The hospitalised child: stress by age, separation, the family and siblings
- Fundamental
Hospital takes a child away from routine, home and often family; the nurse reduces that stress with presence, play, preparation and normal routines.
What it is
For a child, hospital is a stressor in itself: routines break, procedures are strange or painful, strangers come and go, and the child loses control and independence. Children who stay long or are admitted often are at higher risk of anxiety, behaviour problems, developmental delay and post-traumatic stress symptoms, and parental stress adds to that risk. How the child shows stress depends on age: infants and toddlers react mostly to separation and strangers, preschoolers may see pain as punishment, and older children and adolescents worry about control, privacy and missing school and friends. Nursing care keeps the family close and the child's world as normal as possible.
Key points
- In one cited study about a quarter of hospitalised children had raised post-traumatic stress symptoms.
- Structured play sessions lowered behavioural distress and anxiety in hospitalised children.
- Hospital school and schoolwork keep education going during long stays.
- Parents' presence, talk, touch and hugs make children feel safer than distraction by staff alone.
Components
- Infants and toddlers: separation from parents, strangers, restraint and unfamiliar surroundings.
- Preschoolers: fear of bodily harm and the idea that treatment is punishment.
- School-age children: loss of control, missing school and friends.
- Adolescents: privacy, body image, independence and peers.
- The family: parents' worry and fatigue; siblings at home who also need attention.
What it is for
- Recognising stress early lets the nurse adapt care before distress becomes a behaviour or a trauma.
- Keeping routines, play and school protects development during the stay.
- Supporting the parents indirectly supports the child.
In nursing practice
- Encourage a parent to stay, in physical contact if possible; when they cannot, leave a familiar object with the child.
- Keep home routines for sleep, meals and bathing where the unit allows.
- Do painful procedures in a treatment room, not in the child's bed, so the bed stays a safe place.
- Limit the number of strangers entering the room and ask that the professional who knows the child best be present.
- Offer play, drawing, music and stories; link with hospital school for long stays.
- Ask about siblings and suggest that friends or family help at home, so parents can focus on the sick child.
Common mistakes
- Reading a toddler's crying as pain alone, when it often reflects separation and strangers.
- Using the bed for painful procedures, so the child cannot rest there.
- Letting peers or siblings watch a procedure without the child's agreement.
- Ignoring the parents' exhaustion: their stress is a risk factor for the child.
Test yourself
Think of the answer, then tap the question to see it.
Why do infants and toddlers in hospital often cry during procedures?
Crying is a normal response to the strange place, unfamiliar people and separation, not only to pain.
What may a preschooler believe about being ill or having a painful procedure?
That it is a punishment for something they did; the nurse explains it is not.
Why should painful procedures be done outside the child's bed?
So the child does not link pain with the bed, which should stay a safe place to rest.
Which two interventions reduce distress in hospitalised children?
Structured play and parental presence; hospital school, music and preparation also help.
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Intervention practices for promoting well-being and cognitive development in hospitalized children: a scoping review (Eur J Investig Health Psychol Educ 16(3):41) (European Journal of Investigation in Health, Psychology and Education (open access, CC BY 4.0, PMC13025682), 2026); Parental presence in the implementation of atraumatic care during children's hospitalization (Pediatric Reports 12 Suppl 1:8693) (Pediatric Reports (open access, PMC7463144), 2020); Infant test or procedure preparation (Medical Encyclopedia) (MedlinePlus, U.S. National Library of Medicine, 2024); Preschooler test or procedure preparation (Medical Encyclopedia) (MedlinePlus, U.S. National Library of Medicine, 2024).
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Representative model, for educational purposes only.