By Dr Wicus Grové — Emergency Medicine
Protecting Childhood Wonder in the Emergency Department
A child does not enter an emergency department the way an adult does.
Adults arrive carrying diagnoses, responsibilities, and fears we know how to explain. Children arrive with imagination. The fluorescent lights become alien suns. The monitor alarms become warning sirens. A blood pressure cuff can feel like a snake tightening around the arm. A masked stranger leaning over the bed may seem less like a doctor and more like a giant from a storybook.
To adults, the emergency department is medicine.
To children, it can feel like magic and monsters at the same time.
And that matters far more than we sometimes realize.
Healthcare workers across the world increasingly recognize that a child’s emotional experience during medical care can shape future trust in healthcare, emotional wellbeing, and even how they respond to illness later in life. A frightening hospital encounter may become a child’s first experience of helplessness, pain, or loss of control.
But the opposite is also true.
A compassionate emergency department experience can teach a child that even in moments of fear, there are calm voices, safe people, and kindness waiting beside them.
“Children are not things to be molded, but are people to be unfolded.”
— Jess Lair
Children experience fear differently at different ages. Infants are highly sensitive to unfamiliar sounds, separation from caregivers, and painful procedures. Toddlers fear loss of control and separation from parents. Younger children may believe illness or procedures are punishment. School-aged children fear pain and bodily harm, while adolescents often struggle with privacy, dignity, and independence.
What adults sometimes call “difficult behaviour” is often fear translated into the only language children know.
The screaming toddler refusing oxygen.
The child hiding behind a parent.
The teenager becoming angry and withdrawn.
These are not simply behavioural problems. They are emotional survival responses.
The challenge is that emergency departments are not naturally child-friendly places. They are loud, crowded, rushed, and emotionally intense. In South Africa especially, overcrowding and resource limitations often make calm environments difficult to create.
Yet small human actions can dramatically change a child’s experience.
A doctor kneeling instead of standing over the bed.
A nurse explaining a procedure through play.
A warm blanket.
A choice between a red plaster or a blue one.
A parent allowed to remain nearby during procedures.
To adults, these moments seem small. To children, they can transform an entire world.
“Too often we underestimate the power of a touch, a smile, a kind word.”
— Leo Buscaglia
Research consistently shows that reducing anxiety improves medical outcomes. Children who feel safer cooperate better during examinations and procedures. Pain perception decreases when anxiety decreases. Parents also become calmer — and calm parents often help calm children.
Communication plays a major role. Honest, age-appropriate explanations reduce fear significantly. Telling a child, “This won’t hurt,” before an injection may destroy trust within seconds. Saying instead, “It may feel sore for a moment, but I’ll help you through it,” preserves honesty and safety.
Children remember honesty.
They also remember whether adults listened.
Distraction and play are equally powerful tools. Bubbles, cartoons, storytelling, music, toys, or simple imagination can redirect attention away from fear. Play is not merely entertainment in paediatric medicine — it is emotional protection.
A stethoscope can become a “superhero listener.”
An oxygen mask can become dragon air.
A CT scanner can become a spaceship.
Children already live partly in worlds of wonder. Healthcare workers who enter that world respectfully often discover that fear loses some of its power there.
“There should be in every child’s life a few places of enchantment.”
— Phaedrus
The long-term consequences of traumatic healthcare experiences are often underestimated. Frightening hospital visits can contribute to needle phobia, avoidance of healthcare, distrust of medical professionals, and anxiety during future procedures.
Adolescents are particularly vulnerable to silent emotional trauma. Unlike younger children, they may not cry openly. Anxiety may instead appear as withdrawal, irritability, or refusal to engage. Respecting dignity and privacy becomes essential.
Even infants, though they may not consciously remember procedures, can still develop altered stress responses from repeated painful experiences. Pain control in infancy is therefore not simply compassion — it is neurologically important care.
Modern paediatric emergency medicine increasingly embraces trauma-informed care. This approach asks not only, “What illness does this child have?” but also, “What is this child experiencing emotionally?”
Fear changes physiology.
Fear changes cooperation.
Fear can outlast illness itself.
For healthcare workers, this requires emotional energy in already overburdened systems. Yet children remain remarkably sensitive to tone and behaviour. They notice rushed voices, frustration, and tension instantly.
This does not mean healthcare workers must become performers. What matters most is calmness, honesty, gentleness, and presence.
Sometimes the greatest intervention is not medication.
Sometimes it is sitting beside the bed for thirty extra seconds.
“Courage does not always roar. Sometimes courage is the quiet voice at the end of the day saying, ‘I will try again tomorrow.’”
— Mary Anne Radmacher
Childhood forms the emotional architecture of adulthood. The child comforted during crisis may become the adult who trusts healthcare systems enough to seek help early. The child treated with dignity may later teach emotional resilience to others.
Emergency departments therefore influence more than immediate emergencies. They shape future relationships with medicine itself.
Children still believe strangers can become heroes.
They still believe kindness changes endings.
Perhaps we should work harder not to prove them wrong.
“Every child you encounter is a divine appointment.”
— Wess Stafford
A child may forget the diagnosis. They may forget the doctor’s name. But they rarely forget how the hospital made them feel.
And sometimes, preserving a child’s sense of safety, wonder, and dignity is every bit as important as treating the illness itself.