Child in Hospital: Play, Routine and Trust During a Long Stay

How does a child in hospital feel during a long stay? Age-based play ideas, building a daily routine, protecting trust and how parents can cope too.

A drip stand, machines that beep, lights switched on in the middle of the night, faces that change every day. The hospital environment, tiring even for an adult, is a far bigger and more bewildering world for a child. When a stay lasts a few days, most children can turn it into an adventure; but in stays that last weeks, sometimes months, boredom, fear, anger and missing home begin to build up. For a child in hospital, play, routine and trust are basic needs that accompany medical care, even if they do not rank alongside it. In this article I look at a child's inner world during a long stay, what can be done at different ages, ways to create a little order in the room, and how a parent staying with the child can protect themselves. For questions about the medical process, always consult your child's doctors and nurses; rules on visits, play materials and hygiene can also vary from hospital to hospital.

How Does a Child in Hospital Feel?

Children's reactions to hospital vary with their age, temperament, the type of illness and their previous experiences. Still, there are some feelings that are common during long stays:

• Loss of control. The child cannot decide when to eat, when to sleep or who comes into the room. This is particularly hard for preschool children who have only just discovered their independence.
• Fear. Needles, tests, unfamiliar sounds and people in white coats can look like threats in a child's eyes. Young children sometimes see the procedures done to them as a kind of punishment: "Am I staying here because I was naughty?"
• Separation anxiety. Crying, clinging and sleep problems may appear even when the mother or father leaves the room for a few minutes.
• Boredom and restlessness. A child whose movement is restricted and whose play space has shrunk may become more irritable and have more outbursts of anger.
• Missing things. They miss their home, their room, their brother or sister, their friends, even school. Special days such as a religious holiday or a birthday spent in hospital deepen this longing.

Some children put these feelings into words; many more show them through behaviour. Withdrawing, refusing food, intense anger or going back to behaviours from a younger age are some of these. I discuss that last topic separately in the article on when a sick child acts like a baby.

Why Does Play Matter So Much?

Play is a child's language. Just as adults find relief by talking, children find relief by playing; by re-enacting what frightens them in play, they make it more manageable. When a child gives their teddy bear an "injection," acts out the bear crying and then comforts it, they are in fact processing their own experience.

In hospital, play serves several purposes:

• Expressing feelings. The child conveys their fear, anger and sadness through toys.
• Gaining a sense of control. In play, the child makes the decisions: who will be the doctor, who the patient, when the game ends.
• A sense of normality. Playing, even in a hospital room, carries the message "I'm still a child."
• Building connection. Games played with parents, siblings or healthcare staff strengthen the relationship of trust.

If you are curious about the place of play in development more generally, you can take a look at the article on the importance of play. Some hospitals have playrooms, volunteer activities or hospital teachers; asking the ward team about these options is a good place to start.

Play and Communication With a Child in Hospital at Each Age

Babies and toddlers (0–3 years)

At this age the most important thing is the closeness of a familiar adult. Cuddling, skin-to-skin contact, singing lullabies, and a familiar blanket or the dummy and toy from home all give a sense of security. Simple games are enough: peekaboo, finger games, looking at colourful books, clapping along to songs. Keeping the baby's sleep and feeding routine similar to the one at home, as far as medical needs allow, can also reduce restlessness.

Preschool children (3–6 years)

Because preschool children have such rich imaginations, they can fill the hospital with frightening fantasies. Playing doctors with them, using a toy stethoscope and a rag doll, and showing procedures in advance through play are very helpful. Drawing, play dough, sticker albums and short stories are also suitable activities for this age.

Sentences you might use:

• "Today they're going to take some blood. It might hurt a bit, and if it hurts you can cry. I'll hold your hand."
• "Being here isn't your fault. Your body needs some help to get better."

Sentences to avoid:

• "It won't hurt at all." (If it does hurt, trust is shaken.)
• "If you don't behave, the doctor will give you an injection." (A medical procedure turns into a punishment.)

School-age children (7–12 years)

Children of this age want to understand what is going on. Giving them simple illustrated explanations about their bodies, answering their questions and keeping them informed about the treatment schedule increase their sense of control. Board games, card games, puzzles, Lego, crafts and time-limited tablet use are suitable options.

School is an important area of identity at this age. In Turkey some hospitals have hospital classrooms or hospital teachers; during long stays, talking to the school management and the ward team about education options at home or in hospital reduces the child's worry about "falling behind." Drawings, voice messages or short video calls from classmates also maintain the link with school.

Teenagers (13 and over)

For teenagers, hospital is one of the places where privacy and independence are most challenged. People entering the room without warning, conversations about their bodies taking place in front of everyone, and a parent getting involved in everything can deeply upset them. It is important to give a young person their own space, to let them listen to music, message their friends and watch series, and to support their involvement in decisions about their treatment.

Instead of saying "You're glued to your phone, talk to me for a bit," asking "How's your head today? Do you want to talk, or would you rather have some time to yourself?" respects both the young person's need for connection and their need for autonomy.

Building a Routine in the Hospital Room

During long stays the days blur into one another. Routine gives a child a sense of predictability and security. As far as the medical programme allows, you can try the following:

1. A visual daily timetable. Drawing a sequence on paper with pictures, such as "breakfast in the morning, then the doctors' round, then play, nap, video call in the evening," helps young children make sense of the day.
2. Morning and evening rituals. Changing into pyjamas, brushing teeth, reading a bedtime story; when home habits continue in hospital, it sends the message that life has not changed completely.
3. Personalising the room. Putting drawings on the wall, family photos, bringing a favourite pillowcase makes the room a little more "theirs." You can do this after checking the hygiene rules with the ward team.
4. Areas of choice. Leaving small decisions to the child, such as which pyjamas to wear, which game to play or which hand to hold while blood is taken, partly gives back the sense of control they have lost.
5. A "good thing" hour. Let there be a small moment each day that the child looks forward to: a video call with a sibling, a favourite cartoon, a game.

A little order created in a hospital room offers a child a branch to hold on to amid the chaos outside.

Protecting Trust: Honesty and Preparation

A child's trust in the healthcare team and in their parents is the most valuable resource during a long stay. The basic way to protect this trust is honesty. Hiding procedures from a child, springing a last-minute "surprise" or promising "it won't hurt" may seem easier in the short term, but it makes fear grow with every subsequent procedure.

Instead:

• Shortly before a procedure, explain what will happen in language suited to their age.
• Tell them honestly what they might feel: "It might feel a bit cold, then you'll feel a little prick."
• Give them a job: taking deep breaths, blowing as if inflating a balloon, singing a favourite song.
• After the procedure, praise their effort rather than their bravery: "That was a hard thing and you did your best."

If fear of needles and tests is marked, you can also draw on the suggestions in the article on fear of needles in children.

The Parent Staying Over and Siblings at Home

The mother or father beside a child in hospital is often the person sleeping in a chair or on the companion's recliner, skipping their own meals and trying to manage things at home by phone. This tiredness builds up and can also be reflected onto the child.

A few suggestions for parents staying with their child:

• Take turns. If possible, alternate with your partner or a relative you trust. Even a break of a few hours is valuable for having a shower and resting.
• Short breaks. Walking along the corridor while your child sleeps, or getting a few minutes of fresh air in the hospital garden, rests your nervous system.
• Taking your feelings somewhere. While you try to stay strong at your child's side, it is important to find an adult with whom you can share your fears.

Siblings who stay at home may also feel left out or guilty during this time. Making regular video calls with them, asking them to send drawings or letters to their sibling in hospital, and setting up a stable routine with the person looking after them at home all protect the family bond.

What should visitors say?

Relatives and family friends can be a good source of cheer for a child in hospital; but visits should be short and suited to the child's energy. Asking the ward team about visiting rules in advance also reduces the risk of infection.

Sentences that can do a child good: "I've brought you a drawing from your class, look who drew it," "What would you like to play today, can I join in?" Sentences to avoid include: "You've lost so much weight," "Oh, my poor darling, are you in a lot of pain?" or asking the parents detailed questions about the illness in front of the child. Children listen to adults' conversations far more closely than we think, and they can fill in what they hear with their own fears.

When Should You Seek Professional Support?

Sadness, anger and restlessness are expected reactions during a long hospital stay. However, seeing a child mental health professional may be helpful in the following situations:

• The child showing no interest in any game for days and withdrawing completely
• Extreme panic before medical procedures, crying so intensely that they cannot stop
• After discharge, nightmares for a long time and strong avoidance of anything that reminds them of the hospital
• A return to behaviours that are not appropriate for their age lasting for weeks
• The parent staying with them crying constantly, being unable to sleep or feeling helpless

Some hospitals have child psychiatry or psychosocial support units; you can ask the ward team about these options. These signs do not in themselves mean a diagnosis; but they may show that the child is struggling to carry their load and needs a little more support. Difficulties that are noticed early are often easier to address.

How Can Therapy Support a Child in Hospital?

Play lies at the heart of psychological work with children. Within child and play therapy, the child reprocesses the hospital experience in a safe space through toys, puppets and drawings, and learns to express their fears and anger and to calm themselves. In child-centred play therapy the adult does not direct the play; they reflect and accept the child's feelings.

After discharge, too, a child may need to make sense of what they went through. In some children, hospital memories continue in the form of sleep problems or separation anxiety. In this period, sessions with parents are useful for understanding the child's behaviour and planning how to support them at home. When working with teenagers, creating a space where the young person can have their own say and where their privacy is respected is the priority.

Frequently Asked Questions

How much tablet or phone time should I allow my child in hospital?

During long stays, screens can be an important way of easing boredom and staying connected with friends; it is understandable to be a little more flexible than the rules at home during this period. Still, it is good if the screen is not the only activity and is balanced with play, drawing and conversation. Setting a limit in the evening is helpful so that it does not disrupt night-time sleep.

My child gets very angry with me in hospital, is this normal?

Yes, it is quite common. Children often direct their anger at the person they trust most, because they know that person will not leave. Naming the feeling without taking it personally, by saying "Being here makes you really cross, and you're right," helps the anger settle.

How can a religious holiday or birthday be spent in hospital?

As far as the ward team allows, a small celebration can be held: decorating the room, bringing the family together on a video call, singing a song the child loves together. What matters is not a big event, but letting the child feel that the day is special.

My child is struggling to settle back at home after discharge, what should I do?

After hospital, irregular sleep, clinginess or restlessness may be seen for a while. Returning to old routines gradually, and letting the child talk about the hospital experience or act it out in play, helps. If these difficulties last for weeks, you can consult a professional.

• #hospitalised child
• #long hospital stay
• #play for sick children
• #patient psychology

Yazar

Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

Eğitimler