Although being admitted to the hospital can be extremely distressing for anybody but when it comes to a child they may be in more distress and along with them parents also experience distress and anxiety [1]. Anxiety levels might rise significantly due to the strange surroundings being away from loved one, and the frequently intrusive and painful medical treatments [2-4].

Recognizing and addressing this concern is crucial for a child’s recovery an overall health. In these situations, the child may stop cooperating and it can be upsetting and challenging for both parents and medical staff [5]. This review article focuses on publishing studies or articles exploring sources, manifestation and consequences of anxiety along with interventions to overcome such distress and anxiety in a hospitalized child.

Sources of Anxiety and Distress in a Hospitalized Child: Child’s developmental level contributes to their experience of hospitalization and their ability to articulate their experiences [6,7]. The child’s developmental level and several other factors contribute to anxiety in a hospitalized child [8]. These factors include:

Separation Anxiety: When a small child is separated from his or her parent or other primary caregiver they suffer greatly. It is observed that children who are hospitalized report more of homesickness [9,10]. Children also recognize separation from family and friends as a significant stressor [5].

An Unfamiliar Hospital Environment: An unfamiliar hospital setting makes this anxiety worse [11]. Some children say that they had trouble adjusting to routine adjustment as well as they had sleep disturbances. Children’s state they struggled with changes in the bedtime routine and other daily routines and they were disturbed by the nurses who monitored their vital signs all night long [12].

Fear of Unknown: A hospitalized child may not understand their own situation. Being constantly surrounded by new equipment, medical professionals’ nurses and going through medical procedures can be frightening for a child. In studies children admitted that did didn’t knew the reason why they were in hospital. Other children spoke about not knowing what to expect from their hospital stay. Stress during hospitalization was consistently exacerbated by feelings of ambiguity and confusion [7].

Pain and Discomfort: Medical treatments that might cause pain and discomfort such as vaccination blood test, injections, and invasive procedures can lead to anticipatory anxiety. Children frequently said that injections and intravenous procedures were most upsetting part of their hospital stay. It is seen that young children recalled earlier needle prick experiences and anxiety associated with anticipating future medical procedures. When there were questions about the most upsetting part of hospitalization, they frequently made remark concerning pain and discomfort including various medical equipment’s [7].

Fear of Changes in Body Image: A child may experience anxiety because of the changes in the body image which may occur due to any procedure surgery or medications. Especially the school ages and adolescence are worried about body image disturbance while preschoolers are seen anxious about intrusive procedures [13].

Various Environmental Factors: The hospital setting is different from home setting there are intense orders of chemicals odd noises bad lights and different setup, different type of beds, sounds of machineries and the fellow patients may be disturbing and distressing for child and family [14].

Pre-Existing Anxiety: Child's response to hospitalization is determined by trait anxiety too. It was observed that more a child's trait anxiety, the perception of hospitalization as a stressful experience will be more and it may also reduce the ability to cope [3,8]. Sometimes children those who had suffered from anxiety problems are more likely to have elevated anxiety while in the hospital [15].

Signs and Symptoms of Anxiety: Hospitalized children may exhibit a variety of symptoms of anxiety [16-18].

Which may include:

• Weeping, Clinging to parents
• Returning to old behaviors example sucking, bed wetting
• Aggression an irritability
• Sleep disturbance
• Changes in appetite
• Physical symptoms like headache stomach ache increase heartbeat etc.
• Avoidance of medical procedures
• Excessive anxiety and fear and
• Difficulty in concentrating

The child may become non-co-operative, show signs of protest, despair or detachment [19].

Consequences of Anxiety in A Child: If the anxiety not managed it may cause the healing process to be delayed. A reluctant child’s perception of pain increases and it can have detrimental long time psychological impact [20]. Researches on Pediatric hospitalization emphasizes how the severe suffering might hinder the execution of a necessary medical procedure and it may also impact the future medical treatments sometimes may include avoidance of hospitalization or medical procedures. If the anxiety is not controlled it may lead to physical and mental ill health. It may lead to long term emotional problems hinder their recovery and increases the incidence of post stress traumatic disorder [7]. Thus, it’s crucial to give anxiety management for hospitalized child.

Strategies for Managing Anxiety: Children can avoid and control their anxiety with the use of effective tactics and management of the factors that contribute to their anxiety. As it is difficult to prevent a child from being admitted to the hospital to avoid anxiety but there are number of strategies to reduce anxiety.

The parents of the child can stay with the child. Prevention and management of anxiety in child can be effectively accomplished by the co-operative efforts of parents’ or guardians and medical professionals. Some measures to manage distress and anxiety are:

Education and Preparation: Explaining the medical procedures in a language which is appropriate according to the child’s age can reduce anxiety [21]. Families may become scared and intimidated by medical jargon; thus, child and family should be prepared using simple and understandable language. Explaining the purpose of the procedure and its benefits reduces anxiety and prevents misconceptions, and this will help to reduce fear by enabling them to anticipate what they will see, smell, hear and feel [21,22].

Cooperative Staff And Effective Communication: Children feel more ease when nurses are friendly, helpful and communicate properly [21,22], Positive hospital experience for children are correlated with clear with child friendly communication [23].

Parental Presence, Preparation and Awareness: Parents spending as much time as possible with their children can offer security and comfort. Higher level of state anxiety in the parent was likewise strongly correlated with parental education. These findings imply that parents with higher levels of education would prioritize performance over comfort, which would increase their kid’s anxiety and cortisol levels when perform in front of others [24].

Social Support: It is seen that the child is benefitted from support of not only parents but also siblings’ other family members and peer group [25,26]. Peer and sibling supports helps in Coping of children is best when the child gets support from primary caregiver before during and after the medical procedure [22]. Distraction technique-To help kids forget about their worry, engage them in their hobbies like playing games, reading, or watching videos or virtual reality [27,28]. Distraction is considered to be more economical when compared with using medication, in terms of cost and safety aspects. Distraction using play, communication or other measures has been found to have a positive impact on children receiving interventions, as well as on the pain scores [29].

Children labeled distractions that made their hospital experience feel more like daily routine or something exciting. Several children expressed that the playroom, teen room, and other arrangements in hospital served as important distractions.

Yoga and Meditation: Meditation, yoga and other complementary therapies have shown effectiveness in controlling anxiety and worry. Research shows effectiveness of yoga therapy in children with cystic fibrosis in reducing anxiety and pain [30]. Therapeutic Play-In a secure and encouraging setting, play therapy can assist kids in expressing their worries and fears [31]. Studies show games like pop it, balloon inflation, board games effectively reduce anxiety levels during inhalation therapy, invasive procedures etc.. [32].

Life Specialist for Children: Today there are qualified experts who can assist children to overcome the psychological difficulties associated with hospitalization [33].

Medication: Extreme anxiety in children may require medical management.

Consistent Routine: Maintenance of consistent routine especially home like routine reduces anxiety in child by giving a sense of normally. The child can be allowed to bring familiar toys which acts as a comfort for the child. This may also include use of own blanket of the animals such things during the preparation of hospitalization will make the child feeling less nervous [4].

Honesty: It is essential to be honest with the child about what to expect from the procedures. It helps in building trust in the child [19].

Environmental Modification: Creating a comfortable and cozy environment which child likes, Parents may bring child’ favorite toy, cup, dishes and also hospital physical environment should be child friendly like colored walls, toys play area etc. Such environment increases child’s sense of happiness [7].

Such strategies help in resilience which in turn reduces negative effects of hospitalization and this may even promote growth. During childhood and adolescence effective coping helps in resilience, well-being of child and also helps to adjust to difficult life situations [34-36].

Hospitalization leads to anxiety in most of children, such effects can affect the growth, physical and emotional development of a child. Effective coping behaviors provide resilience to mitigate the likelihood of adverse consequences and potentially enhance growth. Effective coping promotes adjustment to stressful life events, well-being, competence and resilience during childhood and adolescence. We along with parents should ensure that the causes of distress and anxiety in a hospitalized child should be identified and managed. Therapeutic strategies to promote comfort and reduce anxiety should be part of hospital system and for anxious children early diagnosis and management should be effectively done.

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