When a Child's Mother Is in Hospital: Separation, Visits and Daily Routine

What does a child whose mother is in hospital feel, and how should you care for them? Practical tips for grandparents on separation anxiety, visits and routine.

After dinner, the four-year-old grandchild sits by the front door and tries to put on his shoes. "We're going to fetch Mummy," he says. His grandmother picks him up and does not know what to say. Her daughter has been in hospital for two weeks and nobody knows when she will be discharged. During the day the child eats, plays and smiles; but when evening comes he cries, and at night he wakes several times calling for his mother. A child whose mother is in hospital often expresses the separation not in words but through behaviour. This article is written for grandmothers, grandfathers, aunts and fathers who are looking after a young child while a parent stays in hospital for a long time. I look at what the child may feel, what you can say to them, how to plan hospital visits and how to keep daily routines going.

What Does a Child Whose Mother Is in Hospital Feel?

For young children, the mother is often the centre of the world. When she suddenly leaves home, it is not just a separation for the child, but a change in everything they are used to. Bedtime, mealtimes, the bath routine, even the house they sleep in may have changed.

Separation anxiety

The most common feeling in a child whose mother is in hospital is separation anxiety. The child may not want to be apart from the person looking after them either; they may follow them even to the toilet and refuse to go to nursery. The question "Are you going to go away too?" is often heard. This shows that the child's sense of security has been shaken and they are looking for something to hold on to. I have discussed the general features of separation anxiety in detail in the article on separation anxiety in children.

Uncertainty and fear

Children sense from adults' conversations, whispered phone calls and eyes red from crying that something is not right. But when they do not know exactly what is happening, their imagination fills the gap. Thoughts such as "Is Mummy never coming back?" or "Did Mummy get ill because of me?" can grow quietly inside the child.

Anger

Some children get angry with their mother. The feeling that "Mummy left me" can show itself as not wanting to talk to her on the phone, turning their back on her during a visit or ignoring her when she comes home. This anger does not mean the child loves her any less; it shows how great their longing and helplessness are.

Regression

A child whose mother is in hospital may step back from skills they had already learned. A toilet-trained child may start wetting again, a child who fed themselves may want to be spoon-fed, or they may go back to a bottle or a dummy. This is usually temporary and is the child's attempt to take refuge in a time when they felt safer. During this period it is important to respond with patience rather than telling the child off.

Differences by the Child's Age

Babies and 0–2-year-olds

Babies cannot make sense of their mother's absence in words, but they feel the lack of a familiar smell, voice and touch. Restlessness, disrupted sleep and feeding difficulties may appear. A T-shirt that carries the mother's smell, lullabies recorded in her voice and the baby being looked after consistently by the same person all support a sense of security.

Pre-school children (3–6 years)

At this age children do not fully grasp the concept of time; "Mummy will be back soon" is vague to them. "We'll see Mummy after two sleeps", or counting down by putting stickers on a calendar, is more concrete. Because of magical thinking, they may hold themselves responsible for their mother's illness, so it is very important to say, "Mummy's illness did not happen because of you."

School-age children (7–11 years)

School-age children want more information and ask questions. At this age it is important to give short, honest explanations and not to brush their questions aside. A drop in school performance, difficulty concentrating, pulling away from friends or, on the contrary, behaving "like a grown-up" at home and trying to take on responsibility may be seen. Some children hide their feelings to lighten the family's load and take on the role of the "good child". From the outside these children may seem to be "coping really well", but inside they may be carrying intense anxiety. Saying to them, "You're allowed to be sad too, and you can tell me", lets them feel that they do not have to hide their feelings.

What Should and Shouldn't Be Said to the Child?

The sentences below are fictional examples.

Sentences you may want to avoid:

• "Mummy has gone on holiday." (When the child learns the truth, their trust is shaken and the feeling of being abandoned may grow.)
• "If you cry, Mummy will be upset and her illness will get worse." (It places on the child a burden as if they were responsible for their mother's health.)
• "If you don't behave, Mummy won't come home." (It turns the separation into a punishment.)
• "Pray for Mummy so she gets better." (Said on its own, it can give the idea that the mother's recovery is in the child's hands.)

Sentences you might try:

• "Mummy's tummy is poorly, and the doctors are working hard to make her better. She'll stay in hospital for a while."
• "It's completely normal to miss Mummy. I miss her too."
• "Mummy loves you very much and she's thinking about you. Let's draw her a picture."
• "If you ask me something I don't know, I'll find out and tell you."

When explaining the illness to a child, there is no need to go into medical detail. What matters is that they know why their mother is there, who is looking after them, how their daily life will carry on and that their mother still loves them.

Even if a child does not fully understand why their mother has gone, they feel safe when they know who will be waiting for them, how and in what routine.

How Should Hospital Visits Be Planned?

Taking a child whose mother is in hospital to visit her is something many families feel unsure about. "Will they be frightened if they see her like that?" is a very understandable worry. Generally, seeing their parent is less frightening for children than the scenario they have imagined. But the visit needs to be well prepared.

• First find out the hospital's rules. On some wards, visits by young children may not be allowed because of the risk of infection. Ask the doctors and nurses.
• Prepare the child in advance. Explain how their mother will look: "Mummy has a thin tube in her arm; we call it a drip, and that's how she gets her medicine. Her bed is a bit different, it goes up and down with buttons."
• Keep the visit short. It can be tiring for both mother and child. A short but warm meeting is better than a long, tense visit.
• Let the child find their own way. Some children hug their mother straight away; others stand at the door, feel shy or hold back. Don't force them.
• Plan the goodbye. Saying goodbye at the end of a visit can be hard. Naming a concrete next step, such as "Now we're going home, and tomorrow evening we'll talk to Mummy on the phone", makes the separation easier.

When a visit is not possible, video calls, voice messages, recordings of the mother reading bedtime stories and drawings the child sends to the hospital keep the bond alive. But on days when the mother is tired or cannot talk because of treatment, telling the child in advance reduces disappointment.

Keeping Daily Routines Going: Tips for Carers

• Keep the routine. As far as possible, stick to the sleep, meal and play times the child is used to. Familiar rituals (the same story, the same bedtime song) support a sense of security.
• Don't change carers too often. Different people taking turns to look after the child in their mother's absence may be an understandable necessity; but it is important for the child to know in advance who they will be with each day.
• Keep Mummy's rules. Keeping the same approach as the mother on things like screen time, sweets or bedtime gives the child the message that "life goes on".
• Let the nursery and school know. When the teacher knows what is happening, they can interpret changes in the child's behaviour correctly.
• Make time for play. Playing doctors or hospitals helps the child process what they are going through. Don't stop these games; join in.
• Help them name their feelings. Questions such as "You seem a bit cross today; are you missing Mummy?" make it easier for the child to recognise their feelings.

In Turkey, care for the child during this period often falls to the maternal or paternal grandmother or an aunt. Sometimes the child is sent to another city to stay with their grandparents. In that case the child is separated not only from their mother but also from their home, their father, their nursery and their friends. If possible, keeping the child in their own home and surroundings reduces the impact of the separation. If this is not possible, regular video calls with their father and mother and taking their own toys and belongings with them can ease the transition.

The Burden on the Mother, the Father and the Caring Adult

The adults at home

The father of a child whose mother is in hospital worries about his wife while also taking on responsibility as if he were the child's only parent. Being squeezed between work, hospital visits, housework and childcare creates intense exhaustion. The grandmother or grandfather, meanwhile, tries to appear strong for their grandchild while worrying about their own daughter or daughter-in-law.

This exhaustion can wear down patience with the child. It is important to notice your own feelings and, when needed, to ask other family members or neighbours for practical help. I have discussed how roles within the family can change during an illness in the article on role changes in the family during illness.

The mother in hospital

The mother in hospital also feels the pain of being apart from her child. Many mothers think less about their own illness than about how their child will be affected by all this; they may feel guilty, as though "I've left them on their own". The child crying on the phone or not wanting to talk can hurt the mother deeply. That is why it is important for the adults caring for the child to give the mother regular, balanced updates: sharing not only the hard moments but also the moments when the child laughed, played or finished their dinner. A photo of a picture the child drew that day, a funny thing they said or a small achievement at nursery lets the mother feel both that her child is being well looked after and that the bond is still there.

Being able to take part in the child's everyday decisions also strengthens the mother. Involving her with small questions such as "What should he wear to nursery tomorrow?" or "At the weekend, should they go to the park or to Grandad's?" supports both the mother's and the child's feeling that "Mummy is still with me". On days when the mother's treatment is intensive, however, it may be better to pass on only short, reassuring news without expecting such decisions from her.

When Should You Seek Professional Support?

Anxiety, anger and regression are expected reactions in a child whose mother is in hospital. However, in the following situations it may help to get support from a child mental health professional:

• The child having intense bouts of crying, sleeplessness or nightmares lasting for weeks
• Persistently refusing to go to nursery or school
• Losing interest in play, food and the things they love
• Marked aggression or self-harming behaviour
• Staying away from the mother for a long time after she comes home or, on the contrary, being unable to leave her side at all

If the mother's condition becomes more serious or there is a loss, be sure to get professional support on how to approach the child.

How Is a Child Whose Mother Is in Hospital Supported in Therapy?

The main tool for working with young children is play. In child-centred play therapy, the child expresses their longing, fear and anger in a safe setting through dolls, hospital play sets, puppets or drawing. The therapist accompanies the child's play without judgement and helps them make sense of their feelings.

Sessions with the caring adults are also an important part of this process. They can cover what explanation to give the child, how to plan visits, how to respond to regressive behaviour and how carers can cope with their own exhaustion. In child and play therapy, sessions with a parent rushing between hospital and home can also take place online when needed.

Frequently Asked Questions

While the mother is in hospital, should we take the child to our home or stay in theirs?

If possible, the child staying in their own home, in their own bed and in familiar surroundings means fewer changes. If this is not possible, bringing their favourite belongings, toys and pillow with you makes the transition easier.

The child doesn't want to talk to their mother on the phone. Should we make them?

No. This may be the child's way of expressing their longing and anger. The mother sending a short message so the child can hear her voice, or the child just listening, still keeps the bond going. In time, the child will find their own way.

When the mother comes home, will everything go back to how it was?

Although the mother's return is a happy moment, it can take time for the child to readjust. Some children keep their distance from their mother for a while; others do not want to leave her side at all. With patience, by keeping routines and by making room for the child's feelings, this period usually eases.

The mother's illness is serious; how much should we tell the child?

It is important to give the child short, honest information suited to their age; but there is no need to involve them in detailed medical information or the adults' worries. When the situation becomes more serious, it can help to seek the mother's and father's views on what language to use and to ask a professional for support.

• #separation anxiety
• #ill parent
• #grandparents
• #child psychology

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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.

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