YOUNG CHILDREN

Young Children

Infants and young children rely on their parents and the adults around them to provide a sense of safety and security and trusted routines.  Your young child can seem to “bounce back” to a calmer or happier state, even after upsetting or painful moments in treatment, when you are there to provide distraction, security, and comfort.

Infants and young children rely on their parents and the adults around them to provide a sense of safety and security and trusted routines.  Your young child can seem to “bounce back” to a calmer or happier state, even after upsetting or painful moments in treatment, when you are there to provide distraction, security, and comfort.

When they are upset, young children tend to SHOW you, rather than tell you. It’s best to watch for changes in their behavior to understand how they are feeling and coping. For example, young children:

  1. Can regress in behaviors (bed-wetting, thumb-sucking, etc.) in response to distress.
  2. May have strong startle responses (being jumpy, frightened, or surprised), nightmares, and outbursts.
  3. Are still developing their ability to use words to process their feelings, and so are more likely to process the illness or injury through play, drawing, and storytelling.
  4. Depend on parent presence and support to soothe and calm them, because they are still developing the ability to self-soothe.
  5. Can experience the sights, sounds, or smells of the medical environment as stressful and/or traumatic.
  6. Can get angry or frustrated with doctors and nurses administering painful procedures.
  7. Can experience separation from parents, siblings, and/or pets as traumatic.
  8. May not understand that some losses are permanent.

When they are upset, young children tend to SHOW you, rather than tell you. It’s best to watch for changes in their behavior to understand how they are feeling and coping. For example, young children:

  1. Can regress in behaviors (bed-wetting, thumb-sucking, etc.) in response to distress.
  2. May have strong startle responses (being jumpy, frightened, or surprised), nightmares, and outbursts.
  3. Are still developing their ability to use words to process their feelings, and so are more likely to process the illness or injury through play, drawing, and storytelling.
  4. Depend on parent presence and support to soothe and calm them, because they are still developing the ability to self-soothe.
  5. Can experience the sights, sounds, or smells of the medical environment as stressful and/or traumatic.
  6. Can get angry or frustrated with doctors and nurses administering painful procedures.
  7. Can experience separation from parents, siblings, and/or pets as traumatic.
  8. May not understand that some losses are permanent.
Ways to help young children

Young children can sense the feelings of their caregivers, especially when they are scared, angry or upset. Their behavior may be affected by what they sense from others.

To best help your child(ren), look at the big picture and consider:

  1. What are things that you need as a caregiver?
  2. What information do the children need to be made aware of?
  3. What resources are available along the way to help?

As much as possible, maintain everyday routines, activities, and limits. It is important to look at what was in place prior to the illness or injury and reassess which ones are still manageable, need to be changed, or eliminated all together. Trying to keep some everyday routines can help things feel more normal at home. Having regular routines and activities (like meal times, bed times, and chores) give young children things to expect and look forward to. Even though it can be tempting to relax family rules to help your child to feel special or make up for hard times, it’s often better to keep most of the rules and expectations the same.

General tips for supporting young children
  1. When talking with your child, get down at your child’s eye level, it will help make them feel comfortable.
  2. Be open and honest, using words that they can understand. Call the illness by its name (cancer, diabetes, etc.).
  3. Encourage your child to ask questions not only to you but also to the healthcare staff. Ask your child what they know about the illness or injury. This will let you know what they are thinking (you might be surprised by what they understand, or misunderstand), and it will give you a place to start. Ask them also what they know about the hospital or clinic.
  4. End each talk by asking your child if they have any questions.
  5. When preparing the child for a hospital or clinic visit, do not do it too far in advance because it may cause your child to worry. To help prepare them, look for books, TV shows, etc. to help make them familiar with helpers in the hospital or doctor’s office.
  6. Your child will do best when they are prepared for whatever they will encounter. Children learn using their 5 senses so prepare them by explaining what they may hear, see, feel, smell and taste. Try having them feel the medical equipment that will be used to try to help them to get better. Can they touch the IV tubing, blood pressure cuff or the pulsox probe?
  7. Remember that your child will not be able to handle a lot of information at once. You may want to break it down to a few mini conversations, addressing only the things that are relevant at the time.
  8. Reassure them that they did not get sick because of anything that they said or did. (If the illness or injury was due in part to something that was done, omit this statement, or emphasize what they are doing now to help themselves get better.)
  9. Encourage your children to share their feelings. There are many ways to share feelings (talking, drawing, story-telling, hugging) at different times (dinnertime, bedtime) and places (in the car, at home, in the hospital). Help you child name their feelings such as being sad, scared, angry, jealous, or guilty. Share your own feelings and be a good listener even if what they have to say is hard to hear. There are some good books or activities to try. Play Doh is good for helping to work out angry feelings.
  10. Do not get upset if your child regresses. Show them that you love and support them during this scary or difficult time. Your child is learning new skills and increasing their independence, try to give them choices, whenever possible. These can be simple choices like which book to read next or whether they want to take a walk vs watching a movie.
  11. Let your child know that it is okay to be scared or cry. Encourage them to talk to you when they feel scared or upset.
  12. Be sure to talk your child about things other than the illness or treatment.
  13. Try to avoid the word “okay” after a sentence. This could imply that your child has a choice when they may not. For example: We need to go to the hospital to get your medicine, okay?
  14. Be careful of the word “just” as your child may feel that their feelings are not validated. In some cases your child may be showing a reaction to what they think it going to happen or how something may feel. At other times the fear of pain may be real to them.
    For example: “It is just tape coming off of your skin.”
    Your child may not like the feeling of tape being removed from their skin and it may cause them a little discomfort.
Supporting young children at the hospital and clinic
  1. If your young child has a comfort object, try to have it present at appointments and at the hospital.
  2. If possible, try to have someone who your child knows stay at the hospital, at times when you are unable to be there during their stay.
  3. Bring pictures of your family and pets to hang up in your child’s hospital room.
  4. Does your child find comfort in hearing their favorite book or song, or is there another approach that helps your child cope? Let the hospital staff know so they can try to use those ideas when you are not able to be at your child’s bedside.
  5. Talk to your child’s nurse about using the treatment room, if possible, for any and all procedures so their hospital room can be a “safe” space. Some hospitals may not have treatment rooms, the treatment rooms may be unavailable or you child may not be able to leave their room therefore the procedure may have to be done at their bedside. Prepare your child in advance and include who will be present, what their job is and talk about ways to help your child cope. Speak first with your child’s child life specialist, nurse or doctor to find out the best way to prepare your child.
Useful phrases to use with your young child

You know your young child best, and you probably have experiences, which you can draw on now, in talking with them about things that are hard or challenging. The child life specialists, doctors and nurses may have specific suggestions for how to explain your child’s illness or treatment in child-friendly terms. Here are some suggestions to get you started.

General:

  1. “How are you doing? Is there anything that you are worried or scared about?” “When I am worried I think it is helpful to talk to someone”
  2. “If you feel like you don’t want to talk right now, how about drawing a picture about what is happening and what you are feeling?”

Hospital/Clinic:

  1. “The hospital/clinic is a new place for all of us. If there is something that you aren’t sure about or that scares you, please let me (us) know so we can talk about it”
  2. “The hospital/clinic is a new place for all of us. There are some things that the doctors and nurses will need us to do so they can try to help your body. You can help too!”
  3. “There are a lot of people who work in the hospital/clinic. They are there to help. If there is something that you do not know, ask them. It’s part of their job to answer your questions!”
  4. “The hospital/clinic can be a scary place because there are new people and it is a new place. All of the people who work in the hospital/clinic are there to help. They care for a lot of kids each day.”
  5. Try to avoid the word “take” as young children may think that something is leaving them.
    Example: “The nurse is going to take your temperature.” Try saying “The nurse is going to check your temperature.”
  6. “Sometime, to best help your body, the nurses or doctors have to check out your body or give you medicines that can only be given at the hospital/clinic”
  7. “Some medicines have to be given by using a needle. It may feel like a pinch. Your job is to hold still, and I can help you think about something else while it happens. You can choose to (hold my hand, look at a book) while nurse/doctor does their job.”
  8. Note: Find out from the child life specialists, nurses and doctors what to expect, and choose your words accordingly. It is important not to make promises (e.g. it will only be a small pinch) that are not realistic.
Helping your child during injections or procedures

Often, the best way you can help your child during an injection or other procedure is with distraction. Help your child look at, think about, and get involved in something else. You might have your child blow bubbles, blow to spin a pinwheel, look at a game on your phone, anything that engages your child’s attention.

It may seem odd, but saying reassuring things to your child (like “It will only hurt a little” or “You are so brave with this pain” or “I am so sorry this is hurting you”) has actually been shown to increase pain or distress during a procedure. So focus on distraction, and praise your child for SPECIFIC things they are doing. (“Great job holding still and focusing on the game!”)

  1. Talk to your child about why the procedure is necessary: “The pinch may hurt for a few seconds. The medicine given at that time should help the pain to stay away for a while.” (medicine)
  2. “You will have to stay overnight in the hospital so that you can get the medicines that your body needs. These are medicines that mom/dad cannot give you at home.”
  3. Types of Hospitals
    •  “We need to go to the hospital so you can get your medicines. This hospital is just for kids.” (Children’s Hospital)
    •  “We need to go to the hospital so you can get your medicines. This hospital has an area where kids, like you, are helped.” (Pediatric Floor in an Adult/Community Hospital)
    •  “We need to go to the hospital so you can get your medicine. This hospital cares for grown-ups and kids. The doctors and nurses know help to help kids, like you.” (Community Hospital without a pediatric floor)
  4. “Sometimes kids have to go to the hospital to get the medicine that their body needs. You are going to go to the hospital but we are not planning on staying overnight. Instead, we will go to the doctor’s office at the hospital, it’s called the clinic. At the clinic you will be cared for by nurses and doctors who will check you out and give you the medicines that you need. “
  5. “In the hospital there are a lot of machines that the hospital workers use to try to help a person’s body. Sometimes they can sound, smell or look different. If we see something that we do not know about, let’s ask and find out so it is not so scary.”
  6. Describe things to your child using the 5 senses. “This cuff will be put around your arm and you will feel it giving your arm a squeeze.” Follow this up with telling them what their job is “Your job is to hold still while it is squeezing your arm.”

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