Factors influencing the pediatric hospitalization experience: a narrative review with recommendations for improvement

Introduction

Background

Pediatric patients’ first impression of the hospital environment and staff sets the foundation for the rest of their stay (1). Children’s perception during hospitalization has important implications in their outcomes: those with positive experiences report greater treatment adherence, higher quality of service, and reduced pain perception, while those with negative experiences report greater anxiety, impaired ability to cope with medical procedures, and both parental and child stress (2-6). Since hospitalization is overwhelmingly considered a threatening and stressful experience, it is crucial to create environments and patient-physician relationships that prioritize comfort (4,6). This may facilitate optimal discharge outcomes by approaching critical medical practice with physical, social, and psychological contexts. The aim of this review is to discuss contemporary research in pediatric hospitalization experience research, provide plausible recommendations for healthcare providers to implement in their office and clinical practice, and to suggest directions for future work.

Rationale and knowledge gap

Per the child-centered care model, children should be active agents who collaborate with physicians, inform them about their preferences and past experiences, and have a voice in their medical treatments (7). Yet there is a paucity of children’s narratives in research, even in literature regarding their own hospitalization experience. Moreover, many children report feeling excluded from communication during their medical appointments (8,9). Prior studies that recorded conversations between families and pediatric physicians found that the children’s involvement during medical visits is limited, accounting for only 10–13% of the visit, and another study found that 75% of adolescents did not perceive themselves to be included in physician conversations when the doctor provided explanations (10-12). Evidently, there is a clear gap between fulfilling the goals of the child-centered model and the current approach to pediatric research and care.

Objective

Due to the exclusion of children’s voices in research and practice, we may be missing out on arguably the most valuable source of information for programs and interventions to promote their comfort in the hospital. Children enter the clinic from diverse sociocultural, familial, economic, and environmental backgrounds, impacting their perception of hospitalization, and consequently, their preferences for care (7,13,14). Therefore, it is important to synthesize literature from the perspectives of children, caregivers, and healthcare professionals to explore the stressors of hospitalization and find ways of making the experience more positive. In turn, this will lead to better health outcomes for children in the post-hospitalization environment and moving forward. The purpose of this literature review is to understand hospitalization stress in pediatric populations and make recommendations in enhancing the experience. This narrative details the synergistic combination of perspectives from children, their caregivers, and healthcare providers. We present this article in accordance with the Narrative Review reporting checklist (available at https://tp.amegroups.com/article/view/10.21037/tp-2025-523/rc).

Methods

Initial search and inclusion criteria

In July 2025, the researchers conducted an extensive search on the PubMed database with some combination of the following search terms: “pediatric, hospitalization, experience, caregiver, patient-centered, family-centered, physician, play, communication, empathy, child-friendly, perspective, anxiety, and negative emotions”. Inclusion criteria for research studies were articles in the English language (either in original text or translation provided by the authors), and those that focused on pediatric patients (i.e., no studies regarding patients above 18 years of age). Articles were considered if they were published within the last two decades (i.e., between January 2005 and June 2025). Moreover, original research articles, review articles, and meta-analysis articles were included in this initial review.

Abstract screening and consensus process

From the original search results, titles were screened for relevance. Next, abstracts were analyzed and met subsequent inclusion criteria if they discussed any combination of the following: (I) sources of hospitalization stress, anxiety, and negative emotions; (II) patient-caregiver-provider communication; (III) physician empathy; (IV) therapeutic play, art, and animal programs; (V) hospital design and decorations; (VI) noise and light levels in hospitals; (VII) caregiver expectations and experiences of care for their hospitalized child; and (VIII) patients’ perspective of their hospital stay. Based on relevant abstracts, full-texts of eligible papers were analyzed independently by the two researchers. Consensus between the researchers was necessary for inclusion, which was determined by assessing whether articles were clearly related to one of the eight topics that was previously listed. If a paper failed to meet consensus, then it was ultimately excluded from the manuscript.

Identification of themes and targeted secondary searches

Based on the content of this search, articles were categorized into individual themes that were related to the pediatric hospitalization experience. The themes that contained the most number of articles were the ones that contributed to topics discussed in this paper. Targeted secondary searches were then conducted to ensure that each theme was thoroughly represented, based on the current work related to that topic. This was accomplished by screening the reference lists of studies that were included in the initial search for addition to the paper. Recurrent themes are identified in the Results and Discussion sections of this paper, and the researchers’ recommendations come from both the initial thematic analysis and supporting evidence identified in the secondary literature review. Table 1 summarizes the search strategy utilized in writing this manuscript.

Results

Physical spaces

Prior work has well documented the benefits of an appropriate hospital environment for children. For example, patients who are treated in a child-friendly environment may communicate better with physicians regarding their symptoms, more easily receive and accept care, experience reduced pain, anxiety, and stress, report higher quality of service, and need less sedation medications (1,3,15-22). However, pediatric patients are often provided a standard hospital environment, which may be designed for the convenience of healthcare professionals rather than the psychosocial needs of children and their families (1,20,23-25). When children are hospitalized in settings that are designed for adults, their safety is negatively impacted and they may experience poor care and heightened stress (17,26-28). Therefore, it is important to understand children’s preferences in the physical space to facilitate optimal care and treatment.

One prominent theme among the literature was the importance of creative design in waiting areas and patient rooms, namely decorations, features, colors, and nature-related elements (29). For example, decorations such as inspirational messages on the wall, art on the ceiling, and balloons, or features such as large televisions with cartoons and fluffy carpets were explicitly cited by children as aspects that made their physical space more enjoyable (1,17,20). Children also reported that they did not want to see medical equipment out in the open, and preferred spacious areas filled with games, books, and child-friendly furniture, including wardrobes, windows, and storage systems of different shapes (1,17,20). Moreover, many studies have found that patients preferred colors in their rooms: the most commonly favored colors were green and blue, and some children desired bright colors, while others desired paler colors (17,20,29,30). Finally, most adolescents shared the importance of nature to enhance their hospitalization experience. For example, patients expressed desire for green gardens, nature walks, aesthetic window views to the outside world, and plant and animal decorations in their rooms (1,20). Clearly, children value fun and developmentally appropriate designs and architecture in the hospital.

In addition to creative designs and features, children describe the importance of light and noise in the hospital (17,29). Specifically, patients report negative experiences with excessively bright artificial lights and loud noises throughout their stay, which may contribute to discomfort, elevated levels of stress, blood pressure, heart rate, and muscle tension, and poor quality of sleep, increasing risk of metabolic and immune dysregulation (29-33). These light and noise stressors may be a frequent occurrence, as one study found that children in a pediatric ward were exposed to disruptive noises that exceeded World Health Organization (WHO) recommendations for sleep in every night that they were hospitalized, and across a 24-hour period, they were exposed to non-optimal light conditions 61.9% of the time (33). In many studies, children expressed their desire to be exposed to natural light, which emphasizes the previously mentioned preference for access to nature and nature-themed designs (20,31). In fact, exposure to bright natural light has been associated with improvement in sleep, less depressive symptoms, decrease in length of hospitalization, and reduction in pain medication costs (22,34). Since attention to sensory details may vary in children, especially those with neurodiversity, hospitals should allow patients to control light and sound volume levels to their preference whenever possible (17,20).

Finally, the physical space has implications in the socialization for both children and caregivers. For children, forming connections with other youth may improve their hospitalization experience, as friendships can help patients cope with illness, foster an optimistic outlook about their hospitalization, and adhere to treatment plans (28,35,36). Indeed, one study by Lambert et al. found that children aged between 5 and 8 years perceived friendships within the hospital as the most positive aspect of their stay (37). Prior work has typically explored socialization through designated play areas or waiting rooms, but emerging evidence suggests that the type of room that patients are assigned play a role as well (12,22). For example, adolescents stated that multi-bed wards provided opportunities to make new friends, while those in single-occupancy rooms reported loneliness and boredom (20,24,38). While traditional wards may facilitate friendships, children also recognize that this situation leads to less privacy, which is an important factor that can improve patient satisfaction and bestow a sense of control over the environment (39). Thus, patients are presented with physical spaces that seem to be unable to support both socialization and privacy needs concurrently. Single-bed rooms are also sources of socialization challenges for parents, as they may have less ability to interact with other caregivers of hospitalized children due to physical isolation, reducing the opportunities for emotional and social support between parents (38). Therefore, healthcare teams and engineers should explore other opportunities to promote socialization among families in the hospital (40).

Play and art therapy

Pediatric patients commonly view hospitalization negatively, as there are many social, psychological, and biomedical sources of stress (20,24,25,41,42). In fact, hospitalization may be traumatic, with some children displaying clinical symptoms of posttraumatic stress disorder after discharge (43-45). Thus, hospitalization may be viewed as an adverse childhood experience (ACE), with other ACEs known to increase the risk of heart and lung disease, depression, alcoholism, suicide attempts, drug abuse, neuropsychiatric problems, and other medical concerns in adulthood (43,46,47). To address these concerns, some hospitals utilize play and art therapy to help patients process traumatic feelings in a more appropriate manner (43).

Play is necessary for developing children and is especially important in hospital contexts, as it may help patients feel safe and comfortable (48). When children are given therapeutic play opportunities, they report less pain after surgery, improvements in anxiety and depression, and a more positive attitude to their disease (48-50). Furthermore, there are even benefits to physicians and the healthcare team when children are allowed to play, as it can encourage them to communicate and collaborate to facilitate treatment implementation and outcomes (1,48). Play does not need to be time exhaustive, as one study found that children were positively impacted by play programs with a schedule as short as 30 minutes a day (4). Frequently, play therapy provided by hospital staff consists of dolls and medical supplies or equipment to roleplay procedures, as this educates children about their treatment and illness, and such an understanding can relieve their anxiety of the unknown (4,48,51). Other opportunities for play include coloring materials, paints, interactive toys and games, and books (1,52). Most studies report positive effects of storytelling with books, however one study by Abdi et al. found unexpected negative effects of storytelling: while younger children aged 3–8 years enjoyed storytelling, older children aged 8–10 years actually experienced increased anxiety (5). This suggests that not all activities may be perceived positively by children, and hospital staff should consider patient contexts and individual preferences when implementing play programs or distributing play materials. Finally, play is typically associated with waiting rooms or designated play areas, even though children explicitly desire more play opportunities in other areas of the hospital such as hallways or front desks (1). Therefore, physicians and healthcare teams should identify additional contexts where children may play.

Similar to play, art therapy involves children engaging with art installations or creating art themselves, and these programs also have positive effects for patients, such as relieving anxiety, promoting emotional expression, and boosting self-esteem (7,52-54). Creating art in the hospital may be particularly special for children, as they may be excited by the fact that they are creating something unique and in turn, view the hospital stay more positively (43). For example, one study allowed children to create and customize their own version of a doll, and even 6 months after hospitalization, children still reported long-term positive effects of their toy (43). Finally, emerging literature suggests that technology has the promise to complement art and play therapy. For example, generative artificial intelligence (AI) may create personalized art or videos to teach children about their treatment, and social robots may provide socioemotional support and play opportunities (55,56).

Communication in pediatric contexts

Medical communication models in pediatric contexts are distinct in that they are typically triadic, involving the child, their caregiver, and the physician during the visit (57). Following the recommendations of child-care and patient-centered practices, physicians should directly address children and allow them to be active participants in their treatment (7,24,45,58). In fact, pediatric patients explicitly report their desires for autonomy and active engagement with the doctor during consultations, as this builds a positive relationship to support trust, treatment cooperation, openness in reporting symptoms, improvement in hospitalization experience, and better medical outcomes (2,7,52,57,59-61). Despite these benefits, many physicians do not adequately include pediatric patients in their own appointments and speak primarily with caregivers: perhaps due to a view of children as too immature, or challenges with communicating in a way that aligns with their unique way of understanding and processing information (12). For example, one study by Capurso and Pazzagli found that 92.44% of children reported that the doctor told caregivers health-related information, and only 7.88% of children recall being actively engaged with the physician (12). Moreover, a literature review by van Woerden et al. found that children only contributed between 4% to 14% of medical appointments, measured by utterances, turns, or time of speech (62). When children’s communicative needs are not met and they are pushed into a peripheral role, they may experience frustration, worry, confusion, emotional pain, marginalization, loneliness, disinterest in their own treatment, and less confidence to participate in health care discussions (1,2,9,12,57,63). Clearly, the psychological and biomedical consequences of excluding children are grave, and physicians are encouraged to directly include pediatric patients in their medical consultations.

In addition to the pediatric patient, their caregivers are also an essential part of the hospitalization experience. For example, parents can help their hospitalized child by interpreting the situation, teaching them coping skills, educating them further about their illness, relieving their anxiety, and advocating their needs to the health care team (24,45,64). Regarding the communication between parents and physicians, one study found that parents of hospitalized children reported that sharing information was the most important aspect of communication in this context, since the main reason for the clinical visit is typically to gain necessary information and seek medical attention for their child (60). Other studies corroborate this finding, as one study of parents with children hospitalized in psychiatric facilities found that they reflected positively on doctors who provided clear information, answered questions, and expressed empathy to create a nonjudgemental environment (65). However, those parents still had unanswered questions, particularly regarding whether treatments would “work”, hospital practices, transportation and transfer policies, length of stay, and other services that the hospital offered (65). In addition to feelings of uncertainty and confusion, caregivers also experience physiological and psychosocial stress during their child’s hospitalization, often juggling multiple responsibilities, and interviews with parents suggest that the health care team may underemphasize availability of resources (such as food and personal care) that the hospital may provide to parents (65,66). When parents experience stress, their confidence in decision-making and engagement in care for their sick child decrease, and this stress may be transferred to the child, contributing to negative hospitalization experiences and poorer outcomes (52,66). Thus, one way that physicians can ameliorate negative hospitalization experiences of pediatric patients is to answer any questions that caregivers have in an empathetic space, and ensure that parents know the various amenities of the hospital to address their stressors. This may be aided by the participation of a social worker who can facilitate these conversations about available amenities.

Physician empathy

From the perspective of physicians, effective communication and expressing empathy with patients can help clinicians experience greater satisfaction, mindfulness, less burnout, and a sense of presence with families (61,67,68). Indeed, physicians report that the relationships with patients is the most significant determinant of job satisfaction (67). Moreover, demonstrating empathy can help doctors obtain relevant medical history, contextualize information, and facilitate shared decision-making processes, as patients and caregivers can more readily share their family preferences and goals, engage in deeper conversation, and express alliance with treatment recommendations (59-61,63). In medical contexts, physicians can express empathy by following an established NURSE mnemonic, which stands for Naming, Understanding, Respecting, Supporting, and Exploring (69). The exploring dimension, defined as the doctor attempting to gain insight into the thoughts, feelings, and experiences of the patient, may be particularly important: a discussion group analysis found that physicians who were thought to be interested “in me as opposed to my condition” were perceived most positively by adolescents, and another study found that pediatric cancer patients wanted their providers to know their “lives outside of cancer” (2,63,70,71). Alarmingly, several studies provide evidence that exploring is underutilized by doctors: prior work has found that physicians may underestimate the importance of children’s emotional reactions and not properly understanding the impact of illness in the child’s life can be a barrier to medication adherence. In fact, one of the least used communication strategies that doctors employ is asking about the others’ point of view, which is also a way to express empathy. A quantitative study revealed that doctors successfully employed empathy in only 38% of consultations, suggesting a clear gap in patient expectations versus physician performance (2,61,72,73).

Furthermore, physicians may overestimate the importance of providing medical information to patients and caregivers, to the point where it interferes with empathy and prevents optimal patient satisfaction and outcomes (57,61). For example, Olszewski et al. analyzed transcripts of care conferences for hospitalized children, and found that sharing medical information was the most common reason for missing an empathetic opportunity, representing 52% of all missed opportunities (61). Moreover, they concluded that both physician empathy without opportunity for the family to respond and not expressing empathy at all resulted in the same negative consequences of less treatment alliance and engagement (61). As one teenage girl succinctly recommends during an interview regarding lack of physician empathy, “just talk to me; I’m human. I have feelings” (63,74). In sum, previous literature suggests that physicians may not properly explore the family’s feelings, lived experiences, and prior knowledge during the consultation, and should recognize a balance between empathy and providing medical information (12,63).

Discussion

A common complaint among hospitalized children is a lack of control over their daily routines and ability to personalize their environment (24,45). Many patients reflect negatively on depersonalized care and rigid hospital routines, and desire positive disruptions, such as play and art activities, decorations to personalize their bed space, and systems to adjust light, temperature, sounds (17,20,45,52). In fact, one study found that patients reported control over aspects of space as the most important feature of an ideal hospital room (17). Therefore, healthcare professionals are encouraged to bring back this sense of control to patients by allowing children to personalize their space whenever possible. Physicians may accomplish this by directly asking children and their families about preferences for toys, providing options for various art activities or decorations, and allowing them to adjust lights according to their level of comfort. Assessing individual preferences is important, as children of diverse ages, genders, and cultures may have different expectations and opinions for their care (7,17,63). This recommendation is aligned with suggestions from prior work, as other studies conclude that physicians should directly address children in consultations and explore their preferences (17,63).

Moreover, patients report that they feel marginalized as a result of exclusion in communications from physicians, who typically consult the caregiver instead (9,12,57). Many adolescents want to be directly addressed by doctors, speak to doctors privately, and to have an active role in their treatment (12,52). It is also important for physicians to understand that families have different expectations about the doctor’s role during visits, as adolescents and caregivers may desire a doctor to have an authoritative communication style (e.g., “I expect the healthcare provider to tell me/my child what to do”), a collaborative communication style (e.g., “I like to ask questions before accepting provider recommendations”), or other styles (75). Thus, physicians are recommended to directly ask families at the beginning of consultations regarding their preferred communication styles, and to frequently provide opportunities for children to be involved in the conversation. With repeated visits, physicians should reassess preferred communication styles and other family expectations, as this may change over time as a result of patients maturing and progressing along their care plan (63).

Perhaps a surprising finding was that provision of medical information was not always positively perceived by children and their parents during consultations (57). Several studies suggest that physicians who provide medical information may miss out on opportunities for displaying empathy, which leads to a decrease in families’ engagement during appointments and motivation with following treatment plans (57,61). However, unanswered questions or confusion are common in both children and parents (45,65). Indeed, one study found that doctors do not adequately encourage questions from patients or caregivers (75). This suggests that physicians may not give sufficient opportunities for families to ask for medical information, provide information that is already known to families, or provide information in a confusing way that fails to address their underlying concerns. Thus, doctors should first assess the family’s initial understanding of the illness and related treatment or procedures before providing additional information. Physicians are also recommended to directly ask patients and caregivers if they have any additional questions or concerns that were unresolved.

A perceived lack of empathy from doctors was a significant factor in adolescents’ perspective of their treatment and patient-provider relationship. Adolescents explicitly desired that physicians express empathy and wanted to know that doctors “had their back”, though many reported that they lacked such empathy or concern (2,63). In fact, some patients even considered a positive relationship with empathetic doctors as more of a “friendship” (63). This idea of patients wanting to be friends with their doctors was evident by quotes from children across many studies. For example, one child reported “if they have time to sit beside me and talk with me, maybe we will be good friends and talk about anything;” another patient asked for doctors to “just come in to talk to me like, just, like friends, or something”; a third patient echoed these sentiments, saying “that’s how I knew they really cared because they wanted to hang out with me as a person” (71,76,77). One way that physicians can display empathy towards patients and create these friendships is to show curiosity in the experiences and feelings of the patient, and especially in non-medical information like the patients’ everyday life (2,63). Therefore, doctors are encouraged to ask interpersonal questions about the child beyond medical contexts, perhaps exploring their hobbies, interests, school life, relationship with peers, and other facets of their background. In fact, emerging research in the field of developmental psychology suggests that adolescents enjoy being asked and answering questions about their life experiences, and feel more connected to people that ask them questions (78). By getting to know a child beyond their illness, physicians can create strong and trusting relationships with adolescents, ultimately leading to the optimal care outcomes (48,52,63). To obtain this information, physicians should consider using open-ended questions, reflecting on patient responses, and asking follow-up questions to get stories and understand children’s perspectives (57,78). Table 2 summarizes the recommendations for physicians to address common concerns among hospitalized children.

Regarding art and play therapy programs, much of the reviewed literature situated these programs in the context of implementation by Child Life Specialists (CLS) (4,45,54). CLS are bachelor-level members of the healthcare team that provide non-medical, psychosocial support for pediatric patients and their families, including services related to preparing the child for treatment, coping with hospitalization stress, educating the family about treatment, and other comforting measures (41,79,80). Prior literature suggest that CLS provide appropriate developmental support for patients and their families, particularly as healthcare professionals report a lack of human resources and insufficient training to offer those resources themselves (41,79,81). While psychological in nature, CLS have a significant impact on the biomedical treatment of patients, as prior work has found that CLS may help to reduce perceived pain, fear during procedures, and overall procedure duration, which all aid in creating more positive perceptions and increased satisfaction of the treatment process (80). One of the main priorities of CLS is to build rapport with the child, and prior work has typically seen play opportunities as the main way to achieve this (82,83). Drawing a connection between CLS and the previous recommendation of asking questions to understand the child beyond their illness, future research should explore the benefits of question-asking behaviors of CLS as a rapport-building strategy, potentially diversifying their toolkit beyond play activities to establish trusting relationships with the patient.

Other resources that hospitals may offer include volunteer programs and animal assisted interventions (AAIs) (42,84). There is a paucity of research that discusses the impact of volunteers in specifically pediatric settings. However, one study by Pereira et al. [2021] explored family and healthcare professionals’ perceptions of adult volunteers in the pediatric intensive care unit (PICU). They found that the majority of PICU families felt comfortable with having a volunteer spend time with the hospitalized child, as the volunteer may provide additional play and socialization opportunities, and may allow the caregivers to take a self-care break (81). Interestingly, a considerable amount of families also reported feeling neutral to these volunteers spending time with their child and feeling neutral about the benefits of their support (81). In addition to an already limited sample size, some families in the study skipped questions in the survey or offered limited explanations for their thoughts about volunteers, indicating that future research should address these gaps to better understand the effect of volunteers in pediatric wards. Other emerging studies about volunteering are optimistic about its benefits. For example, a report by Kellett et al. [2024] about how hospital volunteers delivered a virtually-adapted play therapy program due to the coronavirus disease 2019 (COVID-19) pandemic mentioned early pilot data that children may be less anxious as a result of one session, compared to before (84). On the other hand, there is more established literature about AAI compared to volunteering. Prior studies have typically agreed that AAI, especially those including dogs, may help to reduce stress and anxiety as well as improve quality of life and wellbeing among hospitalized children (42,85-88). One reason why children may positively view therapeutic dogs is because the animals demonstrate empathetic-like behavior towards children who appear sad, helping to create a safe space for patients to process difficult emotions (88). Most healthcare professionals also agree that there are benefits with AAI, though some physicians report concerns about the potential for dogs to trigger allergic reactions, be unsafe for children fearful of dogs, and transfer pathogenic bacteria that can cause zoonosis (89). Due to these valid concerns, AAI cannot be universally-recommended for every child at this time (89).

One factor that unites the themes discussed in this paper (physical spaces, play and art therapy programs, communication, and empathy) is the potentially critical role that physician’s curiosity of the child may have in establishing a positive hospitalization experience. This curiosity likely prompts the doctor to engage in question-asking behaviors to resolve such desire to learn about their patients, which has implications in all of the hospitalization themes explored. For example, by asking questions to the child about their perception of the physical space, decorations, noise and light levels, and privacy, the physician may help address patient concerns regarding comfort. Similarly, by asking the child what their favorite toys and games are, how they think play may be better incorporated into their hospital stay, and whether the provided play, art, child life, and AAI programs are effective, physicians may better reduce sources of stress, anxiety, and negative emotions that are unique to each child. Moreover, the provider’s curiosity of the child beyond medical contexts and asking interpersonal questions about the child “as a person” was previously discussed as a potential way to demonstrate empathy and create friendships between the patient and physician. Finally, doctors can ensure that they are meeting the communicative needs of both the child and caregiver by asking questions related to the family’s preferred communicative style, how the family views the treatment plan, whether there are any unanswered questions that linger after a consultation, expectations of the care plan and hospital stay, and if the caregivers are aware of how to manage their own stress, life, work, and self-care throughout their child’s hospitalization. Currently, there is limited research regarding curiosity in the medical field, and even less about curiosity in pediatric patient contexts compared to adult patient contexts (90). While one theoretical article discusses the potential implications of physician curiosity in addressing adult patients’ chronic pain and vaccine hesitancy concerns, this paper extends the work of curiosity in its potential to alleviate concerns in other contexts, such as the themes previously presented (91). Moreover, this review highlights how curiosity may be particularly important in pediatric contexts to facilitate child-centered care strategies and how hospitals may better accommodate the medical and psychosocial needs of children, which are different from adults (1).

Finally, many studies included in this review utilize semi-structured or open-ended interviews with children, their parents, and healthcare professionals. This, in addition to heterogeneity of study designs and outcome measures, necessitates that our paper primarily followed a descriptive and qualitative analysis, rather than quantitative one. We acknowledge this to be a limitation in our methods.

Conclusions

Several factors have a significant impact on pediatric hospitalization experiences, including access to play and art activities, features of the physical space, active involvement in their treatment process, being directly addressed by physicians, and receiving empathetic care. Lack of control was a common concern among children. Therefore, physicians are recommended to allow children to have a voice in their hospital stay. For example, giving patients a choice in the type of toy or art activities that are available, and allowing patients to control aspects like lighting and temperature. Moreover, patient-provider relationships can be strengthened and better care outcomes can be achieved when doctors ask interpersonal questions to children. Thus, doctors are encouraged to explore the everyday life, hobbies, and interests of patients using open-ended questions and follow-up questions. This strategy of question asking can be applied to understand and address the child’s perception of their physical spaces, art and play therapy programs, and desired communication with the doctor.

Currently, there is still limited research that explores the narratives and direct experiences of hospitalized children, as studies may often assess this through their caregivers. In addition, more work should be done to consider how to bring patients’ preferences into the hospital, transforming unfamiliar environments into more welcoming ones. Also, there is promise of digital tools and AI technologies that may improve communication aids, play spaces, and educational material, suggesting that these are areas of growing research that warrant future inquiry. Lastly, future research should consider additional communication techniques that physicians may employ to better ask questions that are developmentally appropriate for children, as well as the importance of physician curiosity in specifically pediatric contexts.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the Narrative Review reporting checklist. Available at https://tp.amegroups.com/article/view/10.21037/tp-2025-523/rc

Peer Review File: Available at https://tp.amegroups.com/article/view/10.21037/tp-2025-523/prf

Funding: None.

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-2025-523/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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