I Wanna Go Home!
When Your Child is in the Hospital
By Laura Nathanson,
Author of What You Don't Know Can
When a child is
admitted to the hospital, pediatricians have the same concerns that
families have: make sure the child stays safe, comfortable, and as
emotionally secure as possible.
In my childcare book
The Portable Pediatrician,
I talk about the emotional meaning of hospitalization for children of
each age group from Birth to Five. (It’s in the “What If” section of
each age-based chapter, along with such challenges as parental divorce,
death of a pet, arrival of a new sibling, and so on.) While I still
stand by that advice, there have been three big changes since then when
it comes to keeping children as safe and as comfortable as possible:
1. A national shortage
of nurses, including pediatric nurses, may require parents to step up
their own role as caretaker to a greater degree one would ever have
2. Physician care in
the hospital is more likely to be directed by a “Hospitalist,” a doctor
employed specifically to care for hospitalized children. Primary care
physicians are fading from the picture, and sometimes parents need to be
the link among three physician groups: primary care doctor, hospitalists,
and specialists (in such fields as infectious disease, neurology,
cardiology.) This is especially crucial if physicians disagree, and also
at the time of discharge, when follow-up instructions can be crucial.
3. Over the last few
years, the study called MRI has become much more available and more
casually used. At the same time, there are no governmental regulations
or oversight to make sure that safety is maintained. An ordinary
thoughtless action, such as bringing an IV pole into the MRI suite, can
cause disaster, even death; parents need to be present and watchful to
help prevent such accidents.
What You Don’t Know Can Kill You,
discusses in detail the implications of all of these changes, but
primarily for adults. Parents of hospitalized children need a different
take on these matters. I hope that reading these, even casually, before
a planned or unplanned hospitalization, will tell you what to prepare
So here is my advice
for parents on each of these topics, starting with the Nursing
Nurses: Missing in
We are in the midst of
a critical nursing shortage. Nurses are “aging out” -- half are 45 and
older. So there are fewer and fewer of them, which means that they have
to work longer and harder, making it tough to recruit new nurses. And
even if there were lots of candidates, there is a corresponding shortage
of nurses qualified to teach them.
This shortage, with
its avalanche of increased demands, is particularly hard on Pediatric
Nurses, who went into the profession in the first place because they
really like children, and who now rarely may get a chance to interact
with anything that isn’t sounding an alarm.
The bottom line here
is that when you assume a nurse is going to be there, for whatever
situation, there just may not be a nurse available. You, the
parent/grandparent/other loving adult, must step in. To do so, you need
to be familiar with the contents of the child’s room, the ward the room
is in, and solutions to common and to crisis situations.
Most especially, you
need to bond with the nursing and helping staff, making yourself useful
without being intrusive. If something needs to be cleaned up, or
fetched, or changed, see if it is possible to do it yourself -- ask a
staff member if you’re not sure. If you think there is a problem,
present it as your concern, not as a foregone conclusion that the staff
person has erred. Once you have a reputation for being positive,
helpful, and reliable, the staff will be even more responsive to your
The Constant Grown Up
loving, and familiar should be with the child 24/7, both at the bedside
and accompanying the child on any within-hospital trips.
When you stay
overnight in the hospital, you need to be both self-sufficient and
Try not to ask the staff for help with your own needs. You must be
responsible for your own food, drink, and hygiene products. A hospital
overnight kit for the adult should include
all your personal needs, a
flashlight, and a sleep mask and ear plugs. I also recommend a shrill
loud whistle to wear round your neck tucked into your shirt, to use ONLY
if there is a true emergency and nobody comes to help.
Protect against hospital-acquired infections:
Hospital-acquired germs can be very dangerous. Hand-washing is crucial,
and nurses tend to be more fastidious than doctors about this.
Nonetheless, keep a rub-in hand cleanser at bedside: use it yourself,
and offer it to any professional or staff member before they touch your
Since both children
and hospitals tend to be sticky, bring along a container of disposable
antibacterial/antiviral wipes, and frequently clean off the surfaces
that need it most -- TV remotes, telephones (including your own cell),
door knobs, bed control buttons, toys and dolls.
to know your surroundings. Early on, get used to where these are: the
Nurses’ station, the emergency exit, the source of drinkable water, and
the public or visitors’ bathroom (unless you can use a private
bathroom.) At the bedside, locate the “call” button for the nurse, and
vow to use it ONLY in an emergency. Figure out how the bed buttons and
side rails work.
that wards become darker at night. Make sure you can make your way
around with your flashlight. Figure out what you are going to sleep on
well before night falls, and get acquainted with that piece of furniture
-- and make sure it doesn’t obstruct the path to the child’s bed.
the nurse to give you a basic explanation of each of the “Lines” placed
for your child. Lines are tubes: to deliver oxygen, fluids, medication,
blood, liquid feedings; to collect for the lab or to evacuate stomach
contents, urine, drainage, pus, air pockets. Each line should be clearly
identified, so that the fluid or medication doesn’t go into the wrong
tube -- food into a vein, for instance. Ask how the lines are labeled or
identified to be “foolproof” in this way.
And then, of course,
keep a watchful eye when any substance is injected into a “Line.” If you
think someone is about to make an error, speak up at once, but try to be
vigilant, not offensive. “I’m sorry to interrupt, but I thought that
that is the arterial line, and they said nothing should be put into it.”
If a change is made in
lines -- if one is going to be removed or added -- make sure you
understand why, and what it is for. If the person doing the procedure is
one you don’t know, or is clearly a subordinate to the main doctor
involved, make sure that the supervising physician has ordered the
Monitor your child:
Make friends with the
Monitors are computers
that receive and interpret the signals your child’s body is sending out.
These signals are delivered as numbers via a “lead” placed on or in the
body, transmitted by a wire to the machine. Most commonly, monitors
measure heart and breathing rate, blood pressure (how hard the heart
needs to work), and the blood’s supply of oxygen. Other monitors measure
more special signals: the pressure of the spinal fluid, for instance.
The Settings on a
monitor determine at what point the number value of each particular
“vital sign” gets too high or too low, at which point the monitor should
alarm. A heart rate over 150, say, or oxygen saturation under 90. These
settings vary from individual to individual, depending on age and
Well that’s all fine
and good, but it doesn’t take childhood behavior into account. You may
notice, and be alarmed, that when a monitor alarm goes off like a cat
with its tail stepped on, it very often doesn’t get an instant full team
response. Almost always, that’s because nurses, no matter how busy, know
which children are in a precarious situation and which are not.
What if Timmy starts
tantruming about the tapioca pudding and his heart rate goes up to 180?
Or Nancy, also inflamed by the mere concept of tapioca, holds her breath
until she turns blue and her oxygen drops, for thirty seconds, to 78? Or
angelic little Franklin doesn’t like the itchy monitor leads on his
chest and finger and in the space of fourteen seconds takes them all off
and tries to eat them? Or chubby little Poppy sweats so much all her
leads come unstuck?
But it can work the
other way, too. Monitors can’t monitor everything -- how a child is
feeling, or talking, or behaving, or whether he looks as if he is going
to throw up. They also can’t announce that even though the numbers are
within the range of the settings, there is a sinister trend: say that
over an hour the Oxygen Saturation falls from 100 to 93. Clearly, there
is something wrong, but the alarm doesn’t go off. To spot the trend,
somebody’s got to be watching the child. That’s what nurses used to do,
back in the day -- they would get to know their small patients and be
alert to such changes. Now it’s up to YOU.
So keep your eyes
open, and if you think your child’s condition is changing for the worse,
press the Call Button. If no one comes, get out there in the corridor
and snag the next nurse you see. Worse case scenario, blow that whistle.
Finally: yes, it’s
nice to bring treats for the nurses. But even better, bring them real
help, a positive attitude that assumes that they know what they are
doing and have your child’s best interests at heart. A note of praise to
the nurse, with a copy to the supervisor and the head of the hospital,
goes a lot farther than chocolates. If you really want to bring a treat,
fresh fruit is appreciated even more than processed sweets by most
When you get home from
the hospital, it’s always appreciated if you can drop a note to your
pediatrician to report on your stay, and any comments on the care your
Copyright © 2009 Laura Nathanson
Dr. Laura Nathanson is the author of
What You Don't Know Can Kill You
(Published by Collins; May 2007; $15.95US/$19.95CAN; 978-0-06-114582-7)
and The Portable Pediatrician
(Collins, 2002), as well as several other books. She has practiced
pediatrics for more than thirty years, is board certified in pediatrics
and peri-neonatology, and has been consistently listed in
The Best Doctors in America.
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