Why weren't hospitals keen on parents visiting?

When children's distress was seen as a temporary inconvenience

Dec 09, 2023

By 1952, two major changes were embedding themselves within British society. World War II was over. And the National Health Service was under way. Hope was in the air. It is unsettling to realise that, within this optimistic context, one of the things that was not shifting within society was the way children’s emotional needs were understood.

Broken leg? Pneumonia? Hernia? Tuberculosis? If you were a child of the 1950s coping with any of these, or a hundred other, painful conditions, you were allowed to have a doctor and a team of nurses. What you couldn’t have was your parents. It was standard policy to restrict parental visiting. A 1949 survey of London hospitals1 shows that at Guy’s Hospital, visiting was permitted only once a week, on Sundays between 2 and 4 pm. At Westminster Hospital, Sunday afternoon visits were limited to a single hour, although there was also an hour available on Wednesdays between 2 and 3 pm. But if your child was admitted to St Thomas’s Hospital? There was no visiting at all for the first month.

It sounds shocking to us now. A young child admitted to hospital wasn’t allowed to see his or her parents for a whole week? For a whole month? They would be terrified, confused. They would wonder why their parents had abandoned them and why they were being punished simply because they were in pain. They would feel bereaved. How is it possible that anyone in the medical profession thought this was a good idea?

Wanting parents to stay

That was the question social worker James Robertson was asking in 1952. He was one of a large group of campaigners trying to get the medical profession to do something they found difficult: take children’s distress seriously. When children cried in the wards, what the staff saw was ‘behaviour’. Their goal was to decrease the amount of time children spent exhibiting such behaviour.

Parents did not help with that goal. In fact, parental presence exacerbated the undesirable behaviour. In the hours after parents departed, a Ward Sister could be left to cope with any number of distraught sobbing children. Sometimes their screams echoed all the way down the corridor, setting off children in other wards. Things quickly felt overwhelming and unmanageable. It was easier if the comings and goings of parents were restricted. This enabled the children to get used to hospital routines, and it left the staff free to administer those routines.

Robertson wanted to change this practice. He understood, through the growing body of evidence that would later be called attachment theory, that children’s separation from parents caused emotional and physiological harm. The behavioural shifts that medical staff referred to as ‘settling’ were described by Robertson as ‘emotional deterioration’. Children calmed outwardly because they realised no one was coming to help with their sadness. Their constant longing for their mother or father became unbearable, so it was easier to quit hoping for them. Children withdrew psychologically from their relationships with parents, and indeed with adults in general, because they learned they weren’t trustworthy. They often returned home much changed after a lengthy hospital separation from parents. They might be highly anxious or avoidant, displaying behaviours like bed wetting, nightmares, refusal to leave their parent’s side, refusal to accept affection, hitting parents or siblings or self, and losing the ability to talk. Robertson and his colleagues had a simple solution to all this distress: let the parents stay. The trouble was they could not get most staff to agree.

Wanting parents to leave

The vehemence with which the medical profession rejected greater parental involvement feels astonishing from today’s perspective. Historical research gives us a clear sense of how deeply embedded this reaction was.

“The majority of hospitals vehemently opposed (frequent) visiting by parents for a variety of reasons. Parents brought filthy germs into the wards and only upset their children, who would be crying for hours after they left, causing the nursing staff much trouble. Parents only wished to visit their children for egocentric reasons; they were being over-anxious and neurotic. They children themselves certainly did not need the visits; they quickly felt at home in the hospital. Besides, even if a child was not happy (and some doctors and nurses admitted that these children existed), it was always better to have a sad child than a dead child. [Besides]…many parents had no time to visit their children, for example because they had to travel a long time to the hospital or there were other children to take care of. And who would make father’s tea when he got home from work?”2

Pardon? “Who would make the father’s tea if the mother was tending to a child in hospital?” What?? When I am delivering presentations and read out this excerpt to my audience, they always burst into laughter at that line because it sounds outlandishly trivial. And yet, it provides a reminder of the ways in which societal and professional norms shape the treatment of children. You begin to realise how possible it is for children to be left suffering without anyone intending or even realising it.

If such unintended consequences were possible in the 1950s, could they be occurring today? Do our societal and professional norms blind us to children’s needs in a similar manner? In our modern, evidence-based age, are we more open to challenge and change? Are we genuinely open to finding out the answers to such questions?

When faced with continuing resistance, a frustrated James Robertson decided to try a novel approach. Rather than depending on his theory-driven explanations of despair as a way of persuading staff, he employed the technology of cine films to show the problem more directly. A grant of £150 allowed him to purchase a hand held cine camera (which he had never before operated) and 80 minutes of film reels. Using a rigidly structured observational timetable, he would make a film that followed the course of a child’s emotional states during her stay in hospital. The child chosen for filming (with agreement of her parents) was a toddler named Laura, whose stay in hospital lasted eight days. Entitled A two-year-old goes to hospital, the film would come to be regarded as a classic. It is still available for purchase (from Concord Films3), and an excerpt is available on YouTube.

The film’s first screening was scheduled for November 1952. Robertson had hopes that when the staff were presented with film footage of a child’s distress, they would not be able to turn their minds away from the reality of it, as they could during his verbal descriptions. He hoped that this realisation would motivate them to change existing practice.

Robertson’s hopes were misplaced. Badly misplaced. That first screening, delivered to a gathering of paediatric doctors and nurses attending a meeting of the Royal Society of Medicine, is reported to have been met with “a very hostile reception”. Most attendees “frankly refused to admit the child in the film was distressed at all”, and those who did “were reluctant to believe it might cause long-term emotional disturbance”.4Some went as far as accusing Robertson of “slandering paediatrics”. The resistance was so intense that the film’s general release had to be delayed, in order that Robertson and colleagues like John Bowlby could determine how best to present this new, striking form of evidence.

Fierce Curiosity

Robertson had undergone a lesson in what I call Fierce Curiosity. Being faced with children’s experiences can be so uncomfortable for adults that we resist stepping into considering the possibility. Instead, we step into denial, defending our current beliefs and practices. It feels threatening to think that we could be harming children by doing something perfectly ordinary. Harming children is at odds with our sense of self. So we protect our own feelings at the expense of children’s needs. We can do all of that without any conscious awareness we’ve even made a choice.

I like telling stories from the past because they offer a safe place from which to consider the idea that we can fail to meet children’s emotional needs. We can dive deep into this story because we know despair is no longer being inflicted on children in hospital. Parents today expect to be able to stay with their children. They take that for granted. Yeah! The efforts of those 1950s campaigners paid off - although it was a change that would take far longer to achieve than one would have hoped. (That’s another story for another day.5).

Looking backwards through the lens of this story lets us ask questions about ourselves today. Is it possible we could in any way be subject to the same kind of stubborn blindness that operated in the medical field 75 years ago? Have the scientific discoveries about trauma processes, which have become so influential across a range of sectors over the last two decades, moved us out of harm’s way?

Let me put those questions another way. What will future audiences see when they look back at us? What do we hold in high regard that they might see as outlandishly trivial? What will be obvious to them that we cannot see in ourselves?

Suzanne Zeedyk's Substack

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