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Needs for Hospitalized Children

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I am 0-4 Months Old I am 21 - 24 Months Old
I am 5 - 10 Months Old I am 2 - 3 years Old
I am 11 - 15 Months Old I am a Preschooler (3 - 5 years old)
I am a Toddler (16 - 20 Months Old) Considerations for School Aged
Children (5 - 11 Years)
Considerations for Adolescents

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I am 0-4 Months Old

Play:
• I like soft music, singing and rocking.
• I like to play with small rattles and look at mobiles.
• Please talk to me in a low voice.
• I also like to play in front of a mirror.

Social:
• I begin to smile in response to other’s smiles at 6 – 8 weeks old.
• I can show pleasure by making funny noises.
• I love to be rocked and sung to.
• I sleep off and on between feedings, and for about 4 – 6 hours a night.
• You can interact with me by holding me in front of your face, talking about everything you are doing, and moving my arms and legs.

Sleep:
• I need 15-20 hours of sleep per day.

What I can do with my body:
• I can calm myself by sucking.
• I like to use my hands to reach for objects.
• I do not have very good head control, but I’m working on it.
• I like to be rocked.
• Please prop me in your lap so I can see what people are doing.

Concerns I have about being in the hospital:
• I do not like to be separated from my caregiver's.
• I do not get my usual stimulation.
• I am in an unfamiliar setting.
• I am out of my usual routine.

How can you help me while I am in the hospital?
• Please bring my favorite things from home.
• Take me out of my bed when I am awake.
• Let my caregiver be with me as much as possible.
• Provide me with stimulations that I can see, hear, and touch.
• Let me see lots of colors and shapes.
• Think of ways that I can have a routine “play time”.

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I am 5 - 10 Months Old

Play:
• I like to play peek-a-boo.
• I like toys that I can push or pull.
• I love putting everything in my mouth.
• I like large soft toys, rubber rings, blocks and toy keys.
• Banging objects and throwing toys is also fun.

Social:
• I can recognize familiar people and objects.
• I want to explore my environment.
• I can laugh aloud.
• I wiggle around when I get excited.
• I know how to get someone’s attention through crying or making noises.

Sleep:
• I need 14-16 hours of sleep per day.

What I can do with my body:
• When I am young, I like to roll around and work on sitting up.
• As I get older, I may begin to pull up on objects and work on crawling.
• I am learning to pick up small things with my fingers (I like finger foods).
• I can point to show the things I want.
• I like to roll balls on the ground.

Concerns I have about being in the hospital:
• I am afraid of strangers.
• I do not like being separated from my caregiver.
• Please find a comfortable position in which to hold me.
• Do not disturb me when I am sleeping, it will disrupt my routine for the rest of the day.
• I get bored being in my room all the time.

How can you help me while I am in the hospital?
• Please bring my favorite things from home.
• Take me out of my bed to play; I need different stimulation.
• Let my caregiver be with me as much as possible.
• Provide me with stimulations that I can see, hear, and touch.
• Think of ways that I can have a routine “play time”.
• Playing on a floor mat is a great way for me to get stronger and perfect my physical skills.
• Play time is best if it is in a playroom or a place where there is new stimulation.
• During procedures, let me sit comfortably in my caregivers lap.

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I am 11 - 15 Months Old

Play:
• I love peek-a-boo and patty-cake.
• I like toys that I can poke, bang, pull and twist.
• I like to put objects in a container and dump them out.
• I can pretend to care for dolls and animals by feeding and holding them.
• I like stacking blocks, the older I am the more I can stack.

Social:
• I need my caregiver in the room with me so I don’t get scared in strange places.
• I love looking at myself in the mirror.
• I like to imitate adults, especially when they make animals noises.
• I can listen and wiggle my body to music.
• As I get older I can repeat words that I hear.
• Please read me books, this helps me learn common words.

Sleep:
• I need 14-16 hours of sleep per day.

What I can do with my body:
• I will climb on everything.
• I can stand on my own, and am learning to take a few steps.
• I like to use my fingers to pick up small toys.
• I like to pound objects to see how loud I can be.
• I want to be exploring my environment, not stuck in my crib.

Concerns I have about being in the hospital:
• I am afraid of strange people and strange rooms.
• I may try to pull out my tubes.

Development
• I get really frustrated because the medical equipment can hinder my movement.
• I can associate people with pain.
• I need lots of different sights and sounds that can stimulate me.
• I may have more dependent behaviors (I may want to drink from a bottle instead of a cup).
• I may become clingy and whiny when my caregiver is not around.
• My routine may get disrupted, so make sure to create a daily schedule that is similar to what I do at home.

How can you help me while I am in the hospital?
• Give me stimulating activities such as pop-up toys, trucks or dolls that make noise, containers I can put things in and out, and blocks for stacking.
• Talk to me in a calming voice during procedures.
• Let my caregivers help with my care as much as possible.
• Provide a safe place for me to play (playrooms are great, but a mat on the floor is good too).
• Ask me about my favorite toys from home so you can provide similar activities that I normally play with.

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I am 16 - 20 Months Old

Play:
• I like to build block towers and then knock them down.
• When you read to me, I like to point out pictures and turn the pages.
• I like to imitate adults (like pretending to talk on the telephone and taking care of my stuffed animals).
• I like when you hide my toys under or behind objects so I can find them.
• I can scribble with crayons.
• I like toys that I can take apart.

Social:
• I love saying “NO!”, so be careful not to ask me yes or no questions but rather give me options between two things.
• I have a short attention span.
• I can understand simple commands and answer yes or no questions.
• I like for you to hand me things and then let me hand them back to you.

Sleep:
• I need 14-16 hours of sleep per day.

What I can do with my body:
• I am learning to have better balance and coordination.
• I may begin running.
• I can pickup and play with toys from a standing position.
• I can shift crayons and marker from one hand to another.
• I am able to walk backwards.

Concerns I have about being in the hospital:
• I am afraid of strangers and strange places.
• I get very tearful when my caregiver is gone.
• I remember people that cause me pain.
• I do not like being confined to my room, especially if I have to stay in my crib.
• My daily routine is disturbed, so make sure to create a daily schedule that is similar to what I do at home.
• I may respond to nurses and doctors with aggression.

How can you help me while I am in the hospital?
• Provide me gauze so I can wrap up my stuffed animals to look like me.
• Play games with me in my room.
• Let my parents help with my care as much as possible.
• Ask my parents ways that my environment can be as normal as possible.
• Let me help during procedures by playing with the gauze or alcohol wipe.

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I am 21 - 24 Months Old

Play:
• I like to build block towers and then knock them down.
• When you read to me, I like to point out pictures and turn the pages.
• I like to imitate adults (like pretending to talk on the telephone and taking care of my stuffed animals).
• I can scribble with crayons.
• I like toys that I can take apart.
• I like toys that make noise.
• I have favorite toys and dolls.

Social:
• I love saying “NO!”, so be careful not to ask me yes or no questions but rather give me options between two things.
• My vocabulary is increasing every day (I know up to 300 words, and can say 2 word combinations).
• I can show affection by giving hugs and kisses.
• I can understand simple commands and answer yes or no questions.
• I like you to hand me things and then let me hand them back to you.
• I have a strong sense of what is “mine”.

Sleep:
• I need 12-16 hours of sleep per day.

What I can do with my body:
• I can ride tricycles.
• I can jump from low objects.
• I can kick a ball.
• I can drink from a straw.
• I am learning to feed myself with a fork and spoon.

Concerns I have about being in the hospital:
• I am afraid of strangers and strange places.
• I get very tearful when my caregiver is gone.
• I remember people that cause me pain.
• I am not getting enough normal stimulation.
• My daily routine is disturbed, so make sure to create a daily schedule that is similar to what I do at home.
• I may be afraid to explore my environment.
• I may become afraid of the dark.

How can you help me while I am in the hospital?
• Find time for me to have safe play opportunities with new things.
• Play games with me in my room.
• Let my parents help with my care as much as possible.
• Ask my parents ways that my environment can be as normal as possible.
• Let me help during procedures by playing with the gauze or alcohol wipe.

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I am 2 - 3 years Old

Play:
• Playing helps me master my environment.
• I can match pictures, objects and sounds.
• I use play to learn and work through fears and express myself.
• I like to listen to you talk to me and tell me about what you are doing.
• I love playing with Play-Dough and other squishy textures.

Social:
• I can understand “now”, “soon” and “later”.
• I am able to repeat stories from books.
• I can show jealousy.
• I can use my words to make requests.
• I am gaining a sense of control and confidence in my abilities.
• I have a hard time understanding others point of view and am only concerned with MY thoughts.

Sleep:
• I need 10-14 hours of sleep per day.

What I can do with my body:
• I can put on my clothes but have trouble with zippers and laces.
• I can feed myself with a fork and a spoon.
• I can stand in place and hop on one foot.
• I can sleep 10 hours a night.

Concerns I have about being in the hospital:
• I feel like I am losing control and autonomy.
• I am scared to move with IVs and other medical equipment connected to me.
• I may regress in my abilities (potty training) and act like an infant.
• I have a strong fear of strangers.

How can you help me while I am in the
hospital?

• Tell me what you are doing and what it is going to feel like.
• Allow security objects to accompany me to procedures (ie blankets, stuffed animals, pacifiers or dolls).
• Provide me with opportunities for choice and control (you can ask me if I want cherry or grape flavored medicine).
• Blowing bubbles and singing songs can be helpful during procedures.
• I am improving my self help skills, so encourage me to do things on my own.

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I am a Preschooler (3 - 5 years old)

Play:
• I love coloring and drawing.
• I enjoy imaginative play (i.e. pretending to be a parent or a doctor).
• I love showing off my accomplishments.
• I like cutting paper and finger painting.
• I can build structures that symbolize other things such as animals or buildings.

Social:
• I am beginning to have an understanding of time.
• I have a great imagination, which can lead to misconceptions about the hospital.
• I have difficulty separating make-believe from reality.
• I can separate from my parents for short periods of time.
• I am able to learn rules and obey them.

Sleep:
• I need 10-14 hours of sleep per day.

What I can do with my body:
• I can draw circles and squares.
• I can can feed self, brush teeth, comb hair, wash, dress, hang up clothes with little assistance.
• I can form shapes and objects out of clay or play dough, sometimes human and animal figures.
• I can thread small beads on a string.

Concerns I have about being in the hospital:
• I fear long separations from my loved ones.
• Medical procedures can be seen as a punishment.
• Imagining what a procedure is going to be like can be worse than reality; I NEED to be told the truth.
• I feel a sense of loss of control.
• Unknown events scare me.

How can you help me while I am in the hospital?
• Reinforce that illness is not the child’s fault and treatment is not the child’s punishment.
• Give clear explanations as magical thinking and fear of bodily injury is common.
• Encourage parental participation, verbalization and social interaction and give positive reinforcement.
• Set limits and provide structure.
• Allow child to manipulate and explore medical supplies and their purpose.
• Provide preparation for any procedure or “new” thing they will experience.
• Give them a job during procedures (blowing a pinwheel or looking at a book will help them learn coping strategies).

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Considerations for School Aged
Children (5 - 11 Years)

Activities:
• I enjoy playing board games and video games.
• Being with friends becomes increasingly important.
• Organized and group play creates a sense of security.
• School aged children love to talk about themselves and what they like.

Social:
• I have a strong desire to perform well, do things right.
• I have interest in new skills.
• I want to earn recognition and be successful.
• I am independent and modest.
• I have an increased anxiety of missing school.
• I am learning social cooperation and appropriate behaviors.
• I talk about my feelings.

Sleep:
• I need 8-12 hours of sleep per day (varies by age, younger children need more).

Physical Issues:
• Puberty can be a source of anxiety (girls may begin menstruation).
• Differences between peers can be a source of anxiety and self consciousness.

Concerns I have about being in the hospital:
• Disgrace, loss of competence
• Compromised body image
• Invasions of privacy
• Loss of status in peer group
• Death and disability
• Hesitant to reveal fears
• Loss of body control
• Enforced dependence

How can you help me while I am in the hospital?
• Reinforce that illness is not the the child’s fault and treatment is not the child’s punishment.
• “All about me” posters help the child feel in control and allows staff to know the child’s likes and dislikes.
• Allow choices when possible (give them choice of IV location).
• Provide activities and games in order to make atmosphere more normal.
• Preparation for procedure is important to reduce anxiety associated with the unknown.
• Allow children to explore medical equipment and rehearse upcoming procedures.

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Considerations for Adolescents

Activities:
• I enjoy playing board games and video games.
• Being with friends is extremely important.
• Cell phones and e mail may be an important way to allow patient to keep in touch with friends.

Social:
• I have a strong desire to perform well, do things right.
• I have an interest in new skills.
• I want to earn recognition and be successful.
• I want independence and privacy.
• I have an increased anxiety about missing school.
• I am learning social cooperation.
• I can verbalize feelings.

Sleep:
• I need 8-12 hours of sleep per day (varies by individuals).

Physical Issues:
• Puberty can be a source of embarrassment and frustration.
• Sexual development and body image are on the forefront of their minds; be sure to address how procedures and surgeries may impact this.
• Body image and self-worth can be tormenting issues for both males and females.

Concerns I have about being in the hospital:
• Compromised body image
• Invasions of privacy
• Loss of status in peer group
• Death and disability
• Hesitant to reveal fears
• Forced dependence on medical equipment and nursing staff can be frustrating
• Fear of failure in school
• Teenagers may hide from confusion and lack of understanding.

How can you help me while I am in the hospital?
• Respect individual as separate from parents.
• Altered body image, privacy and peers are paramount.
• Involve teenagers in medical responsibilities and decision-making.
• Peer socialization will benefit patient.
• Preparation will help teenagers learn about and cope with procedures and diagnosis.

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The content was provided by Vanderbilt University Medical Center 2008