a sense of guilt that can weaken the drive for healing and help to fuel reactions of passivity.
During hospitalization or an exacerbation of the illness it is normal that some of the factors listed above are put into action; the problem exists when these responses consolidate and persist even during quiet moments, undermining the construction of the child's identity.
WHAT CAN PARENTS DO?
- Showing their comprehension ("I understand that you are ill, that you are facing a difficult time") is already a first containment, which allows the child to share the burden of the situation with the parents and partially neutralize the anxiety experienced.
- Recognising one's own child's emotions and welcoming them in order to encourage the release of tensions and help the child to "organise" his or her own defences to deal with the situation.
- Avoid blaming the child or being judgemental and dissatisfied with the child's way of reacting (for example, criticising his or her complaints): it is necessary to find a way and time to talk together, trying to identify the anxiety hidden behind that behaviour and deal with it.
- Reassuring the child, to help him/her keep his/her fears at bay. It is important, as far as possible, to communicate reality without loading it with one's own anxieties and tensions. For this reason, as for other needs, it is possible to get help from the healthcare staff on the ward.
It is important to encourage activities aimed at reducing anxiety and tension, such as games, which for children (but not only) have a reassuring and potentially cathartic function, allowing them to relieve tension and stimulating a process of re-elaboration of reality. Playing allows the child to express desires, anxiety and repressed needs in a free and creative way (Koukourikos et al., 2015). Playful activities also facilitate communication, interaction and help to counter the fear of painful and traumatic medical procedures (Soares et al., 2014). Given the central role of play during hospitalization and rehabilitation, several hospitals provide parents and children with volunteers and specialized operators, often coordinated by associations such as AIBO (Association for the Child in Hospital). These help families, starting from the first admission, to move easily in the new environment (informing, welcoming and accompanying) and organize socialization activities to involve children and adults during the period of hospitalization, until discharge.
Translated by Francesca Cioffi
Original version by Sara Bergamini