The Child's Response to Hospitalization 

The  factors influencing the response of  the child to hospitalization are the child's age, his personality, the preparation he received before hospitalization and his previous experiences with health professionals and the hospital environment. The  severity of his illness and length of his hospital stay also affect his response. The greatest influence, however, tend to be how his parents respond to his hospitalization and how health professionals approach him. 

Babies under six months of age tend to show less anxiety than in  later months. Children from around six months to four years show the maximum adverse effects of separation and the stress of hospitalization. 

Robertson has coined the term setting in to describe how young children react to the stress of hospitalization. The first stage is protest. The child has a strong conscious need for his caretaker, and cries intensely when the caretaker leaves, does not accept the attempts of nurses or staff to comfort him, and will go  to the farthest comer of his bed or crib to avoid their contact. The second stage is despair. The child still has a conscious need for his caretaker, but when that person does not come the child cries monotonously. The child becomes less active, withdraws and becomes apathetic. He may sob intermittently, rock back and forth, or engage in other repetitive behaviors. The third stage is denial. The child shows more interest in his surroundings, related to the nurses and staff as well as to other children, and is perceived by other as happy. This behaviour may be interpreted to mean that the child is  setting in and adjusting well to  the hospital. When the young child is allowed to progress through all three steps of "setting in" behaviour, he is in danger of experiencing long-term negative effects. 

Wolff  found that certain children are more vulnerable. These are:  

1. Only children 
2. Youngest children 
3. Living with extended families 
4. Those with a history of responding poorly to strangers 
5. Those who have experienced recent trauma 
6. Those who are exposed  to other people only rarely 

Children with a history of poor adjustment  tend  to respond most adversely  to hospitalization. Children who have major physiologic stresses such as burns, malignancies requiring mutilating surgery, or chronic illness requiring frequent hospitalization are also more vulnerable to the traumatic effects of hospitalization.

Regardless of their age, most children will react to hospitalization with regression. The child's  response to procedures and pain, fears about procedures and  pain result in stress for both the child and his parents. Often misconceptions exist about the purpose of  the procedure and what  is to be done.