When a child is admitted to the hospital, pediatricians have the same concerns that families have: make sure the child stays safe, comfortable, and as emotionally secure as possible.

In my childcare book The Portable Pediatrician, I talk about the emotional meaning of hospitalization for children of each age group from Birth to Five. (It’s in the “What If” section of each age-based chapter, along with such challenges as parental divorce, death of a pet, arrival of a new sibling, and so on.) While I still stand by that advice, there have been three big changes since then when it comes to keeping children as safe and as comfortable as possible:

1. A national shortage of nurses, including pediatric nurses, may require parents to step up their own role as caretaker to a greater degree one would ever have expected.

2. Physician care in the hospital is more likely to be directed by a “Hospitalist,” a doctor employed specifically to care for hospitalized children. Primary care physicians are fading from the picture, and sometimes parents need to be the link among three physician groups: primary care doctor, hospitalists, and specialists (in such fields as infectious disease, neurology, cardiology.) This is especially crucial if physicians disagree, and also at the time of discharge, when follow-up instructions can be crucial.

3. Over the last few years, the study called MRI has become much more available and more casually used. At the same time, there are no governmental regulations or oversight to make sure that safety is maintained. An ordinary thoughtless action, such as bringing an IV pole into the MRI suite, can cause disaster, even death; parents need to be present and watchful to help prevent such accidents.

My book What You Don’t Know Can Kill You, discusses in detail the implications of all of these changes, but primarily for adults. Parents of hospitalized children need a different take on these matters. I hope that reading these, even casually, before a planned or unplanned hospitalization, will tell you what to prepare for.

So here is my advice for parents on each of these topics, starting with the Nursing Shortage.

Nurses: Missing in Action

We are in the midst of a critical nursing shortage. Nurses are “aging out” -- half are 45 and older. So there are fewer and fewer of them, which means that they have to work longer and harder, making it tough to recruit new nurses. And even if there were lots of candidates, there is a corresponding shortage of nurses qualified to teach them.

This shortage, with its avalanche of increased demands, is particularly hard on Pediatric Nurses, who went into the profession in the first place because they really like children, and who now rarely may get a chance to interact with anything that isn’t sounding an alarm.

The bottom line here is that when you assume a nurse is going to be there, for whatever situation, there just may not be a nurse available. You, the parent/grandparent/other loving adult, must step in. To do so, you need to be familiar with the contents of the child’s room, the ward the room is in, and solutions to common and to crisis situations.

Most especially, you need to bond with the nursing and helping staff, making yourself useful without being intrusive. If something needs to be cleaned up, or fetched, or changed, see if it is possible to do it yourself -- ask a staff member if you’re not sure. If you think there is a problem, present it as your concern, not as a foregone conclusion that the staff person has erred. Once you have a reputation for being positive, helpful, and reliable, the staff will be even more responsive to your requests.