This page will give you an overview of what typical developments expect in your child, their needs, and how to help them during their hospitalization at different age stages. You may also download this page in PDF Format
I am 0-4 months old
Play:
- I like soft music, singing and rocking.
- I like to play with small rattles and look at mobiles.
- Please talk to me in a low voice.
- I also like to play in front of a mirror.
Social:
- I begin to smile in response to other’s smiles at 6 – 8 weeks old.
- I can show pleasure by making funny noises.
- I love to be rocked and sung to.
- I sleep off and on between feedings, and for about 4 – 6 hours a night.
- You can interact with me by holding me in front of your face, talking about everything you are doing, and moving my arms and legs.
Sleep:
- I need 15-20 hours of sleep per day.
What I can do with my body:
- I can calm myself by sucking.
- I like to use my hands to reach for objects.
- I do not have very good head control, but I’m working on it.
- I like to be rocked.
- Please prop me in your lap so I can see what people are doing.
Concerns I have about being in the hospital:
- I do not like to be separated from my caregiver's.
- I do not get my usual stimulation.
- I am in an unfamiliar setting.
- I am out of my usual routine.
How can you help me while I am in the hospital?
- Please bring my favorite things from home.
- Take me out of my bed when I am awake.
- Let my caregiver be with me as much as possible.
- Provide me with stimulations that I can see, hear, and touch.
- Let me see lots of colors and shapes.
- Think of ways that I can have a routine “play time”.
I am 5 - 10 months old
Play:
- I like to play peek-a-boo.
- I like toys that I can push or pull.
- I love putting everything in my mouth.
- I like large soft toys, rubber rings, blocks and toy keys.
- Banging objects and throwing toys is also fun.
Social:
- I can recognize familiar people and objects.
- I want to explore my environment.
- I can laugh aloud.
- I wiggle around when I get excited.
- I know how to get someone’s attention through crying or making noises.
Sleep:
- I need 14-16 hours of sleep per day.
What I can do with my body:
- When I am young, I like to roll around and work on sitting up.
- As I get older, I may begin to pull up on objects and work on crawling.
- I am learning to pick up small things with my fingers (I like finger foods).
- I can point to show the things I want.
- I like to roll balls on the ground.
Concerns I have about being in the hospital:
- I am afraid of strangers.
- I do not like being separated from my caregiver.
- Please find a comfortable position in which to hold me.
- Do not disturb me when I am sleeping, it will disrupt my routine for the rest of the day.
- I get bored being in my room all the time.
How can you help me while I am in the hospital?
- Please bring my favorite things from home.
- Take me out of my bed to play; I need different stimulation.
- Let my caregiver be with me as much as possible.
- Provide me with stimulations that I can see, hear, and touch.
- Think of ways that I can have a routine “play time”.
- Playing on a floor mat is a great way for me to get stronger and perfect my physical skills.
- Play time is best if it is in a playroom or a place where there is new stimulation.
- During procedures, let me sit comfortably in my caregivers lap.
I am 11 - 15 months old
Play:
- I love peek-a-boo and patty-cake.
- I like toys that I can poke, bang, pull and twist.
- I like to put objects in a container and dump them out.
- I can pretend to care for dolls and animals by feeding and holding them.
- I like stacking blocks, the older I am the more I can stack.
Social:
- I need my caregiver in the room with me so I don’t get scared in strange places.
- I love looking at myself in the mirror.
- I like to imitate adults, especially when they make animals noises.
- I can listen and wiggle my body to music.
- As I get older I can repeat words that I hear.
- Please read me books, this helps me learn common words.
Sleep:
- I need 14-16 hours of sleep per day.
What I can do with my body:
- I will climb on everything.
- I can stand on my own, and am learning to take a few steps.
- I like to use my fingers to pick up small toys.
- I like to pound objects to see how loud I can be.
- I want to be exploring my environment, not stuck in my crib.
Concerns I have about being in the hospital:
- I am afraid of strange people and strange rooms.
- I may try to pull out my tubes.
Development
- I get really frustrated because the medical equipment can hinder my movement.
- I can associate people with pain.
- I need lots of different sights and sounds that can stimulate me.
- I may have more dependent behaviors (I may want to drink from a bottle instead of a cup).
- I may become clingy and whiny when my caregiver is not around.
- My routine may get disrupted, so make sure to create a daily schedule that is similar to what I do at home.
How can you help me while I am in the hospital?
- Give me stimulating activities such as pop-up toys, trucks or dolls that make noise, containers I can put things in and out, and blocks for stacking.
- Talk to me in a calming voice during procedures.
- Let my caregivers help with my care as much as possible.
- Provide a safe place for me to play (playrooms are great, but a mat on the floor is good too).
- Ask me about my favorite toys from home so you can provide similar activities that I normally play with.
I am 16 - 20 months old
Play:
- I like to build block towers and then knock them down.
- When you read to me, I like to point out pictures and turn the pages.
- I like to imitate adults (like pretending to talk on the telephone and taking care of my stuffed animals).
- I like when you hide my toys under or behind objects so I can find them.
- I can scribble with crayons.
- I like toys that I can take apart.
Social:
- I love saying “NO!”, so be careful not to ask me yes or no questions but rather give me options between two things.
- I have a short attention span.
- I can understand simple commands and answer yes or no questions.
- I like for you to hand me things and then let me hand them back to you.
Sleep:
- I need 14-16 hours of sleep per day.
What I can do with my body:
- I am learning to have better balance and coordination.
- I may begin running.
- I can pickup and play with toys from a standing position.
- I can shift crayons and marker from one hand to another.
- I am able to walk backwards.
Concerns I have about being in the hospital:
- I am afraid of strangers and strange places.
- I get very tearful when my caregiver is gone.
- I remember people that cause me pain.
- I do not like being confined to my room, especially if I have to stay in my crib.
- My daily routine is disturbed, so make sure to create a daily schedule that is similar to what I do at home.
- I may respond to nurses and doctors with aggression.
How can you help me while I am in the hospital?
- Provide me gauze so I can wrap up my stuffed animals to look like me.
- Play games with me in my room.
- Let my parents help with my care as much as possible.
- Ask my parents ways that my environment can be as normal as possible.
- Let me help during procedures by playing with the gauze or alcohol wipe.
I am 21 - 24 months old
Play:
- I like to build block towers and then knock them down.
- When you read to me, I like to point out pictures and turn the pages.
- I like to imitate adults (like pretending to talk on the telephone and taking care of my stuffed animals).
- I can scribble with crayons.
- I like toys that I can take apart.
- I like toys that make noise.
- I have favorite toys and dolls.
Social:
- I love saying “NO!”, so be careful not to ask me yes or no questions but rather give me options between two things.
- My vocabulary is increasing every day (I know up to 300 words, and can say 2 word combinations).
- I can show affection by giving hugs and kisses.
- I can understand simple commands and answer yes or no questions.
- I like you to hand me things and then let me hand them back to you.
- I have a strong sense of what is “mine”.
Sleep:
- I need 12-16 hours of sleep per day.
What I can do with my body:
- I can ride tricycles.
- I can jump from low objects.
- I can kick a ball.
- I can drink from a straw.
- I am learning to feed myself with a fork and spoon.
Concerns I have about being in the hospital:
- I am afraid of strangers and strange places.
- I get very tearful when my caregiver is gone.
- I remember people that cause me pain.
- I am not getting enough normal stimulation.
- My daily routine is disturbed, so make sure to create a daily schedule that is similar to what I do at home.
- I may be afraid to explore my environment.
- I may become afraid of the dark.
How can you help me while I am in the hospital?
- Find time for me to have safe play opportunities with new things.
- Play games with me in my room.
- Let my parents help with my care as much as possible.
- Ask my parents ways that my environment can be as normal as possible.
- Let me help during procedures by playing with the gauze or alcohol wipe.
I am 2 - 3 years old
Play:
- Playing helps me master my environment.
- I can match pictures, objects and sounds.
- I use play to learn and work through fears and express myself.
- I like to listen to you talk to me and tell me about what you are doing.
- I love playing with Play-Dough and other squishy textures.
Social:
- I can understand “now”, “soon” and “later”.
- I am able to repeat stories from books.
- I can show jealousy.
- I can use my words to make requests.
- I am gaining a sense of control and confidence in my abilities.
- I have a hard time understanding others point of view and am only concerned with MY thoughts.
Sleep:
- I need 10-14 hours of sleep per day.
What I can do with my body:
- I can put on my clothes but have trouble with zippers and laces.
- I can feed myself with a fork and a spoon.
- I can stand in place and hop on one foot.
- I can sleep 10 hours a night.
Concerns I have about being in the hospital:
- I feel like I am losing control and autonomy.
- I am scared to move with IVs and other medical equipment connected to me.
- I may regress in my abilities (potty training) and act like an infant.
- I have a strong fear of strangers.
How can you help me while I am in the
hospital?
- Tell me what you are doing and what it is going to feel like.
- Allow security objects to accompany me to procedures (ie blankets, stuffed animals, pacifiers or dolls).
- Provide me with opportunities for choice and control (you can ask me if I want cherry or grape flavored medicine).
- Blowing bubbles and singing songs can be helpful during procedures.
- I am improving my self help skills, so encourage me to do things on my own.
I am 3 - 5 years old (preschool)
Play:
- I love coloring and drawing.
- I enjoy imaginative play (i.e. pretending to be a parent or a doctor).
- I love showing off my accomplishments.
- I like cutting paper and finger painting.
- I can build structures that symbolize other things such as animals or buildings.
Social:
- I am beginning to have an understanding of time.
- I have a great imagination, which can lead to misconceptions about the hospital.
- I have difficulty separating make-believe from reality.
- I can separate from my parents for short periods of time.
- I am able to learn rules and obey them.
Sleep:
- I need 10-14 hours of sleep per day.
What I can do with my body:
- I can draw circles and squares.
- I can can feed self, brush teeth, comb hair, wash, dress, hang up clothes with little assistance.
- I can form shapes and objects out of clay or play dough, sometimes human and animal figures.
- I can thread small beads on a string.
Concerns I have about being in the hospital:
- I fear long separations from my loved ones.
- Medical procedures can be seen as a punishment.
- Imagining what a procedure is going to be like can be worse than reality; I NEED to be told the truth.
- I feel a sense of loss of control.
- Unknown events scare me.
How can you help me while I am in the hospital?
- Reinforce that illness is not the child’s fault and treatment is not the child’s punishment.
- Give clear explanations as magical thinking and fear of bodily injury is common.
- Encourage parental participation, verbalization and social interaction and give positive reinforcement.
- Set limits and provide structure.
- Allow child to manipulate and explore medical supplies and their purpose.
- Provide preparation for any procedure or “new” thing they will experience.
- Give them a job during procedures (blowing a pinwheel or looking at a book will help them learn coping strategies).
I am 5-11 years old (school aged)
Activities:
- I enjoy playing board games and video games.
- Being with friends becomes increasingly important.
- Organized and group play creates a sense of security.
- School aged children love to talk about themselves and what they like.
Social:
- I have a strong desire to perform well, do things right.
- I have interest in new skills.
- I want to earn recognition and be successful.
- I am independent and modest.
- I have an increased anxiety of missing school.
- I am learning social cooperation and appropriate behaviors.
- I talk about my feelings.
Sleep:
- I need 8-12 hours of sleep per day (varies by age, younger children need more).
Physical Issues:
- Puberty can be a source of anxiety (girls may begin menstruation).
- Differences between peers can be a source of anxiety and self consciousness.
Concerns I have about being in the hospital:
- Disgrace, loss of competence
- Compromised body image
- Invasions of privacy
- Loss of status in peer group
- Death and disability
- Hesitant to reveal fears
- Loss of body control
- Enforced dependence
How can you help me while I am in the hospital?
- Reinforce that illness is not the the child’s fault and treatment is not the child’s punishment.
- “All about me” posters help the child feel in control and allows staff to know the child’s likes and dislikes.
- Allow choices when possible (give them choice of IV location).
- Provide activities and games in order to make atmosphere more normal.
- Preparation for procedure is important to reduce anxiety associated with the unknown.
- Allow children to explore medical equipment and rehearse upcoming procedures.
I am 13+ years old (adolescent)
Activities:
- I enjoy playing board games and video games.
- Being with friends is extremely important.
- Cell phones and e mail may be an important way to allow patient to keep in touch with friends.
Social:
- I have a strong desire to perform well, do things right.
- I have an interest in new skills.
- I want to earn recognition and be successful.
- I want independence and privacy.
- I have an increased anxiety about missing school.
- I am learning social cooperation.
- I can verbalize feelings.
Sleep:
- I need 8-12 hours of sleep per day (varies by individuals).
Physical Issues:
- Puberty can be a source of embarrassment and frustration.
- Sexual development and body image are on the forefront of their minds; be sure to address how procedures and surgeries may impact this.
- Body image and self-worth can be tormenting issues for both males and females.
Concerns I have about being in the hospital:
- Compromised body image
- Invasions of privacy
- Loss of status in peer group
- Death and disability
- Hesitant to reveal fears
- Forced dependence on medical equipment and nursing staff can be frustrating
- Fear of failure in school
- Teenagers may hide from confusion and lack of understanding.
How can you help me while I am in the hospital?
- Respect individual as separate from parents.
- Altered body image, privacy and peers are paramount.
- Involve teenagers in medical responsibilities and decision-making.
- Peer socialization will benefit patient.
- Preparation will help teenagers learn about and cope with procedures and diagnosis.
This content was provided by Vanderbilt University Medical Center 2008.