by Jamie Droke
Child Life Specialist

As children are growing and learning, one thing that many parents notice is their intense need for control. My mom has always said that my first full sentence as a toddler was “I can do it myself” and this sentence is probably not much different from other kids’ first sentences. (If that’s not true, I’m not sure what that says about my independent nature.) This need for control is much better understood when looking at it through the lens of developmental stages.

Control first comes into play in the toddler years (about 18 months to 3 years old). Erik Erikson was the man responsible for titling the stages of development that we will look at today, and he titled this stage autonomy vs. shame. In this phase of development, it is essential to children that they learn how to be independent and in control of some aspects of their lives. Don’t get me wrong; I am not saying that children should control everything. But it is important that they have some opportunities to practice their new found autonomy.

This need for control continues into the preschool years (about 3 to 5 years old). This stage is called initiative vs. guilt. You can see the connection between autonomy and initiative. If children are not given opportunities to practice some forms of independence in the toddler years, they will be less likely to take initiative in the preschool years.

Initiative in the preschool years turns into industry in the school age years (about 6 to 12 years old, the stage called industry vs. inferiority). When children learn to take initiative in some aspects of their life in the preschool years, they begin to be industrious in those areas in their school age years.

Although the need for control is different in adolescents than in young children, the need for control persists. The adolescent phase (about 12 to 18 years old) is known as identity vs. role confusion. The children who learned to be industrious in their school age years begin to form their identity in their adolescent years based on what they do.

As you can see, control is a very important piece in development. And when children come to the hospital, most of that control is stripped away from them. That is why in the hospital (and in life in general) it is so important to offer as many valid choices as possible and to resist the temptation to offer choices when a choice does not exist. I often offer choices of activities for kids to do while in the hospital. Or during a procedure I offer them choices about how they want to cope (by sitting in mom’s lap, holding mom’s hand, or watching what the nurse is doing).

Even with the best intentions, sometimes health care professionals offer choices where a choice does not exist. They ask if they can listen to a child’s heart or start another IV. These are not real choices because even if the child says no, the health care professional still has to listen to the heart and start a new IV. Instead, health care professionals can tell children what they are doing instead of asking if they can do it. (“I’m going to...” instead of ”Can I...”) When children feel like they have lost control, they will find a way to regain some; but it is much better for their development when they are given control throughout their admission.