Hospitals Easing Kids' Fear Factor

In the eyes of children, a hospital can be a scary place.

It's filled with people they don't know, doing things they don't understand. There's rarely anything homey or comfortable about it, and serious conversations and strange noises can be heard throughout its dreary institutional halls.

Even hospital workers acknowledge that admission can be a traumatic experience for children.

Many medical institutions, including the Children's Hospital at Montefiore Medical Center in the Bronx, have launched education and awareness programs to eliminate the fear factor.

"Child Life was created to help children and their families to deal with the psychological and social issues of going to the hospital or the doctor's office. We want to make it easier for everyone who can be helped by a surgery or a doctor," says Troy Pinkney-Ragsdale, director of the Phoebe H. Stein Child Life program at Montefiore.

Child Life specialists try to explain to children what they can expect during a hospital visit and what their specific procedure will entail, all in words and pictures that are age-appropriate. Role-playing and illustrations are both key elements.

The program covers in- and out-patient services and the pediatric emergency room.

"We have kids who come for surgery and ask, `Are we going to wake up?' Others ask, `Why am I here?"' says Moniqua Jackson, one of Montefiore's Child Life specialists. "We try to be honest and use child-friendly language, and parents should be honest and use child-friendly language. But no one should try to sugarcoat things."

Meanwhile parents — who might be trying to put on a brave face — have different fears.

They're afraid they'll be kept away from their children or that their children will hate them for scheduling the surgery in the first place, reports Pinkney-Ragsdale.

It's OK if children cry and scream — it's natural and won't last forever, Jackson says, and most hospitals will make every effort to have a parent be the last person children see before their procedure and the first person they see when they wake up.

While parents shouldn't necessarily share their concerns with their children, they should make an effort to find out any and all worries their children may have, she says.

If children are hesitant to use words, or don't have a sophisticated enough vocabulary, Jackson suggests asking them to draw a picture of the hospital or to pretend that they are a doctor and mommy or daddy is a patient. "This will help you see clearly what their fears about going to the doctor are," she says.

She adds: "Let kids express their fears. The thing that you don't talk about is what is the most scary. Kids then conjure up their own ideas what it's going to be about, and it's usually much worse than the reality."

Additionally, Montefiore has a "teddy-bear clinic" which aims to give children some empowerment.

"Play is a wonderful mechanism to teach children about what is going to happen to them. We've even used dolls and teddy bears, even with teenagers, to show them what's going to happen," Jackson explains. "We'll give toddlers the face mask to play with so that when they go into the operating room they won't be seeing it for the first time. Sometimes they even decorate their masks with stickers ahead of time."

Jackson also encourages pre-admission hospital visits to eliminate another "unknown," this way children will know what the rooms look like, if there are chairs for parents and visitors, and where the bathrooms are.

Hospitalization should never come as a surprise to a child, but toddlers and preschoolers only need advance warning of a day or so because they don't have a good sense of time and might worry unnecessarily for days beforehand, Pinkney-Ragsdale notes. It's possible to still do the role-play, reading and drawing in the days leading up to the procedure but parents don't have to make a direct connection, she says.

Older children might need more time to process what's going on.

Of course, each child, each medical procedure and each hospital are different, Pinkney-Ragsdale says, and a family has to find out what works best for it.

There are, however, two "universals" in Pinkney-Ragsdale's book:

Honesty is the best policy. "If you tell your child that something won't hurt — and it does — then the next time will be that much worse because the child won't trust the parent anymore."

You don't have to do this alone. "Talk to your doctor, talk to your nurse, call the Child Life department — it's what we do. Ask us, `What do I say to my child about his surgery? How can I make him less scared?"'

By Samantha Critchell