The Unseen Journey: Paediatric Hospitalisation, Separation and the Destabilisation of Attachment from the Primary Caregivers Perspective

This chapter breaks through the limitations of the book by expanding its scope in many ways for potential comparative use. It provides a qualitative exploration of the psychological and emotional journey of young children (0–5 years old) and their primary caregivers following a significant period as a hospital inpatient. Whilst medical frameworks have advanced, the psychological consequences of prolonged separation from the ‘base environment’ of home during a child’s critical attachment window remains unexplored. This study, grounded in attachment theory and the historical context separation research aims to address this gap from the primary caregivers’ perspective.

A qualitative methodology was employed, using semi-structured interviews with 18 primary caregivers whose children were admitted to hospital for 2 weeks or more. Thematic analysis of the caregivers’ narratives revealed a consistent and challenging process of post-discharge adaptation. The central theme identified was ‘Returning to the base environment: behavioural and relationship change and attachment’.

Findings indicated that, upon returning home, children presented significant secondary separation effects. These manifested as three sub-themes: a profound fear of leaving the base environment, leading to school refusal and anxiety; a deficit in social development, including difficulty interacting with peers and a persistent need for adult attention; and a destabilisation of the attachment bond, manifesting into either anxious-secure (clinging, dependency and sibling jealousy) or avoidant-insecure (withdrawal, self-soothing) behaviours.

This study concludes that hospital discharge is not the end of the trauma, but the beginning of a complex psychological recovery phase for both the child and their caregiver. It offers validation of the caregivers’ perspective and suggests that separation causes immeasurable harm on the attachment between them and their child. The chapter recommends that paediatric care models be expanded to include mandatory pre-discharge psychological screening, psychoeducational support for families to re-frame these behaviours as trauma response, and a policy shift which treats the child’s emotional and attachment security as a critical component of successful treatment.