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Emotional responses of young children to hospital and surgery : a comparative study of procedures and facilities in the Vancouver General Hospital, 1953-58 Holloway, Shirley Kathleen

Abstract

The present study constitutes an attempt to observe and measure the emotional responses of young children to hospitalization and surgery. There has been much inquiry and comment from psychiatric and medical sources which suggests that this experience may be seriously traumatic for some children, and social workers are rightly concerned about the possibilities of modifying the frightening aspects of hospital routines on the basis of their knowledge of children's emotional needs. A sample group of children (20) referred for tonsillectomy and adenoidectomy by the Ear, Nose, and Throat Clinic of the Vancouver General Hospital was studied. The mother of each child was interviewed, three months after the hospitalization of her child, on the basis of a comprehensive questionnaire designed to determine the child's behaviour before and after surgery, including his usual reactions to punishment and the nature of the punishment. Relevant references by medical and social workers were studied, including the Albany Research Project which was a notable example of team research by a paediatrician, an anaesthetist, a psychiatrist, and a social worker, to establish patterns of child's reactions to the same operation in the Albany Hospital. Similar methods of assessing adjustment by measuring neuropathic traits before and after the experience were used. In the present study, special emphasis was laid upon ascertaining the nature of the mother-child relationship and the degree of anxiety around separation. Some follow-up was also incorporated. The same wards were observed five years later and differences in setting, policy, and procedures were noted and evaluated in terms of the earlier findings. It was found that ten of the twenty children suffered a severe emotional setback as a result of their illness and hospitalization. It was also observed that many of the children confused surgery with punishment and many had unrealistic ideas about the purpose of hospitalization. It is suggested that poor preparation contributed to this confusion, and that unimaginative methods of applying standard hospital procedures to small patients often confirmed fears and anxiety. Because the child's reaction to hospitalization is essentially based on the quality of his relationship with his mother, it is concluded that surgery should be postponed, if possible, until after five years of age; or, where postponement is impossible, mothers should be able to accompany young children to hospital. Some modifications in hospital routines applicable to children in hospital are suggested. The later observation of Vancouver General Hospital showed great changes in setting and policy, especially in regard to visiting, but found the two major procedures of admitting to hospital and preparation for anaesthesia and surgery virtually unchanged.

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