Concerns for Hospitalized Children

It’s every parent’s fear – a serious illness or injury that leads to a hospital stay for your child. It’s stressful for any patient to spend time in a hospital, but needless to say, a child’s hospitalization can be especially traumatic for young patients and their parents. Certainly, you worry about your child’s health and what your child’s future holds. But do you worry about the emotional stress associated with a hospital stay? Do you know what to consider when choosing a hospital for your child? How can you prepare for a hospitalization? What about other concerns for hospitalized children?

Importantly, a child’s treatment and hospitalization can produce a tremendous amount of stress in addition to stress caused by the illness itself. Furthermore, the limited maturity and lack of life experience can make it hard for children to properly understand the reasons for their hospitalization, potentially leading them to see it as a punishment for something they did wrong. Similarly, this inability to understand the importance and purpose of a hospitalization and associated medical treatments may make children uncooperative while in the hospital.

Hospital safety concerns for hospitalized children.

Certainly, hospitalization is emotionally difficult for pediatric patients. But there are also safety concerns you must consider. Although serious harm in children’s hospitals is rare, it can happen.

Consider these 6 patient safety concerns associated with risk for harm in any children’s hospital, compiled by the Child Health Patient Safety Organization:

1. Nasogastric tube misplacement.

Nasogastric (NG) tubes provide nutrition through the nose and into the stomach for patients who cannot swallow. Unfortunately, when tubes are put incorrectly, patients can develop complications, including:

• Esophageal perforation.
• Bronchopulmonary intubation – when the tube goes into the lungs instead of the stomach.
• Pneumothorax – a collapsed lung from air leaking into the space between the lung and chest wall.
• Hydrothorax – when fluid accumulates in the pleural cavity (the space enclosed by the pleura, which is a thin layer of tissue that covers the lungs and lines the interior wall of the chest cavity).
• Empyema – when pockets of pus collecting inside the pleural cavity.
• Pneumonia – an infection in one or both lungs.

Frighteningly, misplacement can cause serious harm and even death.

The good news is that there are proven practices that make this procedure easier and safer. The bad news is that some nurses use older methods to verify proper placement, which are not as foolproof as newer methods.

Alarmingly, research estimates that at least 25% of children with NG are at risk for harm. The risk increases for neonates, children with neurologic impairment, children who are sedated, unconscious, or critically ill, and children with reduced gag reflex.

Learn more about feeding tubes here.

2. Thermal injuries

Although most people consider hot or cold thermal devices like heating pads and over-the-counter products safe to use, they can cause significant harm to children. Misusing products or using items not intended for patient care can lead to severe burns, pressure ulcers, blisters, and wounds that require additional medical treatment.

Risk of harm increases for children who cannot adjust their bodies or alert staff in response to pain or discomfort. Additionally, patients on medications that cause drowsiness, and/or are immobile, non-verbal, or have diminished sensation also have an increased risk of harm.

3. Medication safety.

According to the American Academy of Pediatrics, between 6% -11% of hospitalized children may experience adverse drug events. Importantly, more than 20% of cases reported to the Child Health Patient Safety Organization involve medication errors, the highest of all categories.

Medication errors can occur when patients receive the wrong medication or wrong dose, either of which can cause a harmful adverse drug event, which may require additional medical treatment. These mistakes can occur due to a mistake in ordering or during administration.

Additionally, medication errors can occur if the hospital staff do not conduct a proper medication reconciliation process. This process creates an accurate list of all medications the patient takes, including name, dosage, frequency, and route. Reconciliation helps avoid errors such as omissions, duplications, dosing errors, or drug interactions. Importantly, proper medication reconciliation requires access to the patient’s full medication history.

4. Diagnostic errors and communication.

Diagnostic errors including missed, delayed and/or wrong diagnoses – considered a significant contributor to patient harm. Alarmingly, diagnostic errors represent 17% of cases submitted to the Child Health Patient Safety Organization. Interestingly, the most serious patient harm frequently occurred in conjunction with communication failures – a top cause of serious and severe moderate harm.

5. Diabetes care management.

It’s important to properly manage childhood diabetes – at home and in a hospital. Fortunately, many children’s hospitals have specialists experienced in caring for children with diabetes. However, some hospitals don’t have the expertise and experience needed to care for children with diabetes, which can be dangerous. For instance, they may lack sufficient resources, including staff experienced in caring for diabetic children and appropriate patient monitoring systems.

Importantly, if staff do not properly anticipate or recognize early symptoms associated with diabetes complications, the child’s life may be at risk.

Read Tips for Newly Diagnosed Diabetes Patients to learn more about diabetes.

6. Procedural mishaps.

Retained foreign objects: Unfortunately, surgeons and other staff sometimes leave objects inside patients during surgeries and other procedures. Frighteningly, objects left behind can result in perforation or infection and may even lead to death.

Wrong-site surgeries: Alarmingly, across all US hospitals, wrong-site surgeries occur approximately 40 times per week. The Child Health Patient Safety Organization shows reports the communication failures between healthcare providers increase the risks of wrong-site surgery. Unsurprisingly, the risk is also higher for procedures involving difficult-to-mark surgical sites.

Minority patients have a higher incidence of harm.

Sadly, Black and Hispanic hospitalized children are significantly more likely to experience adverse safety events as compared to white children, according to findings from the 2019 Kids’ Inpatient Database. The disparity includes a 55% higher chance of developing postoperative sepsis for Black children, and a 34% higher chance of postoperative respiratory failure in Hispanic children.

Emotional and psychological concerns for hospitalized children.

Unsurprisingly, it’s traumatic and anxiety-provoking for children to be in the hospital, dealing with a serious health issue. Research shows hospitalizations can cause temporary or long-term behavioral and psychological difficulties. In fact, experts estimate that 10-30% of hospitalized children experience severe psychological distress, while as many as 90% experience slight emotional upset.

For some children, a hospitalization can be a life crisis which could increase their feelings of fear, loneliness and frustration. Furthermore, hospitalization can block or distort their development, potentially damaging their sense of identity and self-esteem.

Expectedly, children’s cognitive and emotional limitations and their dependence on others makes it harder for children to manage the physical and emotional stress involved with illness and hospitalization. Hospitals are foreign, intimidating environments, where children are often separated from their parents for long periods of time – missing out on the comfort and support parents can provide. In fact, hospitalized children often report feeling lonely and scared. Moreover, hospitalized children are surrounded by strangers, getting poked and prodded – all while feeling ill and/or pained.

Importantly, concern about losing bodily functions or becoming disfigured due to their health condition or surgery, is prevalent among hospitalized children. These concerns can increase the anxiety of hospitalization and can even threaten their sense of self.

Interestingly, playing – an important coping mechanism for children – can alleviate anxiety and make it easier to adjust to their surroundings. However, hospitalized children generally have less opportunities to engage in play activities. And when they do have a chance, it is often repetitive, solitary play.

Moreover, when children are confined to bed and/or socially isolated, it can feel like an unending state of imprisonment, even for short hospital stays.

Needles and surgery increase stress.

Without a doubt, most children hate needles. Research on hospitalized children shows that procedures involving needles, including injections, or blood draws, and transfusions often cause distress and fear in young children.

Furthermore, surgical procedures are among the most distressing events for children – often perceived as assaultive and mutilative, even when the procedure is minor. Interestingly, studies show that for children and adolescent patients, pre-surgical anxiety can increase the possibility of negative psychological consequences throughout their recovery, including ongoing anxiety, separation anxiety, problems with sleep, nightmares, irritability, and aggressiveness.

Special concerns for chronically ill children.

Chronically ill children often suffer from additional anxiety and long-term adjustment problems. Importantly, chronically ill children often miss out on “normal” routines and activities which can help children become behaviorally and emotionally competent in life. For instance, they may miss school, socializing with friends and peers, and/or interactions with their parents and siblings. Unsurprisingly, chronically ill children often express sadness and anxiety over what experiences they miss due to their health.

When is the stress the highest?

There is never a time where you feel free from any concerns for hospitalized children. However, there are some periods that are harder for children.

Expectedly, the hardest time in a child’s hospitalization is often soon after arriving at the hospital, as they experience unexpected, scary, potentially painful procedures and treatments for the first time, as they adjust to new surroundings.

However, research also indicates that the psychological impact of a hospitalization can continue even after they go home, although the impact generally weakens soon afterwards.

Does your child’s age matter?

Certainly, children of all ages can feel stressed and anxious while hospitalized.

But, unsurprisingly, hospitalization is hardest on young children – a group more likely to associate the discomfort of illness and hospitalization to typical child fears and anxieties related to time away from their parents and home.

Concerns for hospitalized children: Your hospital choice matters.

Importantly, whenever possible, choose a hospital that only treats children or adolescents (usually birth to age 21). In addition to having expertise in the medical needs of children, children’s hospitals also specialize in supporting the emotional needs of children and their families.

If you don’t have a specialty children’s hospital in your area, look for a hospital that has pediatric specialists that offer care focused on the medical and psychological needs of young patients.

Most importantly, look for a hospital with experience caring for children with the same (or similar) condition as your child. Note that you may have to travel to a specialized hospital if your child has a rare and/or life-threatening condition.

Additionally, you want a hospital that provides care appropriate for your child’s developmental stage. Look for healthcare professionals who will care for your child’s physical, psychological, and emotional needs – including doctors, nurses, psychologists, and social workers.

How to find a hospital.

If it’s an emergency, take your child to the closest hospital!

However, if you have time to select a hospital, it’s worth doing your homework.

If you’re lucky, you live within easy commuting distance to a children’s hospital. If you don’t know where you can find a children’s hospital, you can search for a hospital using the Children’s Hospitals Association hospital directory of their 220+ member hospitals.

Also, US News and World Report ranks pediatric hospitals, including best overall and then best by a number of specialties, including cancer, cardiology, behavioral health, and endocrinology.

Additionally, you can use The Leapfrog Group’s Ratings website to analyze quality factors, including minimal information on pediatrics and more information on overall safety measures. Note – not all hospitals participate in this analysis. If you only want to learn about hospitals offering pediatric services, use the drop-down menu on the right that says “Guided Search”, and then select Pediatric Care from the drop-down menu that says “What do you want information on?”. You can limit the geographic location of the search as well.

What questions should you ask?

When evaluating hospitals, ask these questions regarding your child’s medical needs:

• Do they have specialists in your child’s condition?
• How many patients with your child’s condition do they treat each year? What are the outcomes?
• Do staff have training and experience in the medical and emotional needs of children?
• What steps are in place to ensure patients get the right medications at the right time?
• Are parents allowed to stay with their child 24-7? Does the hospital provide a bed or sleeping chair in the patient’s room?
• Do doctors include parents in daily “rounds”? At what time of day do these meetings take place?

Additionally, ask prospective hospitals these questions about your child’s emotional needs:

• What programs are in place to reduce hospital-related anxiety and stress?
• How do they ensure that all communication with each child is age-appropriate?
• Do mental health providers visit patients to assess mental health? How do they care for patients showing high levels of distress?
• For children with physical differences due to illness or surgery, how do they help patients learn that being different is not negative.
• Do they have a program to help children and their parents get acquainted with the hospital before their admission?
• Are there play areas? If so, what kind of equipment and supplies are available? Who oversees the play? How often would your child have access to these areas?
• Do support animals visit patients to provide comfort and distractions?
• If you expect a long-term hospitalization:
  • Are there teachers available for schooling help?
  • Are there outings to local zoos, botanical gardens, public libraries, and other attractions?

If your child will need surgery, read Preparing for Your Child’s Surgery.

Concerns for hospitalized children: Parental involvement is key.

Prepare your child for an upcoming hospitalization.

Although you don’t always have notice before your child becomes hospitalized, in many situations you’ll have time to prepare your child.

Consider these suggestions:

• Help your child understand what he/she can expect. Be honest, but age appropriate.
• Listen to and address your child’s concerns.
• Schedule a hospital tour.
• If your child is old enough, explain the importance of advocating for him/herself. Encourage him/her to speak up if something seems wrong or if he/she has questions.
• Help your child pack, including items that will provide comfort, such as a favorite stuffed animal or blanket. Also include items to keep your child busy, such as books, coloring books, games, a tablet and/or phone, and all needed chargers.
• Teach your child relaxation techniques, such as deep breathing and blowing bubbles.

During your child’s hospitalization.

Importantly, remember that many hospitalized children are confused and frightened, while coping with pain, illness, and concerns. Therefore, your child needs your support and reassurance, as well as an honest explanation of what is occurring, or about to occur – shared in an age appropriate manner.

Importantly, research found that hospitalized children have a harder time when parents are not present or when parents are highly anxious and cannot calmly respond to their children.  Similarly, research shows the importance of allowing parents to stay in the hospital with their children. Your presence is reassuring and can help ease fears.

Here are some ways you can make a hospital stay easier for your child:

• Provide comfort care, such as adjusting pillows and providing water and snacks.
• Keep your child amused and as active as possible.
• Lighten your child’s mood with small gifts, flowers, cards, and video calls with friends and family.

Importantly, try your hardest to control your emotions while with your child in the hospital. If you appear anxious, your child’s anxiety will increase. To help you control your emotions, consider meditation, yoga, journaling, or deep breathing. And don’t ignore your own health – including good nutrition and adequate sleep! Lastly, don’t try to do this alone – seek the support of family members and friends.

Stay involved in the process.

Unsurprisingly, quality healthcare is one of the biggest concerns for hospitalized children. Importantly, you can play an important role in the quality of care provided. You should:

• Keep an eye on your child’s condition and speak up if something doesn’t seem right. Don’t be afraid to be the polite, squeaky wheel!
• Speak to the medical team if you think your child’s condition is worsening. Trust your instincts. And be persistent if needed.
• Monitor bedside equipment and notify staff if no one responds to a critical alert.
• Keep a notebook bedside to record information shared by the medical team, test results, medication lists, and your questions.
• Make sure your child is given the right medication at the right time.
• Check the accuracy of your child’s medication at admission, for each care transition (e.g., for shift changes, moving to a new room, etc.), and at discharge.

Learn more…

Along with understanding the concerns for hospitalized children outlined above, read these posts to learn more:

• How to Recover Faster After Surgery.
• Majority of Patients Don’t Understand Discharge Instructions.
• How To Care for Someone Who Is Bedridden at Home.

NOTE: I updated this post on 5-30-25.