1. A national shortage of nurses, including pediatric nurses, may require parents
to step up their own role as caretaker to a greater degree one would ever have
I Wanna Go
When Your Child is in the Hospital
Nathanson, M.D., FAAP,
Author of What You don't Know Can Kill You
When a child is admitted to the hospital, pediatricians
have the same concerns that families have: make sure the child stays safe,
comfortable, and as emotionally secure as possible.
In my childcare book The Portable Pediatrician,
I talk about the emotional meaning of hospitalization for children of each age
group from Birth to Five. (It’s in the “What If” section of
each age-based chapter, along with such challenges as parental divorce, death
of a pet, arrival of a new sibling, and so on.) While I still stand by that
advice, there have been three big changes since then when it comes to keeping
children as safe and as comfortable as possible:
Physician care in the hospital is more likely to be directed by a
“Hospitalist,” a doctor employed specifically to care for
hospitalized children. Primary care physicians are fading from the picture, and
sometimes parents need to be the link among three physician groups: primary
care doctor, hospitalists, and specialists (in such fields as infectious
disease, neurology, cardiology.) This is especially crucial if physicians
disagree, and also at the time of discharge, when follow-up instructions can be
Over the last few years, the study called MRI has become much more available
and more casually used. At the same time, there are no governmental regulations
or oversight to make sure that safety is maintained. An ordinary thoughtless
action, such as bringing an IV pole into the MRI suite, can cause disaster,
even death; parents need to be present and watchful to help prevent such
book What You don't Know Can Kill You,
discusses in detail the implications of all of these changes, but primarily for
adults. Parents of hospitalized children need a different take on these
matters. I hope that reading these, even casually, before a planned or
unplanned hospitalization, will tell you what to prepare for.
here is my advice for parents on each of these topics, starting with the
Nurses: Missing in Action
are in the midst of a critical nursing shortage. Nurses are “aging
out” -- half are 45 and older. So there are fewer and fewer of them,
which means that they have to work longer and harder, making it tough to
recruit new nurses. And even if there were lots of candidates, there is a
corresponding shortage of nurses qualified to teach them.
shortage, with its avalanche of increased demands, is particularly hard on
Pediatric Nurses, who went into the profession in the first place because they
really like children, and who now rarely may get a chance to interact with
anything that isn’t sounding an alarm.
bottom line here is that when you assume a nurse is going to be there, for
whatever situation, there just may not be a nurse available. You, the
parent/grandparent/other loving adult, must step in. To do so, you need to be
familiar with the contents of the child’s room, the ward the room is in,
and solutions to common and to crisis situations.
especially, you need to bond with the nursing and helping staff, making
yourself useful without being intrusive. If something needs to be cleaned up,
or fetched, or changed, see if it is possible to do it yourself -- ask a staff
member if you’re not sure. If you think there is a problem, present it as
your concern, not as a foregone conclusion that the staff person has erred.
Once you have a reputation for being positive, helpful, and reliable, the staff
will be even more responsive to your requests.
The Constant Grown Up
competent, loving, and familiar should be with the child 24/7, both at the
bedside and accompanying the child on any within-hospital trips.
you stay overnight in the hospital, you need to be both self-sufficient and
Self-Sufficient: Try not to ask the staff for help
with your own needs. You must be responsible for your own food, drink, and
hygiene products. A hospital overnight kit for the adult should include all your personal needs, a flashlight, and
a sleep mask and ear plugs. I also recommend a shrill loud whistle to wear
round your neck tucked into your shirt, to use ONLY if there is a true
emergency and nobody comes to help.
Protect against hospital-acquired infections:
Hospital-acquired germs can be very dangerous. Hand-washing is crucial, and
nurses tend to be more fastidious than doctors about this. Nonetheless, keep a
rub-in hand cleanser at bedside: use it yourself, and offer it to any
professional or staff member before they touch your child.
both children and hospitals tend to be sticky, bring along a container of
disposable antibacterial/antiviral wipes, and frequently clean off the surfaces
that need it most -- TV remotes, telephones (including your own cell), door
knobs, bed control buttons, toys and dolls.
Get to know
your surroundings. Early on, get used to where these are: the Nurses’
station, the emergency exit, the source of drinkable water, and the public or
visitors’ bathroom (unless you can use a private bathroom.) At the
bedside, locate the “call” button for the nurse, and vow to use it
ONLY in an emergency. Figure out how the bed buttons and side rails work.
then, of course, keep a watchful eye when any substance is injected into a
“Line.” If you think someone is about to make an error, speak up at
once, but try to be vigilant, not offensive. “I’m sorry to
interrupt, but I thought that that is the arterial line, and they said nothing
should be put into it.”
wards become darker at night. Make sure you can make your way around with your
flashlight. Figure out what you are going to sleep on well before night falls,
and get acquainted with that piece of furniture -- and make sure it
doesn’t obstruct the path to the child’s bed.
Ask the nurse
to give you a basic explanation of each of the “Lines” placed for
your child. Lines are tubes: to deliver oxygen, fluids, medication, blood,
liquid feedings; to collect for the lab or to evacuate stomach contents, urine,
drainage, pus, air pockets. Each line should be clearly identified, so that the
fluid or medication doesn’t go into the wrong tube -- food into a vein,
for instance. Ask how the lines are labeled or identified to be “foolproof”
in this way.
a change is made in lines -- if one is going to be removed or added -- make
sure you understand why, and what it is for. If the person doing the procedure
is one you don’t know, or is clearly a subordinate to the main doctor
involved, make sure that the supervising physician has ordered the change.
Monitor your child:
friends with the Monitors.
are computers that receive and interpret the signals your child’s body is
sending out. These signals are delivered as numbers via a “lead”
placed on or in the body, transmitted by a wire to the machine. Most commonly,
monitors measure heart and breathing rate, blood pressure (how hard the heart
needs to work), and the blood’s supply of oxygen. Other monitors measure
more special signals: the pressure of the spinal fluid, for instance.
Settings on a monitor determine at what point the number value of each
particular “vital sign” gets too high or too low, at which point
the monitor should alarm. A heart rate over 150, say, or oxygen saturation
under 90. These settings vary from individual to individual, depending on age
that’s all fine and good, but it doesn’t take childhood behavior
into account. You may notice, and be alarmed, that when a monitor alarm goes
off like a cat with its tail stepped on, it very often doesn’t get an
instant full team response. Almost always, that’s because nurses, no
matter how busy, know which children are in a precarious situation and which
if Timmy starts tantruming about the tapioca pudding and his heart rate goes up
to 180? Or Nancy, also inflamed by the mere concept of tapioca, holds her
breath until she turns blue and her oxygen drops, for thirty seconds, to 78? Or
angelic little Franklin doesn’t like the itchy monitor leads on his chest
and finger and in the space of fourteen seconds takes them all off and tries to
eat them? Or chubby little Poppy sweats so much all her leads come unstuck?
it can work the other way, too. Monitors can’t monitor everything -- how
a child is feeling, or talking, or behaving, or whether he looks as if he is
going to throw up. They also can’t announce that even though the numbers
are within the range of the settings, there is a sinister trend: say that over
an hour the Oxygen Saturation falls from 100 to 93. Clearly, there is something
wrong, but the alarm doesn’t go off. To spot the trend, somebody’s
got to be watching the child. That’s what nurses used to do, back in the
day -- they would get to know their small patients and be alert to such
changes. Now it’s up to YOU.
keep your eyes open, and if you think your child’s condition is changing
for the worse, press the Call Button. If no one comes, get out there in the
corridor and snag the next nurse you see. Worse case scenario, blow that
yes, it’s nice to bring treats for the nurses. But even better, bring
them real help, a positive attitude that assumes that they know what they are
doing and have your child’s best interests at heart. A note of praise to
the nurse, with a copy to the supervisor and the head of the hospital, goes a
lot farther than chocolates. If you really want to bring a treat, fresh fruit
is appreciated even more than processed sweets by most nursing staffs.
you get home from the hospital, it’s always appreciated if you can drop a
note to your pediatrician to report on your stay, and any comments on the care
your child received.
Copyright © 2008 Laura Nathanson
Dr. Laura Nathanson is the author of What You Don't Know Can Kill You
(Published by Collins; May 2007; $15.95US/$19.95CAN; 978-0-06-114582-7) and The Portable Pediatrician (Collins, 2002),
as well as several other books. She has practiced pediatrics for more than
thirty years, is board certified in pediatrics and peri-neonatology, and has
been consistently listed in The Best Doctors
more information, please visit www.lauranathansonmd.com