Learning Objective #1: Identify at least three different child responses to an unanticipated childhood PICU hospitalization

Learning Objective #2: Identify gender differences in child emotional and behavioral responses following an unanticipated PICU hospitalization

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Toddler and pre-school children have been identified as being at risk for post-hospital behavioral sequelae, especially when confronted with an unanticipated intensive care unit hospitalization. Given the host of possible negative outcomes and the shortened nature of current child hospitalizations, it is important to identify which children may be at highest risk for post-hospital maladaptation to ensure proper and early identification and appropriate monitoring following the hospitalization. The purpose of this study was to determine predictor variables that can be assessed early on during hospitalization which predict later internalizing and externalizing behaviors, and negative behavioral changes of two to seven year old children at three and six months following an unanticipated hospitalization. This was a prospective, predictive secondary data analysis of a larger multi-site, longitudinal clinical trial. Measures of predictor variables included Speilberger's State-Trait Anxiety Inventory and Melnyk's Index of Parental Participation, as well as selected demographic/clinical variables (e.g., maternal age, child gender). Child behavioral outcome measures included the Behavioral Assessment System for Children (BASC) and the Post-Hospital Behavior Questionnaire. The predictive nature of demographic/baseline and early hospital variables on child outcomes following hospitalization was tested in six stepwise, forward regressions. Findings from this study indicate that children's pre-hospital behavioral patterns, maternal anxiety early in the ICU hospitalization period, maternal marital status, maternal involvement in the emotional care of their child, and child gender were significantly predictive of later behaviors. Additionally, gender specific patterns of child behaviors were identified following hospitalization suggesting that gender differences in coping responses exist in very young children. More specifically, children developed levels of behaviors approaching or placing them in ‘at risk' categories at different times following hospitalization that were gender specific. This study has resulted in the identification of contemporary factors that specifically predict maladaptive child coping outcomes following an unanticipated PICU hospitalization.