How patients and siblings react to hospital care
Common reactions of patients to their diagnoses and hospital care
Being in the hospital causes many changes to a family’s everyday routine. It is normal for you to see a
change in the behavior of your child or teen. Each child responds to stress in a unique way, because of
age and individual personality. However, regression, aggression and withdrawal are the most common
responses to being in the hospital. These behaviors are usually temporary, and they often decrease once
the child or teen starts to feel more comfortable and secure, and once your family’s new routines are
established.
Withdrawal
Some children respond less openly to hospital care or treatment by withdrawing. For example, you may
notice your child becoming less interested in activities he or she used to enjoy. Your child may be sleeping more, talking less, eating less or not making eye contact.
Aggression
In the hospital setting, many decisions are made for children. Patients can often feel like they have
no control. It is common for children and teens to react to this with anger and fear. These responses
sometimes include crying, yelling, kicking, resisting medicines or lashing out at staff or family
members.
Regression
Children can sometimes regress as a way of coping with a new situation. For example, a child who has
recently been potty trained may wet the bed for a period of time. Other children may adopt an old comforting style that they had given up, like sucking a thumb, becoming more “clingy” to parents, or whining more than before they came to the hospital.
We realize that these changes in behavior can cause parents to be concerned. This can also be a
confusing time for the patient as he or she may be having these new feelings for the first time. As a
primary caregiver, it is very important for you to acknowledge your child’s feelings, concerns and fears
as valid and real, whatever they may be. Providing and modeling appropriate ways to direct and express
those feelings is one of your greatest tools as a parent.
Ways to support your child or teen through this transition
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Tell your child about his or her illness and answer questions in honest and simple terms.
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Let your child know which family member will be with him or her during treatment.
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Let your child know that his or her feelings are normal, and that it is OK to cry, be angry or scared.
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Allow your child to take part in self care.
~ Giving his or her own medicine by mouth in a syringe
~ Handing supplies to the caregiver
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~ Choosing an arm for blood pressure or a leg for a shot
~ Flushing his or her central line after getting permission from the nurse
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Provide appropriate outlets for his or her feelings.
~ Hitting a pillow rather than parents when angry
~ Making lists of things he or she likes and does not like about the hospital
~ Making a video of the hospital to send home when missing friends
~ Talking about feelings instead of hiding them or holding them in
~ Keeping a journal (can be writing or drawing)
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Continue to set rules and limits to keep routines and give a sense of security.
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Recognize your child’s accomplishments with verbal praise.
~ Getting through a difficult procedure
~ Waiting patiently
~ Taking medicines
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Allow your child to play with no interruptions. Play can provide your child with a normal setting
and some control over his or her situation. Accomplishments during play can build up your child’s
independence and self-esteem. It can also give your child a chance to express his or her feelings
about the hospital using art and role playing.
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Let your child control his or her play. Let him or her decide what to play with, how he or she wants
to play with it and for how long.
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Provide choices when possible. (example: during a blood draw, tell your child he or she can look at
what is happening or look at something else like a book for distraction).
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Include your child in packing his or her favorite toys, comfort items or other things that can be
used as a distraction while waiting for appointments (coloring books, cards, Game Boy, Walkman).
How brothers and sisters react to their sibling’s illness
Once a child or teen is diagnosed with an illness, it affects the entire family, including brothers and
sisters. Siblings of a patient can experience extended separation from a parent or the patient. They also
may have to cope with the unfamiliar hospital setting and changes in routines at home. It is normal for
siblings to act differently. During this time, sibling behaviors may include being jealous, “clingy” or
demanding. Siblings might also have nightmares or trouble sleeping. Each sibling responds to stress in a
unique way, but all need your understanding and reassurance. These changes in behavior are usually not
permanent and should improve as the family establishes a new routine.
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Brothers and sisters often have unspoken questions and fears when their sibling is first diagnosed and
goes to the hospital. For example, they may not understand the diagnosis or why the patient cannot
come home. Siblings may be wondering if they or the patient have done something wrong to cause the
illness. They might believe that they can “catch” the illness or worry about who will care for them in
their parent’s absence. Talk about these unspoken fears with your children and answer their questions
honestly and in simple language. This will help to maintain trust and keep the lines of communication
open.
If the siblings spend little or no time at the hospital, they might imagine something very different than
what is really happening to the patient. Brothers and sisters are encouraged to visit the hospital. Child
life specialists can meet with siblings to prepare them for some of the new things they will see. For
siblings who are too far away to visit, child life specialists can assist parents in making those siblings
part of the hospital experience. They can give parents materials to send home, such as books, audio
tapes, video tapes, photos, medical play dolls and personalized letters to explain the patient’s diagnosis.
Ways to support siblings
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Tell them about the patient’s illness honestly, using words they understand.
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If possible, arrange for them to visit the hospital.
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Let siblings know who will be taking care of them while you are away.
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Answer questions simply and honestly.
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Ask how they are feeling; listen to their feelings; and let them know that it is OK to have these
feelings.
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To encourage siblings to express their feelings, provide similar outlets to those listed earlier for
patients.
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Exchange letters, photos, phone calls or video tapes about what the patient and parent are doing
away from home.
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Talk to the sibling’s school teachers or counselors so they are aware of home stresses.
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When together, plan times for just the two of you to do something special (reading a story, playing
a game or going on a short outing without the patient).
Questions?
If you have questions about the common reactions of patients and siblings to hospital care, please call
the Child Life Program at (916) 703-3024.
Adapted with permission from St. Jude Children’s Research Hospital. Revised 10/03
UC Davis Cancer Center 12/06
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