By Elizabeth Gore
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6. Preseparation experience of illness/separation. Arrangements for 'humanising' children's wards have been implemented in most hospitals. Daily and often unrestricted visiting, allowing the parents of young children to help with procedures and feeding, to be present at bedtimes, all help, as do increased stimulation, the provision of playthings (and play therapists), and allowing children home for weekends. However, it is not so much what is done, but how it is done; mothers need to feel welcome and useful on the wards.
They create a kind of life style, but one which may modify or even change as the child grows older. Anna Freud looks upon them as healthy developments which have greater flexibility than the defence mechanisms which may become rigidly fixed, and she considers that they help rather than hinder the development of ego strengths. 5. Object relations and ambivalence These are a part of distancing and individuation, of accepting first the mother, then the father, then 'important others' as capable of satisfying and frustrating, loving and hating, and of the child's ability to accept his own feelings of love and hate.
Factors likely to reduce stress. 1. Familiar substitute caretaker 2. Known foods and routines. 3. Toilet demands unaltered. 4. Own belongings. 5. Unrestricted body movement. 6. Familiar environment. 7. Reassurance of eventual reunion. 8. Keeping apart fantasy and fact ('My Mummy doesn't love me'). 9. Reminding child of parental disciplines. 10. Support from father. 11. Willingness of caretakers to talk about parents and previous life. C. Child's psychological status which may increase or reduce overt distress during separation, may increase or decrease the overt upset after separation, may increase or decrease the long-term effects.