Childhood is a journey of new experiences, some good, others not so good. Children cannot be viewed simply as small adults – they have special and changing needs, making varying demands at different stages of their life. Therefore, mere consideration of their age and developmental level is not sufficient in recognising these unique diverse needs. Ill health can be regarded as undesirable and yet also allows the child to develop a coping strategy for being ill. Respect of how a child’s life experiences affect his or her ability to cope with illness, and indeed how these experiences ultimately affect the child’s future development requires consideration. The experienced illness and the actual event of ‘being ill’ should be viewed as part of a learning process – the illness can be adapted, fought, accepted or rejected (Douglas 1993). The development of psychological coping mechanisms complements the evidence that illness enhances the maturing immune system to help manage further episodes of ill health (Hall & Elliman 2003).

The child’s family, notably the parents, are usually the first to recognise illness and to act on the changing verbal and observational cues gained from knowing their child so well. It is important to remember that the majority of sick children will not require hospitalisation, or even a visit to their own GP, but will be managed by a range of skills and advice gained from previous experience and from others. Recognition of the potential difficulties and coping mechanisms utilised by healthy families and their children requires consideration. The child and family often regard admission to hospital as a serious consequence of ill health, therefore setting the scene for the child and family to be apprehensive, fearful and anxious. Hospitalisation has long been recognised as being a potentially stressful time for children and families alike (Darbyshire 1994). Health professionals on the admitting ward may well consider the child’s illness to be relatively ‘minor’ in terms of morbidity and sometimes fail to anticipate or recognise the family’s overwhelming concern. Unfamiliarity with both the situation and the organisational boundaries – the need for compliance, disruption to the family unit and the overall impact these variables have on the family – must be considered throughout.

This chapter seeks to investigate the decision process that leads to a child being admitted to hospital and looks at how the child and family might react in this situation. It will consider both planned and unplanned hospital admissions and consider the socialisation process associated with ill health.

Perhaps the most useful activity to set the scene for this chapter is to establish how sick children are managed by the family and by the health services. This will provide an understanding of ill-health episodes families experience with their children and also the ratio of primary and secondary care episodes. What will be more difficult to extract is how many children become ill and yet do not see a GP or are referred to the hospital. It will also be useful to see if there are any trends in age groups of children being referred to the GP or hospital:

It is suggested there are three inter-related and overlapping arenas in which health care takes place – the ‘popular’ sector (or family wisdom), the ‘folklore’ sector (involving cultural and personal beliefs about health care) and the ‘professional’ sector (Kleinman 1980). It is important for the children’s nurse to understand and recognise the importance of these care arenas, as families will usually arrive in the hospital setting with a range of knowledge and interventions taken from the first two sectors that can assist, support and direct the nurse during the admission and planning process. Families are integral to the care and support of their children therefore the impact of any health care intervention must be considered within this context. An understanding of the theories seeking to explain how families cope and interact under stress is essential and several theories have been postulated and subsequently applied to children’s nursing (Crawford 2002).

Immunisation is the use of a vaccine to protect against a specific disease. Vaccines act on preventing disease in one of three specific ways:

Vaccines also contain substances to enable them to work effectively (DoH 2002).

The fundamental aim of an effective immunisation programme is to reduce the incidence (i.e. the number of people acquiring the disease in the population as a whole) of a specific disease, with the ultimate aim of eradication where possible. It is important, however, to remember that some diseases will never be eradicated either because there is a ‘carrier’ population (i.e. people who are able to carry a disease but who themselves remain unaffected) or because of the specific mode of transfer/activity (e.g. tetanus is carried in the soil spores). Indeed, despite improvements in hygiene, nutrition, health care and public immunisation programmes, some diseases continue to cause serious complications and fatalities (DoH 2002). Equally, there are dramatic success stories: before the introduction of the measles vaccination in 1988 an average 250,000 cases/year were noted, resulting in 85 deaths. By 1999, a significant reduction to 2438 cases/year, with two deaths, was evident (DoH 2002).

There is a well established, although regularly challenged, functionalist theory on how society might expect someone to behave when ‘sick’ in order to protect the individual and society (Bury 1997). This theory was originally described by Talcott Parson in 1951, and was used by many health practitioners and employers at that time to determine whether the individual was ‘sick’ or ‘ill’ (Parson 1951). Medical support and employment support would then be offered according to this analysis.