A Doctor's journal
A Child Goes to Hospital
By MILES
HO W AR!)
EDICINE, in the age of mechanism, took little account of the patient's reaction to people (such as mother-in-law, the lodger or the doctor) or to events (such as admission to hos- pital, operation or pill-taking). Pills and mixtures in a bottle were thought to cause changes for the batter (if there were any) by virtue of chemical action and that alone. If you were ill and had to be sent to hospital, you went, were treated and came out; it was as simple as that. The emo- tional state of the ill person was not merely under- estimated—it was ignored. Now, in these rather more enlightened days, most doctors agree that to take a young child away from its parents and put.it in a strange place among strange people for any length of time is a serious matter. It may have to be done if the child's illness is such that it cannot be handled at home, but .the decision is always a momentous one.
The Professor of Child Health in the Univer- sity of Sheffield has reviewed the whole subject most admirably in a recent paper.* As he said, some people are apt to underestimate the effects of hospital admission on the young child. It would be very surprising indeed if small children were not upset; in the first three to four years of life they are closely attached to their parents and at no time do they need the comforting love of mother and father more than when they are feeling poorly. Just because the child is quiet in the ward and behaves well the casual observer may judge that he is not unhappy. Nothing could be farther from the truth. Professor Illingworth describes a visit he made to an institution for illegitimate children in a foreign city. In a first- floor room there were twenty to thirty children, all under four, sitting on the floor like Madame Tussaud's figures. They did not laugh, cry or talk. A french window opened out of the room, with a drop below. The visitor inquired whether this was not rather risky, and was told that no child had ever fallen out. 'We doubted whether any child ever would. The effects of emotional deprivation were so gross that the children did not move.'
Now this is an extreme case, but it does remind us that the effects of 'starvation' of affection may be shown by silence and 'subdued behaviour, as well as by crying. At all ages there are some children who seem to be untouched by admission
to hospital; they settle at once and appear quite happy. In young children, however, this is quite exceptional, and Professor Illingworth outlines six types of emotional reaction, including failure of appetite and hence failure to gain weight.
These factors were found to be important in determining the form and intensity of disturb- ance : (1) the age of the child : the younger he is the greater the risk; (2) length of stay in hos- pital: the shorter the better; (3) the parent-child relationship : the better this is and the more secure the child, the less likely is he to be upset; (4) the nature of the child's experiences while in hospital; (5) the nature of the illness; (6) the per- sonality of the child; and (7) the preparation of the child for hospital and the attitude of his parents on discharge. Threats by the parent—for instance, that if he does not behave he will be left in hospital—are always bad; unwise remarks and promises can do a great deal of harm.
We can, then, assume that having to go to hos- pital will always cause disturbance of some de- gree in the young child. How can this be kept down to the minimum? Firstly, don't send the child in if it can be avoided. The more efficient the outpatient department the fewer children will be admitted to the wards. It should seldom be necessary to admit a child because of an infectious disease; the great majority can be safely nursed at home. The various divisions of the public- health services—health visitors and home helps, for example—are at the command of the family doctor.
Preparation of the child for his stay in hos- pital is essential; too much of this can be as harmful as too little. Too much talk about doctors and operations will make the child unduly anxious; too brief a notice or no notice at all is asking for trouble. The manner of admission is important too; the mother should go up to the ward with her child and see him into ,bed, and his favourite teddy or toy or whatever is his 'fetish object' should, of course, go with him. My own daughter, at eight and a half, still needs her oldest friend (Goggy, a blue blanket with a hundred tails) at bed-time before she can sleep. The reassuring presence of a Goggy-type of possession is even more vital when a child is ill and away from home.
Finally, all children's hospitals and wards should allow daily visiting. Arguments against this have their origin in failure to comprehend what is going on inside the child. If he has cause to feel let down arid deserted by his parents when he needs them most, of course he will feel dis- appointed and resentful. It is true that the younger child will almost always cry when his parents depart, but the crying spell seldom lasts long; it is far better that he should, so long as he knows that they will come again next day.
In conclusion, to use Illingworth's words, the child who stands at the end of his bed with his nappie half-down his legs and his nose running, screaming all day long, is not a naughty, spoiled child, but a normal one; the subdued two-year- old who lies in bed without a murmur, when at home be would be noisy and boisterous, is not being 'good'; he is being emotionally starved and needs all the care and affection his attend- ants can give.
* Lancet, July 26, 1958.
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