Thuis verder met uw kind,’When you got home’

• Babies up to 1 year old
  Babies are sensitive and are exposed to many impressions during a hospital stay. After being discharged and back home with the parents in their familiar environment, babies may cry more, be hyper-alert, irritable and restless and may find it difficult to sleep, or are restless during their sleep. Crying has the function of releasing the baby's tensions and calming them down. During the first few days, limit as many stimuli as possible, comfort your baby and give them extra attention and warmth, creating a feeling of safety and security. Having a regular routine in the day gives your baby rhythm and predictability. Recognize the signs of being tired and offer your baby rest at those times, which will help him to keep his/her energy and not get overtired. Sometimes they have difficulty with the day and night rhythm. Let the baby sleep in their own bed as much as possible; a light, and soft calm music, can help

1-12 years Difficulty adjusting to the home situation again
During hospitalization, your child may have received more attention from you than usual at home. This was necessary because of their illness, the treatment they received and the different environment. Once at home, your child may have difficulty finding their normal lifestyle and behavioral pattern. This can manifest itself in poor eating, playing and sharing. It is important to use your own rules, structure and habits as soon as you return home. This gives a clear closure to the hospital period and your child knows where it is. The trusted rules provide security. Children want to be in the safe vicinity of their parents/caretakers in this first period after hospitalization. They often express this through being clingy. You offer your child safety by telling them what you are going to do and not leaving them alone for too long, even when you are working elsewhere in the house. For the first few days, keep the visits of others to a minimum, the excitement of being home again is often enough. Stay at home as much as possible during the first days. You can discuss with the doctor when your child can return to playgroup, day care or school. Many children feel the need to start slowly; for your child it can often be nice if you come along for the first time.

Try not to pay too much attention to when your child has less of an appetite. Try to keep the mealtimes pleasant. Offer your child food at the usual mealtimes.

The other children in the family (if any) are likely to require more attention from you because you have been in hospital a lot recently and they have missed you. Try to divide the attention between your sick child and the other children as much as possible. Talk to the other family members about the period in hospital; your 'sick' child will get the feeling that it concerns not only him or her, but also the other children. In time, the old living and family pattern will be picked up again.

Difficulty sleeping
Some children have difficulty sleeping. This may be a result of an insecure feeling that they have experienced during the hospitalization. Your child may be afraid of being alone. Take your time bringing them to bed. You can do this with the help of a ritual. This allows your child to round off the day and to calm down. You can, for instance, think of talking about their day, reading a book, saying goodnight to their cuddly toy or singing a song. If your child is afraid of falling asleep alone, your presence can provide security. You can check more often or, if necessary, stay in the room until your child is asleep. You can say what you expect from your child, such as "go to sleep". Try to wrap up the contact and keep it calm and limited to a distracting chit-chat, and no more games. You can gradually reduce your presence by going from the bedroom to the hallway and eventually a room next to it, it gives a safe feeling when they can still hear you. Sometimes a child is scared and/or restless during the night. Children process many experiences when they are asleep and dream. After a hospitalization, this can manifest itself by repeatedly waking up and having bad dreams. When your child wakes up and calls out to you, it is important to respond and reassure them. Feel free to leave a light on or open the door of the room if you notice that this calms your child. In case of bad dreams, you can let him or her tell you about this or they can draw it. After hospitalization, children often want to sleep in the same bed as their parents. When you start with this, it is often difficult to break this habit later. You may be able to avoid this situation by staying close to your child while they fall asleep in their own bed.

Regression to an earlier developmental phase
Processing costs energy. After discharge, children may temporarily regress to an earlier stage of development. For example, a child who was dry at night can start wetting the bed again. A child who could speak well will use two-word sentences again or a child will suck their thumb again or may want a dummy again. Children display this regression because they derive safety from it. The developmental phase in which the child was before hospitalization now demands a lot from the child. And the child now needs energy to process the hospitalization. An earlier stage of development is familiar and safe. Do not pay any attention to this and reassure your child. Children will automatically develop further.

Processing and behavior
Once at home, children process all the experiences of hospitalization. Sometimes they express this by showing negative behavior, such as hitting, swearing, or arguing. Children do this in a safe situation at home and often take their emotions out on their parents or brother / sister. This is not easy for the other family members. It is important to explain to siblings that this is anger about everything the child has experienced in the hospital. Let your child feel that you understand their anger and explain clearly why this kind of behavior is not acceptable. Offer alternatives such as claying, throwing balls, playing soccer, boxing on a pillow, or playing with wild animals. Children can withdraw more than you are used to from them. You can offer your child opportunities to talk and/or draw about the hospital experiences. This can help your child process their experiences and may give you a better understanding of what is on their mind.

In general, children use play to process what has happened. This can be done as described above by expressing emotions with play material. It can also help children to play with hospital equipment. You can think of a doll and a doctor's case with hospital material, hospital Duplo or Playmobil. They can re-examine the materials or re-enact situations in their own time and at their own pace. In this play situation, your child has the control and direction to be able to express their experiences and emotions. This can help your child to regain control and can lead to a reduction in any possible behavioral change.

Children themselves determine the moment to play out or discuss experiences. They also determine the frequency and the manner in which they do so. You can provide the right conditions: in addition to play material within easy reach of the child, attentiveness and a quiet environment provide an opportunity to process through play.
In addition, you can make a memory book, or read a book about the hospital, together with your child. As a result, you can talk to your child about their period in hospital. Hospital materials can also be taken to school to provide explanations to the teacher and class. This may possibly make the step back to school easier. Telling about the child’s hospitalization contributes to this processing.

From 13 years old
From this age onwards, children usually have a better understanding of what to expect if they are admitted to hospital. Yet after their discharge from hospital, it is possible that you will see a drastic change in their behavior.
This could manifest itself in quiet and withdrawn behavior and reacting defensively in contact with someone. In response to their renewed dependence on adults once again, they can be rebellious, angry, and obnoxious. Adolescents can also regress in their development, and can become more dependent on their parents.
As a parent/educator, it is important to show understanding, but also to ensure that normal life is restored through the reaffirming of old rules and the structure of the family. Your child may feel insecure about their body. Try to discuss this with them. Adolescents may also benefit from writing down something about their hospital admission and / or talking about it with friends /classmates.

If you are worried or if the following issues are still present after 6 weeks (or sooner if you need support), you can ask for help:

• Your child has trouble eating and/or sleeping
• Your child is very affectionate/ clingy or weepy
• Your child is not able to return to the daily routine
• Your child is anxious or worried

You can do this at the outpatient clinic when you are there, or contact the child life specialists: 071- 5263864 (Monday to Friday)

Pedagogischezorgwakz@lumc.nl