Solace in the Midst of Childhood Hospitalizations

July 6, 2007— -- As a young physician-in-training, I cared for many children who spent extended periods of time in the hospital, frequently in very intensive situations.

Nikki, for example, was born at 28 weeks' gestation and experienced multiple complications from her prematurity.

To make matters worse, her mother abandoned her shortly after birth.

Nikki spent almost her entire first year of life in the hospital. The nurses became virtual mothers to her: She responded to them as her primary care takers, and they, in turn, had a mother bear's protective instinct to shield Nikki from unnecessary intrusions and procedures -- to shield Nikki from ignorant learners like me.

One nurse eventually adopted Nikki, yet despite the love and attention she received, Nikki endured behavioral and developmental harm that is likely irreparable simply from growing up in the hospital.

The hospital, as you can imagine, is a hard place in which to grow up.

In this week's issue of the Journal of the American Medical Association, Dr. Maryland Pao and colleagues from the National Institute of Mental Health summarize some of the challenges faced by children who spend a significant part of their childhoods in the hospital -- and ways that medical institutions might mitigate some of the detrimental effects.

In a certain respect, growing up in the hospital reflects the wonderful advances of medicine over the past century. Improved childhood survival from erstwhile lethal diseases has increased the number of children who have been saved from conditions ranging from cystic fibrosis to leukemia to congenital malformations.

This has also increased the number of children who experience multiple, prolonged and intensive hospitalizations.

Pao and colleagues cite that, in 2000, approximately 2 million children were hospitalized, accounting for 5 million hospital days each year.

Although essential for the medical care of these chronically ill children, prolonged hospital stays interrupt school, family life, physical and emotional development --