Is it safe for a child to visit a hospital: Preparing Children to Visit Someone in the Hospital

Опубликовано: April 2, 2023 в 6:01 am

Автор: alexxlab

Категории: Child

Preparing Children to Visit Someone in the Hospital

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When you have a loved one in the hospital it can be a difficult time for everyone in the family, especially children.

Often children will want to come to the hospital because they know their loved one is there and they want to see them. As long as visitors of certain ages are allowed in the hospital, it is typically okay to have children come and visit a loved one. Click here for the latest visitor guidelines at HSHS St. Vincent Hospital. If your child is properly prepared for the hospital visit, then you can help make visiting a positive experience for the child and yourself. If your loved one is in serious condition, please use your best judgment as you know your child best.

When preparing your child for a visit to the hospital, it’s important to do the preparing in a quiet/safe place such as being at home or a quiet room in the hospital. Try to make it free from distractions. Turn off the TV and cell phones and make sure there are not too many people in the room.

Have your children make a special “hospital bag” that they can put toys, movies, or activities in to help keep them busy while they are visiting.

You need to prepare your child for what they will see and hear when they come to the hospital. The older the child, the more details you may have to give them. It is okay to go into as many details as you think is appropriate. Take pictures of hospital room, the machines, and the loved one that is in the hospital. Explain to them in simple details what every machine is used for:
- The computer on the wall is monitoring grandma’s heart.
- The pole with the bag of water is helping to give grandma’s body a drink through a little tube in her hand. This tube can also help give grandma medicine.
- There is a tube that is in grandma’s nose and that is to help give grandma food because she is not awake enough to eat right now.
- There is a tube in grandma’s mouth and that is helping grandma to breath. The doctor is giving grandma some medicine that makes grandma really sleepy so her brain can rest. When her brain is resting, the doctor has this big machine to help grandma breath. The machine makes a little noise when it works. Sometimes it will beep. It’s okay when it beeps because the nurse and doctor are watching the computer to make sure everything is working well.

Make sure you leave the decision up to the child about if they want to visit or not. Some children want to visit and some of them don’t. Some children want to wait a few more days and then want to visit. It should be the child’s decision.

Explain to the child in appropriate language why the patient may not respond the way they usually do. Let them know that even though they may look different, it is still grandma/mommy on the inside. Remind them that they can talk to them, but they may/may not be able to talk back.

When you bring the child to the room, let them lead you. They may want to stay back and walk in slowly. Do not tell your child to go up to the bed and hold the person’s hand. Let your child know that they can come up and hold their hand if they want to or they can stay back farther. If your child decides to go into the room, have your child make a card ahead of time and then they can give it to their loved one. This can be a good conversation starter upon entering the room.

Keep the visit short per the child. If they feel comfortable staying, allow them to. If they want to leave sooner than expected, that’s okay. For some children it may be a lot to take in all at once, so be prepared that they may want to leave after a short time and then may want to come back in again shortly after.

After a child sees someone they love in the hospital, it may bring about some emotions. Acknowledge the child’s emotions and let them know that it is okay to feel this way. Let them know that it is okay to cry if they want to. Also let them know it’s okay to be happy. Don’t say to a child “Try to be brave and try not to cry.” Crying is a means of coping.

If you know that your loved one is going to look better in the next few days, we suggest you have the child wait to see them until they start looking better (especially if there are a lot of tubes, swelling, etc.). If you know that the loved one will not look better and may pass away, then you should prepare your child and ask them if they want to visit and say goodbye.

When visiting isn’t an option, or in-between visits, click here for ways to keep children connected to a loved one while in the hospital.

If you have questions or you’re concerned about how to discuss these topics with your child, Child Life Specialists at HSHS St. Vincent Children’s Hospital can help. They are trained to teach children and families the skills it takes to cope with the loss of a loved one. If you are interested in speaking or meeting with a Child Life Specialist, call 920-433-8641 or notify your child’s doctor.

Taking Your Child to the Hospital During COVID-19

Written by WebMD Editorial Contributors

Medically Reviewed by Dan Brennan, MD on January 02, 2023

One visitor limit. Most hospitals ask that only one parent or guardian stay with the child. Siblings generally aren’t allowed, so leave any other children at home. If your child needs to stay in the hospital overnight, friends and family members will likely not be able to visit. But video calls may help them stay in touch. One parent or caregiver is allowed to stay with your child in the hospital 24/7 and can sleep in their room, even during COVID-19.

Masks. All staff and visitors must wear masks at all times. Bringing a mask from home will help the hospital from running out. If you don’t have a mask, they will give you one. Babies younger than 2 don’t have to wear masks. If your child is older than 2 and has trouble wearing a mask, call the hospital in advance and ask how to handle it.

Symptom checks. A nurse may check your temperature when you get to the hospital and ask you about possible symptoms of COVID-19. Sometimes these are the same questions you already answered online. If you have a fever or cough, you may have to go home and reschedule your child’s appointment.

COVID-19 tests. Staff may test your child if they will have outpatient surgery or need to spend the night for any reason. They may have rooms set up for children who have COVID-19 to keep them away from anyone else.

Social distance. You may still see floor markers and seats in waiting rooms set up to help you stay at least 6 feet away from others. Signs will tell you how to safely use elevators and common areas such as cafeterias, pharmacies, therapy gyms, and gift shops. Some of these places may be closed.

Rules for staff. You can feel assured that the doctors and other staff members caring for your child are checked every day for signs of COVID-19. They also must wear masks, gowns, gloves, and other safety gear to make sure your child and everyone else stays safe.

If you feel unsure or uneasy about heading to the hospital after isolating at home, talk to your pediatrician or the hospital.

My child is in the hospital. What do you need to know? Instructions from Meduza — Meduza

When children end up in the hospital, it always becomes a great stress for parents. In an emergency, many are lost and do not know what to do: how to communicate with a doctor and how to support a child who is scared and hurt. We talked with a lawyer, a doctor, a philanthropist and a psychologist and tell you how to behave in such a situation.

If possible, choose a hospital yourself

In a planned hospitalization, you can choose the hospital for your child’s treatment. Sometimes the attending physician helps to determine this. In case of emergency hospitalization, there is also the right to choose, but most often the ambulance team goes to the nearest hospital, ready to receive such a patient.

An ideal hospital would have a doctor who is well versed in the subject, a good team of other specialists, good care and good infrastructure. In the real world, this rarely happens. Therefore, unfortunately, there is no universal recommendation on how to choose a hospital. However, if there are patient communities for your child’s illness, you can discuss this issue there. Their participants should know which doctors are well versed in the problem, especially if it is a rare disease.

Take the necessary documents

Lawyer, founder of the Faculty of Medical Law company Polina Gabay notes that there is no single list of all documents required for hospitalization. Therefore, medical organizations establish their own lists of documents for hospitalization. They differ depending on the region, hospital profile and disease. Usually, the attending physician at the appointment tells you in advance what you need to take during hospitalization.

The basic set of documents for patients undergoing planned treatment looks like this:

Certificate of absence of contact with infectious patients for the last three weeks (and for the accompanying person)
Fluorography results (and for the accompanying person)
Tests for the absence of intestinal infections (for children under two years of age and their representatives) for the last two weeks
Insurance policy
Child’s birth certificate (or passport)
Passport of one of the parents or guardian
Documents establishing relationship
Referral for hospitalization
Extract from the medical record

If the child is admitted to the hospital urgently, then it is not necessary to provide documents immediately, this can be done later. If you are hospitalized with him, you should have a fluorography done without waiting in line, and be tested for tuberculosis in the medical facility itself.

Stay in the hospital with the child (if necessary and possible)

A parent, family member or legal representative may stay in the hospital with the minor for free during the entire treatment. Even if it is a tuberculosis hospital or an infectious diseases department.

If the child is under four years old, or if the child is older but has medical indications for joint hospitalization, one of the parents is required to feed and provide him with a bed free of charge. What kind of indications are determined by the medical institutions themselves, says Polina Gabay. Usually these include the need for feeding, changing clothes, accompanying the child for procedures.

If there are no such indications, but you want to be near the child, you can stay in the room. However, you will have to pay for food and a separate bed. Gabai emphasizes that medical organizations often deny relatives this right. This is illegal, but the reasons are often objective (for example, crowded rooms and lack of beds), and it is difficult to do something about them.

Gabay says that parents cannot equip the room on their own (put a cot or an air mattress there), because this would violate fire safety rules and sanitary standards of the hospital. Then they get out of the situation in a different way – they sleep on the same bed with the child.

Some hospitals have family rooms created by the Ronald McDonald House Foundation: in Moscow, Ulyanovsk, St. Petersburg, Saratov, Cheboksary, Nizhny Novgorod and Voronezh. They are arranged differently, but may consist of a living room, bedroom, playroom, kitchen and shower room. Parents can spend the night there if they did not find a place in the ward, and children can spend time. “The project is in great demand, because parents come with their children for long-term treatment from different regions. These conditions are reminiscent of a home environment, which is essential for the psychological well-being of parents,” says Ekaterina Myslitskaya. According to her, it is problematic to equip such rooms in every children’s hospital: most often, a medical institution simply does not have free space that can be donated to charitable foundation projects.

Be prepared for the fact that the hospital may have its own unspoken rules, according to which parents must regularly clean not only the ward and do other things that employees do not have time to do. Theoretically, you can refuse all this (these rules are clearly illegal), but this will definitely not improve the attitude towards you.

Now, due to the pandemic, according to Polina Gabay, one of the parents can still be hospitalized with the child, but other relatives or friends will not be allowed to see him due to quarantine measures. Children are not allowed to walk and move around the wards. It is possible to donate clothes or food, but each hospital sets its own rules – it is better to clarify them in advance. During planned hospitalization, the child and parent will require a negative test result for coronavirus.

In intensive care, you can also go to bed with a child, but it will be much more difficult.

Intensive care units, all these rules about staying with a child also apply. Although a permanent stay in Russia is associated with enormous difficulties. Not all hospitals allow parents to stay in intensive care around the clock, notes Polina Gabay. You can try to agree on this, but the rules for staying in intensive care in a separate hospital are set by the head physician.

For a long time, parents were generally not allowed into the intensive care unit where their children were. Now there are only a few such cases, according to the Children’s Palliative Foundation. In September 2020, the order of the Ministry of Health of Russia on visiting patients in intensive care (that is, on time-limited visits) came into force. At the same time, no more than two visitors per person should be in the ward, and now this is possible for both the patient’s friends and his brothers and sisters. In theory, they must let you in without test results, a certificate of the absence of diseases, as well as medical caps, gowns, masks and shoe covers. At least, there are no such rules in the order of the Ministry of Health, however, the hospital can set its own restrictions. Remember that it is forbidden to use the phone in intensive care.

If you are denied permission to visit or stay with your child, remain calm and try to resolve the issue with your doctor without scandal. If this does not help, contact the head of the department. If he does not let you go, go to the head doctor – have a statement with you asking for access to the child in two copies. If this does not work, file a formal complaint addressed to him, and also call the hotline of the Ministry of Health, Roszdravnadzor or your insurance company.

The Children’s Palliative Charitable Foundation published a brochure “What to do when your child is in intensive care” a few years ago. Some of the rules are already out of date, but it will be useful to read it in order to know how to support yourself and your child and how to communicate with medical professionals and other patients.

Prepare the child mentally for what awaits him in the hospital

How exactly to do this, of course, depends on the age of the child and his illness. But in general, it would be nice to talk about hospitals and doctors, even if there is no need for hospitalization. Then, if such a need arises, the child will be better prepared. In any case, with planned hospitalization, it is better to discuss everything at least a couple of days in advance.

Children under three years of age get tired quite quickly, it is difficult for them to control their behavior and emotions. Psychologists advise to distract the child, calmly explain to him what is happening, and constantly be around. You need to take your favorite toys and some new things with you that will divert his attention at the right time.

Children from three to seven years of age already have a better understanding of what is happening. They become able to express their feelings in words, they have a vivid imagination, says Tatyana Pavlova, a clinical psychologist at the Center for Cognitive Therapy and the author of the Post_Alarm telegram channel. At this age, children are very active and curious. Pavlova advises preparing the child for the hospital in advance, he may need time to realize what is happening. You can act out scenes from the hospital in joint games, tell what will happen through the game, emphasizing that when you leave the hospital it becomes easier. It is worth taking with you to the hospital some object that will remind you of your home and relatives – your favorite toy or book.

If the hospitalization is emergency and the child is crying from fear and stress, you can explain what is happening and reassure him: “Your tummy hurts, it needs to be treated. We will go to the hospital, and you will feel better, and I will be next to you.” At the same time, it is important not to deceive, not to say that you will be there if it is impossible, or that it will not hurt at all if it does. With the help of such deceit, one can persuade them to undergo some kind of procedure, but this will undermine trust and cause more problems in the future. Complex procedures can be explained in the language of a fairy tale or lost. It’s good if you can give the child a reward for unpleasant procedures – a small toy or a sticker, Pavlova notes. Sometimes there are “boxes of courage” with such things in hospitals, but if not, you can give these things to the doctor or nurse before the procedure so that they will give the toy to the child as soon as everything is over.

When communicating with schoolchildren and adolescents who have ended up in the hospital, it is worth encouraging their independence and expression of feelings. Pavlova advises including the teenager in medical decision-making if possible, this will help him feel some control over what is happening. Keep in mind that stress can change a teenager’s behavior, and they may behave like younger children. This is a normal temporary phenomenon under stress. Therefore, do not tell him that it is bad to cry, it is shameful to be afraid, and that feelings should be kept to oneself. This does not help in reducing anxiety, but, on the contrary, increases stress.

Buy a notebook for your child, he may want to keep a diary. It is important not to deprive him of a friendly environment and not pull him out of society. Arrange video calls or ask friends to visit if possible.

Toys

In addition to bringing toys to the hospital that are valuable to the child and help him calm down, they can be used in other ways. Even at home, with their help, you can play medical scenes. For example, operate on a bear or inspect a doll. In some countries, hospitals even have Teddy Bear Hospital, a project that means that on certain days children come to the hospital with their toys, and medical students or even hospital staff help to examine and / or cure them.

In order to make it easier for children to explain the essence of the disease and upcoming procedures, special dolls are also used. For example, MediKin dolls. This is not a cheap toy – the base kit costs $335. And in 2015, such dolls appeared in Russia thanks to the Give Life Foundation. And Claire Towell, the mother of a deaf girl, has started a company that sells dolls with hearing aids, tracheostomy tubes, feeding tubes, and more. True, there is no delivery to Russia yet either, but you can try to do something similar on your own. If you have time, you can adapt an ordinary doll by adding everything you need to it.

Applications

Of the decent applications in Russian, two paid ones can be distinguished:

My PlayHome Hospital (AppStore, Google Play) – according to the developer, suitable for children from four to five years old
Toca Life: Hospital (AppStore, Google Play ) — according to the developer, suitable for children from six to eight years old

Both applications have the same structure: you can do whatever you want in a hospital, where there are different devices, rooms, patients and the ability to perform various manipulations.

Books

Books can also be very useful in adaptation. For example:

“Heart Story” is a book for children with congenital heart defects. It was created by the Cardiomama project.
Help book series for children with cancer
“Curious George ends up in the hospital” by Margaret Rey and H.-A. Rhea
“Hospital Mouse” by Lucy Cousins
Secrets of Medicine by Zoe Fritz and Kathy Danes

Organize your life

A hospital room can be a very uncomfortable place, and if possible, it would be good to adapt it a little to your needs. However, it is important to remember that due to fire safety rules, it is forbidden to use electrical heating appliances (kettles, boilers, coffee makers) in the wards, says Ekaterina Myslitskaya, General Director of the Ronald McDonald House Foundation. You can use phones, tablets and laptops. Don’t forget to bring hygiene products (toilet paper, shampoo, deodorant, toothbrushes and paste, razor and soap), comfortable clothes, change of underwear and towels.

Sometimes things turn out so that you can take a short break in treatment. However, if the child has come from afar, he is left in the hospital, because it may not even be safe for him to go home. And some charitable foundations provide rented apartments for such cases, so that the child has a change of scenery and does not lie in the hospital. For example, the Gift of Life foundation for helping children with oncohematological and other serious diseases does this. Therefore, if necessary, it is worth looking for such an opportunity.

In addition, the Ronald McDonald House foundation opened a family hotel in Kazan at the Children’s Republican Clinical Hospital. The director of the fund says that 24 rooms can be occupied there at the same time. Accommodation at the hotel is free, priority is given to single parents and families with many children, as well as if families come from afar or if their child needs long-term treatment. In 2022, a similar family hotel should open in Moscow on the basis of the Children’s Clinical Hospital. Z. A. Bashlyaeva. It will be for 29numbers.

Communicate with healthcare workers correctly

The most important thing in any situation is to be polite when communicating with your doctor, says neurologist Maria Ostrovskaya, who worked at the Russian Children’s Clinical Hospital. Although, of course, in a stressful situation, when emotions are running high, this is difficult to do. If you feel that you are not coping, ask relatives, friends, neighbors to go to the hospital with you.

If you feel that your rights are being violated or you are rude, do not record video and audio without warning. This will worsen relations with medical staff. Of course, there are situations when a person achieves his goal with hysteria and perseverance, Ostrovskaya admits. But it shouldn’t be abused. Firstly, you may end up with a stubborn doctor who will only be offended by your behavior. Secondly, any medical worker appreciates a calm patient much more, who is able to build a dialogue, does not make scandals, treats his advice with respect and trust.

By law, medical professionals must inform the patient (or his legal representatives) in an accessible form about his state of health, what procedures he will have, what risks this entails, what will happen if he refuses this treatment. A person’s condition may change, he may need new interventions, so such conversations cannot happen only once upon admission to the hospital. Moreover, according to the law, you can get access to medical documents. In order for such conversations to go better, you should prepare, formulate questions, talk about your concerns, ask if there are other options in this situation, ask about the prognosis and when discharge is possible in different scenarios.

Also, try to learn more about the disease and treatment options from quality sources. This will help to speak the same language with the doctor and notice if the doctor’s knowledge differs from modern ones. Any disagreement about what the doctor says and what is written in good sources is best discussed with the medical specialist in the correct form.

Nevertheless, this advice, of course, is not absolute. For example, if after hospitalization a doctor does not come to your child for a long time, you should go to the internship and look for a specialist. “If [with the child] everything is in order, you can wait a little longer. If not, you should look for anyone and demand to urgently come, ”advises Ostrovskaya.

If you do not like the attending physician at all and the situation is critical, you can contact the head of the department with a request to replace the specialist. However, as Maria Ostrovskaya says, this should be done politely: “Calmly approach the manager and say that you can’t make contact with some doctor, explain what doesn’t suit you and why switching to another specialist will help you.” If there is another doctor in the hospital who specializes in your problem, by law he must take you, however, most likely, he will perceive you as a difficult patient.

The law does not say what to do if there is no other attending physician in the medical institution. Most likely, you will have to stay with your doctor, and the attitude towards you will not change for the better.

You also have the right to transfer your child to another hospital if his condition allows it and the other institution is ready to accept him.

Help your child cope with pain

Ask your doctor if injections can be replaced with suppositories or tablets. Often this can really be done, and injections are just a tribute to tradition. Exceptions are, for example, vaccines or intolerance to drugs that can be taken by mouth.

If injections are unavoidable, the child should be properly adjusted, says Maria Ostrovskaya. Do not lie that he will not be hurt. Do not scare with phrases like “if you don’t stop crying now, I’ll give you to my uncle.” The child is scared, he needs to be supported in such a situation.

During the injection, if appropriate, you can hold the baby in your arms, try to distract him, and if it is an infant, you can breastfeed him or give him sweetened water (or dip the nipple in such water). Maria Ostrovskaya advises distracting children’s attention with the help of a kaleidoscope, soap bubbles, cartoons or games.

Health care providers may use special techniques to relieve pain: local anesthetics, coolants, and vibrating devices to be applied to the injection site shortly before the injection.

If a catheter is placed in a child, it must be of the smallest diameter and securely fastened.

The Podari Zhizn Foundation has several instructions to help parents just for these situations: for example, here.

Take care of yourself

We need anxiety in order to mobilize and solve the problem when something bad happens, says psychologist Tatyana Pavlova. By itself, this emotion is normal, but it has some side effects. If we have an alarm turned on, we tend to see everything as more dangerous than it is. Also, anxiety creates a kind of perception tunnel: we focus on the problem and see nothing but it.

If the emote has already started, it will not be possible to get rid of it by clicking. The emotion is worth naming, telling yourself that it is normal in this situation. It is important to recall that emotion distorts thoughts, and not to react to the impulses that it gives us (to start urgently running, calling, looking for information on the Internet), advises Pavlova.

It is worth admitting to yourself that it is normal to experience anxiety and fear in your circumstances. If you try to shut yourself off from your feelings, they still won’t disappear. Name your emotions, be aware of them. What you think about your emotions determines how you will experience them and how the child learns to cope with his experiences. Do not try to hide your feelings from him, do not pretend that everything is fine with you, thereby you will only convey to the child the feeling that anxiety is dangerous, it must be hidden. Your task is to show that you are anxious, it is normal to worry sometimes, but you cope with it, the psychologist believes.

Remind yourself that anxiety is distorting your thoughts now. For example, if you think “What if something goes wrong ?!”, reformulate: “I have thoughts that something might go wrong. These thoughts are caused by my anxiety.”

If you feel that you are focusing a lot on the child’s condition (getting into tunnel perception), try to switch your attention to something else, do something that normally helps you cope with stress (this can be a walk, an activity sports, meeting with a friend: you can leave the hospital). Maybe this is not easy because of the thoughts that you are a bad mother or a bad father and instead of caring for a child, you are trying to distract yourself. But what will help to cope with this is the realization that in this way you will do better not only for yourself, but also for the child, because you will be able to support him better. After all, when you switch to another topic, it will be easier for you to see later some other options for solving the problem that were invisible.

Communication with other people also helps to switch for a while, Pavlova continues. You need a person who can listen to you, support you, accept your emotions and not try to change them. If there is no such person nearby, you can call the children’s helpline, where parents are also consulted on issues related to children.

In emergency situations (when the child is in intensive care or suddenly taken to the hospital), Pavlova advises to relieve acute anxiety with the help of several practices. The first is breathing techniques. Square breathing (inhale for four counts, hold for four, exhale for four, hold for four) or diaphragmatic belly breathing when exhalation is longer than inhalation.

You can also do the Five, Four, Three, Two, One exercise when you turn your attention to the senses. You can find five objects of the same color, four sounds, three physical sensations, two smells and one taste. This helps to return to reality and deal with your emotions more easily.

Natasha Kondrashova

Together we can: issues of joint stay of parents with children in intensive care units

“Joint stay of parents with children in intensive care units and intensive care”.

Problems relating to ensuring the right of a child to remain with his parents, even if he ends up in hospital, exist to varying degrees in all countries of the world. Often they are associated with certain cultural, economic and other features of a particular country, but the essence, as a rule, is the same everywhere. This is due to the fact that over a fairly long period of time, which is measured not even in decades, but in centuries, hospitals, in principle, functioned as a closed system.

The prototypes of hospitals are isolation-type institutions, in which people, as a rule, of low social status, who did not have a home and family, relatives and friends, who were ready to take care of them, fell.

In order to protect society, isolate and contain the possibility of transmission and spread of infection, such people were placed in hospitals. At the same time, any contacts with the outside world were interrupted. This practice largely explains the “prohibitive approach” that has dominated the health care system in most countries of the world for many years. Until the 50s of the 20th century, in most countries of the world, relatives of patients could not get into intensive care or other departments. But gradually the situation began to change thanks to the research conducted by scientists. Already in the 50s. publications have appeared about the psychological trauma that a child receives when he is separated from his parents.

The authors of the studies have shown that the negative consequences of such a separation are numerous, up to a delay in cognitive development. The term “hospitalism syndrome” is introduced, and researchers draw attention to the fact that when a child is separated in a hospital, harm is caused not only to the child himself, but also to his relationship with his parents.

The child feels that at an extremely difficult moment in his life, his parents, the closest people, abandoned him, betrayed him. This is detrimental to building the trusting and secure family relationships that a child needs to grow and develop to their full potential.

Thanks to research and public discussion, by the 80s-90s. In the 20th century, developed Western countries recognized the problem and dealt with it. The joint stay of children with their parents in the hospital has become a widespread practice. At the same time, in most of these countries there are no special legislative norms that would regulate the right of relatives to be with their loved ones in the hospital, including in the intensive care unit. This issue is resolved by the officially expressed position of the professional community.

Examples of such communities: British Society for Pediatric Intensive Care, American Academy of Pediatrics, Italian Bioethics Committee, etc. If such an organization declares that parents should be able to be with their children in intensive care, then such a statement works as a rule of law. The authority of professional medical communities is very high, and a single doctor will not go against the opinion of the association to which he belongs – these are huge professional, reputational risks and negative consequences. We are still only at the beginning of the path of forming strong professional medical communities that would be engaged not only in conducting scientific research, providing methodological support, etc., but also setting the standards for organizational approaches in healthcare. In our country, the issue of joint stay of children and parents in the hospital is decided by law.

There are two main documents regulating this issue: the Convention on the Rights of the Child and the Federal Law “On the Basics of Protecting the Health of Citizens in the Russian Federation” dated November 21, 2011 N 323-FZ. The Convention on the Rights of the Child was adopted in 1989 by a resolution of the UN General Assembly and ratified by the Russian Federation. Ratification of this international document means that its norms are an integral part of the legal system of our country and are binding. Art. 9 of the Convention clearly states that the child has the right not to be separated from his parents. The only exception to this rule is the separation of a child from parents based on a court decision in the interests of the child.

The rule on the right of parents or legal representatives to stay together with a child in a medical organization in Russian legislation appeared in 2011. It is worded thus:

“One of the parents, another family member or other legal representative is granted the right to free joint stay with the child in a medical organization in a hospital during the entire period of treatment, regardless of the age of the child” (part 3 of article 51 of the Federal Law “On the fundamentals of the health of citizens In Russian federation”).

Here it is necessary to specify one point: in this article, the legislator uses the term “child”, while Russian legislation unequivocally defines a child as a person under the age of 18 years. It is important to record this, because in 2019 the law was amended, which can cause confusion and even manipulation by the administration of medical institutions. The fact is that the amendments made to the law, on the one hand, were caused by good intentions – to clarify that the right to stay together applies to all structural units, including those that conduct intensive care and resuscitation; on the other hand, they caused discrepancies in the interpretation of the norms of the law and, accordingly, problems in its application.

Amendment to the law (clause 15, part 1, article 79) reads as follows: “a medical organization is obliged … to provide an opportunity for relatives and other family members or legal representatives of a patient to visit him in a medical organization, including in its structural unit intended for carrying out intensive care and resuscitation measures…” Thus, Art. 51 speaks of free joint finding with a child, and Art. 79 – about the possibility of visits to patients.

It is logical to assume that in the case of a child, that is, a person under 18 years of age, parents have the right to stay with the child at the department at all times, and if it is a person of 18 years of age and older, to visit him, guided by Order of the Ministry of Health of Russia dated August 19, 2020 N 869n “On approval of the general requirements for organizing visits to the patient by relatives and other family members or legal representatives of the patient in a medical organization, including in its structural divisions intended for intensive care and resuscitation, when providing him medical care in a hospital. If you are discussing with the administration of a medical institution the possibility of being next to your own child, including in the ICU, refer to the correct norm, namely part 3 of Art. 51 of the Federal Law “On the fundamentals of the health of citizens in the Russian Federation”. It is she who is directly related to what concerns the stay of children in the hospital. And neither the amendments made, nor the general requirements for organizing visits adopted by the Ministry of Health, cancel the right of parents to stay together with their child in the hospital.

The process of “opening” hospitals and intensive care units is long and difficult. This is due to many factors, and the main one, as already mentioned, is traditional prohibitions, attitudes that have been formed and worked in the healthcare system for a very long time. But this system is developing, albeit slowly, towards the predominance of a family-oriented approach.

This approach is based on the postulate that the relatives, parents, relatives of the patient are perceived as members of the team, allies, and not as some outsiders who interfere with work. They are included in the care of the child in intensive care units and intensive care units, they have their own specific functions. This forms a partnership between the medical staff and the patient’s family members. People who are involved in the child’s illness, whose lives it has a huge impact, must necessarily participate in the treatment process, creating the so-called “protective capsule” for the child.

Only then will the help given to him be effective. There is a rather serious list of studies (among them, unfortunately, there is not a single Russian one yet) proving the positive therapeutic effects of the presence of parents in intensive care units. Children recover faster, feel better, the symptoms of the disease stop faster, the length of their stay in the hospital is reduced, which ultimately saves the financial and human resources of the healthcare system.

For children who need palliative care, the presence of parents in hospitals, in the ICU is an absolute necessity. And for their parents, such presence, among other things, is a unique opportunity to learn everything that will need to be done when the child is transferred home (for example, providing mechanical ventilation at home).

Very serious changes have taken place in the Russian healthcare system over the past few years, and it can be said that there is no longer open opposition to the practice of joint stay of children and parents in the ICU. Discussions and discussions continue, but they have changed their tone and become more constructive: now the agenda is not about how to keep parents out, but how to let them in and at the same time respect the interests of both departments, and patients, and their families.

The professional community represented by the Russian Association of Pediatric Anesthesiologists and Resuscitators unequivocally declares its position, supporting the right of the child to stay with their parents. In many children’s medical institutions, the practice of cohabitation is being introduced to varying degrees of scale. Thus, we are inevitably moving towards the introduction of a family-oriented approach to healthcare, when the family becomes a full participant in the process of treating and caring for a sick child and a sick person in general.

The role of parents, relatives, close patients in the speed of progress along this path is enormous. This process is possible when there is movement on both sides, and it requires patience, cooperation, and not conflicts and mutual accusations. Open resuscitation requires open communication.

Unfortunately, the level of interaction leaves much to be desired on both sides. Medical workers in such a situation should have the skills to communicate with people who are under stress, in a serious critical situation, know how to talk about a serious illness, possible death, about all the problems associated with the critical situation of a child, while not injuring parents and being able to support them.

Many foreign medical universities teach this, they have courses on clinical interaction with the patient. In our country, more than 70% of the complaints that the healthcare system receives from patients and their families are related precisely to the inability to communicate and interact. And here the parents, relatives of the patient, despite all the emotions, must understand that one cannot oppose oneself to the medical staff, take the position of “we and you”. While the child is in the hospital, in intensive care, both doctors and parents have one task – to save the child, cure him, put him on his feet. Parents and doctors are not opposing sides, but allies. And it is necessary to act, that is, to cooperate, on the basis of this message.

Behavior while in the intensive care unit

Despite the legislative consolidation of the possibility of joint stay of the child and parents in the hospital, including in the ICU, admission to the department in different institutions is organized differently, there is no single policy on this issue, and much depends on the subjective position of each individual head of the department. As mentioned above, the discrepancy in the wording of Art. 51 and Art. 79The Federal Law “On the Basics of Protecting the Health of Citizens in the Russian Federation” and the general requirements for organizing visits adopted by the Ministry of Health allow institutions to organize admission at their own discretion, establishing a format that is more convenient for staff than for parents / relatives.

Now almost no intensive care unit has a categorical ban on visits, but the time for visits can be very different: from half an hour to a round-the-clock stay. At the same time, in practice, there are extremely rare cases when people are ready to be next to their child in intensive care 24 hours a day. But the opportunity to be with the child at a convenient time for parents during the day should be created.

What should parents do if they are not allowed into the department? First, try to remove emotions and understand that arranging a conflict with the doctor broadcasting this decision is unproductive, especially if this is the child’s doctor. The decision was made at the level of administration – the head of the department or the head physician. It is to them that you need to turn.

If the head of the department also refuses access, you need to write an application addressed to the head physician and ask him to either allow you access to the child, or give a written refusal indicating the reason. The application should be written in two copies, one of which should be marked in the head physician’s office indicating that the appeal has been accepted for consideration. If you receive a refusal, then you need to appeal it to a higher authority – a regional ministry or department of health.

At the same time, you can contact the Ministry of Health of the Russian Federation (via the website or the hotline in your region). There is also a special oversight agency in the field of healthcare – Roszdravnadzor (you can also contact through the website, hotline 8 800 550 9903). Finally, there is the territorial Compulsory Medical Insurance Fund and the prosecutor’s office. The main thing at the same time is to remember that the resuscitation staff do the maximum that can be done in a particular situation, they save the child, and you have a common goal.

It is necessary to communicate with representatives of a medical institution as calmly, rationally and convincingly as possible, without initially getting into an accusatory position. Be prepared for the fact that in most of our hospitals full-fledged conditions for the permanent stay of parents have not been created. In some institutions, earlier, in pre-Covid times, they used this tactic: during the day, the parent was with the child in the ICU, and spent the night in another department. But now this practice is rather problematic.

Department behavior

If possible, you should prepare in advance for the fact that you will not end up in a regular hospital department, but in a place where resuscitation is carried out. Your child may be in a coma, unconscious, and will not respond to your presence. In this situation, you need to gather all your will into a fist and control your emotions, all the time keeping in mind why you ended up in the department – to help the child. And the only way to do this is to remain calm. There is an internal connection between parents and the child, and even if the child is unconscious, he reads your state.

Questions for staff. Each of the employees of the intensive care unit has their own areas of responsibility, their own functionality. Information about your child is provided to you by the attending physician. The doctor on duty can answer some questions, but not so thoroughly and in detail. The nurse does not have the right to talk about the intricacies of the diagnosis, prognosis, etc., this is information that only the attending physician can give. Therefore, it is better to immediately understand who, when and what you can ask, so as not to waste time and effort, both your own and the medical staff. It is very important to evaluate the time and situation, because employees do not always have the opportunity to answer your urgent questions on the go. In this case, it is better to agree in advance on what time it will be convenient for the doctor or nurse to talk to you, and thereby remove the communication problem.

Privacy. Remember that you are not the only parents or relatives on the ward. Unfortunately, most pediatric intensive care units are not yet ready to offer the possibility of isolated patients. At the same time, all patients need personal space and confidentiality, try to respect them. You should not take photos of the department, staff, patients and their relatives and, moreover, post them on social networks – this violates the law (Article 152.1 of the Civil Code of the Russian Federation).

Use of mobile phones. In some departments, the use of mobile phones is prohibited. In general, this is a normal position, taking into account the respect for the confidentiality and personal space of other patients. In addition, parents should be fully involved in the process associated with the child, without being distracted by social networks and Internet surfing. And if there is a need to talk to someone on the phone or convey some information, you can always go outside the ICU and do it.

Compliance with sanitary standards. As practice and studies show, in intensive care units with open access, there is a decrease in nosocomial infection. But this does not negate certain rules that must be observed when visiting the ICU: clothes must be clean, without lint; hair must be pulled back; use disposable gowns, shoe covers and regularly clean your hands with a disinfectant solution (this should become a higher habit, worked out to automatism). If you have symptoms of SARS or any other disease, refrain from visiting your child: at this moment you are a danger not only to him, but also to other patients.

Compliance with safety regulations. This is a very important issue, which often creates in practice many problems in the implementation of access to the ICU. Please remember, this is a matter of your child’s life and safety: everything you do in the department must be coordinated with the attending physician! It is not necessary to feed and water a child, give him medicines brought from home, and even more so folk remedies – all this can bring not good, but harm, or even lead to tragic consequences.

The role of parents in the intensive care unit. The main attitude with which parents come to the child is to help him. Do not put a check mark on the visit, do not give free rein to your emotions and feelings, but help actively. How can this be done? First, remember that your presence, your attitude, contact, the feeling of your closeness helps the child. You can talk to your child, even if he does not react to your presence, sing songs to him, read your favorite fairy tales. With the permission of the doctor, you can hold the child’s hand. As far as possible, you can participate in the care of the child: turn the child over, change his diaper, perform hygiene procedures. The staff will be able to show you how to do it right, and your new baby care skills will come in handy at home. Use the time spent in the ICU to learn all the things that will be essential when the child is at home, such as providing a ventilator at home. Active participation is the best way to minimize anxiety and stress, to switch them into real help. Assume that in the process of caring for a child, a mother always has a certain function that she must perform, but this function just changes depending on the situation.

Presence of parents during resuscitation. According to surveys conducted among parents, most of them expressed their willingness to be present during resuscitation of the child. In practice, this is a rather controversial issue, since these are activities, for example, invasive manipulations, which are still not intended for a non-professional look. An unprepared person may react inadequately, and then, instead of resuscitating the child, help will have to be provided to his mother. Such cases, alas, happened. This distracts the medical staff from their main task – saving the child. Therefore, if you are suddenly asked to leave during any manipulation, it is better to do so. You will not help your child in this situation, but at least you will not interfere by distracting the staff.

Interaction. Everything that happens while the child is in intensive care should be aimed at one goal – the speedy recovery of the child. Therefore, in matters of communication with staff, your task is cooperation. You need, it is simply vital to build a constructive, normal relationship. Despite the horror of the situation, your emotions, fears, stress, anxiety – they will have to be left outside the intensive care unit, you will express them at home. And in the hospital, clenching your will into a fist, still cooperate, based on the fact that you and the medical staff are allies in the fight for the life and health of the child.

Self-preservation. Remember that a child needs an active, healthy and relatively calm mother who will provide him with comfort and a sense of security both in the hospital and then at home. Therefore, the so-called excessive heroism, the willingness to be on duty 24 hours a day, while not sleeping, not eating or drinking, only leads to the depletion of mother’s resources. This means that at some point she will be unable to help her child, and all her heroic efforts will be useless. Take care of yourself, remember that your resources are not endless and require careful treatment and replenishment. In order to keep your baby afloat, you need strength, so you have to eat, sleep and rest.

Circle of relatives who may be present in the ICU. If we turn to the text of the law and interpret it literally, we will see that one of the parents, another family member or another legal representative can be with the child. At the same time, relatives and other family members or legal representatives of the patient can visit the child. The Family Code of the Russian Federation (Articles 2, 14) among relatives lists: children and parents, grandchildren and grandfathers and grandmothers, full and half brothers and sisters; and among family members – spouses, parents and children. In practice, the situation varies greatly depending on the rules adopted in a particular medical institution. In some institutions, the circle of relatives and family members is determined in accordance with the above-mentioned norms of the Family Code, while in others this circle is expanded, and may include, for example, aunt and uncle, etc. As for the visit of the child by his underage brothers and sisters, now it is possible, since in the new edition of 19August 2020 of the “General requirements for the organization of visits to the patient by relatives and other family members or legal representatives of the patient in a medical organization, including its structural units, intended for intensive care and resuscitation, when providing him with medical care in a hospital” earlier the existing ban on visiting the ICU by children under 14 years of age has been lifted. The same General Requirements establish that no more than two visitors of one patient can be in the ward at the same time. Usually, when a child is admitted, the parents themselves determine the list of relatives and friends who, with their consent, can come to the child. Foreign experience in such a situation is as follows: all those who can visit the child are divided into two categories: “family members” and “visitors”. For people who are included in the first category (a specific list is being compiled), access to the ICU is open 24 hours a day; for visitors (this category may include friends, acquaintances, classmates, etc.) visit times are allocated. In our country, there is no such differentiation yet, but it is quite possible that it will appear in the future.

Rules. The Ministry of Health has obliged each medical organization to post information about the rules for organizing patient visits, including information about the requirements established by sanitary rules, on its website and in public places within the organization itself. Read them carefully, this will help you properly build interaction with the staff and avoid unnecessary questions. The more information you get about how to behave in a given ICU, the easier it will be for you to navigate and stay calm in an already difficult situation. And, ultimately, the more effective your help to the child will be.

Visit during the coronavirus epidemic. Unfortunately, the Ministry of Health in the General requirements for the organization of visits spoke unequivocally on this subject: “visits are not made to patients who are in infectious disease wards and infectious disease wards, as well as during the introduction of restrictive measures (quarantine) in a medical organization (its structural unit) “However, in practice, it is possible to organize a joint stay of a child with one of the parents, if, firstly, the ICU itself is not a red zone; secondly, it is clear that the child will be in the department for a long time; thirdly, the parent will enter the department if there is a negative result of the PCR test and the entire period of the child’s stay in intensive care will not leave the department.

Useful materials

Memo for family members on joint stay with the child in the ICU. This is a document developed by the Children’s Palliative Charitable Foundation together with the Association of Pediatric Anesthesiologists and Resuscitators of Russia, Russian National Research Medical University. Pirogov and St. Petersburg State Pediatric Medical University.

Video materials on the topic of open resuscitation and the organization of joint stay of parents with children in the intensive care unit: “The project “Open resuscitation” and the webinar “Organization of the joint stay of children and parents in intensive care units”.

On the website of the Foundation for the Development of Palliative Care “Children’s Palliative” in the section “Library” there is a subsection “Joint stay of parents with children in intensive care units”. It contains all the methodological literature that exists on this topic in our country at the moment. It is available for free, all materials can be downloaded in pdf format. Especially for parents, there are two books that are recommended for reading: “Together with Mom” and “Together it’s not scary.