Hospitals are scary. (For Parents Particularly).

Eric always wants to climb the highest tree limb and race along on his skateboard. His parents keep the health insurance card near the door so that it is always within reach. Parents do all they can to keep a child safe, but you cannot always protect a child from himself!

Joe has to have his tonsils removed. This is usually a simple outpatient procedure. His parents, however, know that he will have to be hospitalized overnight if there are complications. They wonder, "How can we help our son get through this?"

Jessie's parents worry about her asthma. They know that complications can change an emergency room trip into a hospital stay. They keep a bag packed for emergencies. If Jessie has to stay at the hospital, having her own things will make her more comfortable.

Parents work hard to provide a safe environment for their children and support their health development. Yet, unexpected illnesses and emergencies may require hospitalization. When this happens, parents need to learn as much as possible about the child's condition and treatment and they need to make good decisions. When a child is hospitalized, parents must consider the child's emotional, as well as physical, well-being.

Each hospital stay is different. Hospitalization can stem from injuries, as with energetic children like Eric. In such cases, there is little time to prepare, so parents must focus on reducing their child's anxiety and answering questions. At other times, parents can anticipate what to do, and so they will have the opportunity to tell their child what to expect.

* Parents First. Parents need to keep calm in the event of an emergency, as difficult as that might be. Children are extremely sensitive to emotional cues, so parents must work to control their own worries. Fear and anxiety will not only lead to hasty or poor decision making, but also increase the child's level of fear and anxiety. Parents of children with chronic diseases (like Jessie's) can manage their stress through support groups, meditation, and exercise. It is important to get enough rest to be emotionally prepared for unexpected obstacles. Bring a distracting project with you to the hospital, such as needlepoint, or bring some favorite reading material.

* The Strange World of a Hospital. Children can feel helpless in medical environments, where everything is strange and impersonal. Help keep your child's emotions under control. For a very young child, physical contact is the best way to give comfort. Rocking, singing, or offering a pacifier or a favorite stuffed animal are all soothing strategies. To prepare an older child for a longer hospital stay, spend time practicing such coping skills as breathing deeply, counting backwards, squeezing the hand of a nearby parent, blowing bubbles, thinking back to a happy event, and looking at a distracting picture. Your child can use some of these techniques when he or she is unable to be with you.

* Reducing Fears. Parents can give their child a sense of control through reasonable, age-appropriate choices. Casts come in different colors, for example, and hospital menus offer different meal choices. A child can choose to wear a pink bandage, or one with Sesame Street characters. These choices provide a sense of autonomy for the young patient. Keep up familiar routines, like reading bedtime stories, to maintain a sense of continuity during this time of upheaval. Stay at the hospital overnight, if possible, and ask if you can be present during potentially frightening procedures.

* Questions and Answers. Overnight or extended stays require more preparation. Talk with your child honestly. Without accurate information, children will piece together an explanation that can be more frightening than the truth! Find a quiet time and place to talk with your child. Keep it simple. Give straightforward responses to your child's questions, with guidance from your doctor if necessary. Be aware of statements that can have more than one meaning. Telling a child that he will be "put to sleep" may trigger memories of the death of a family pet. Discuss what your child should expect, like scars or any other changes to his or her appearance. Tell your child when the procedure will take place and how long the hospitalization will last. Be sure that your child understands that hospitalization is not permanent and is not a punishment. Emphasize that it is a temporary situation meant to help her feel better.

* When To Tell? Initiating a discussion about an anticipated hospital stay depends on the child's age. Children up to 2 years old have a limited sense of time. It helps to reduce anxiety when you tell them about their imminent stay one to three days in advance. Children 3 to 6 years old handle the situation better if they learn about it one week before the stay. Children from 7 to 12 years old generally need one to two weeks to adapt to the situation. Teenagers should know immediately; this shows them respect and helps prevent feelings of resentment. Personality is also important in deciding when to tell your child. If your child is a habitual worrier, delay the discussion for a few days to reduce his or her anxiety.

* Experiences That Help. Children need to know what they will see, hear, or feel at the hospital. The type of procedure and length of hospitalization will determine what they will experience. Shorter visits will probably be limited to the emergency room. In these situations, children benefit more from parents remaining calm than from hearing lengthy explanations of what might happen to them. For a longer stay, children want to know that a parent will greet them after a procedure or surgery. In addition, many hospitals have tours that introduce your family to the people who will be taking care of your child. They also may familiarize your child with the equipment that will be used during the procedure. Toy medical kits allow your child to handle some instruments, such as a stethoscope. Visit your local library or bookstore to find material you can read together. A list also can be found at www.chop.edu/childlifeplay_rec_read_list.shtml.

* Getting Ready To Go. Extended hospitalizations require even more preparation. Make the process of packing and labeling your child's belongings into a special activity. Encourage your child to select favorite toys and games to relieve boredom. Bring pajamas, stuffed animals, and photos of family, friends, and pets to make your child's stay more comfortable. The hospital also may have accommodations for family members. Check the hospital's Web site to familiarize yourself with its programs, visiting hours, and regulations.

* Siblings Worry, Too. When parents become overwhelmed with the needs of a sick or injured child, they can forget the needs of their other children. It is important to talk to them as well. Siblings need to understand why their brother's or sister's hospitalization is necessary. Keep them updated on the condition of their sibling. Encourage your other children to visit, when possible, and prepare them for what they will see. Help them select get-well cards and gifts. Keep life for the siblings as normal as possible by being there for their after-school activities, like musical concerts and athletic competitions.

* Returning Home. Welcome your child home from the hospital with a special family dinner or similar activity. Allow time for everyone to discuss the situation together. Be supportive during the readjustment period. It may take time for your child to recover and heal. Some children like to put get-well cards and other mementos in a scrapbook, to help them remember the challenge they overcame.

Illness and injury can be frightening for both a parent and a child. It taxes our judgment, our stability, and our spirit. It challenges the child's sense of security and wholeness. Parents need to use available resources and support to work through such difficult times. The caring and cooperation within a family can be a source of strength for a child. As Dr. Seuss tells us, "But it all turns out all right, you see. And I go back to being ... me."

Copyright [c] 2002 by the Association for Childhood Education International. Permission to reproduce this column intact is not required. It is hoped that readers will distribute copies to parents, colleagues, and others who work with children.

To contact the column editor: Write to Helen Altman Klein, Professor of Psychology, Wright State University, Dayton, OH 45435; or send E-mail to: [e-mail]

Leeanne S. Escobedo is a graduate in psychology, Wright State University, Dayton, Ohio.