For young children, an experience of hospital-related might be so traumatic that it influences the well-being of the child. The fear may damage the sense of security felt by the children, and weaken the child's willingness to trust health-care professionals. The children often expressed their fear in a contradictory manner or denied it. Children need the help of adults to express their hospital-related fears, including the objects of these fears.

It is important to observe and support the child's individual coping strategies. Pre-school-aged children need information and guidance to orientate themselves in unknown situations and to participate in decisions concerning their everyday life. Most of all, they need opportunities to play and experience pleasure. Children can also be taught coping strategies that give them an active, positive role.

Aim:The aim of this study was to describe the child-reported coping strategies for hospital-related fears in 4-6-year-old children. Method: The data were collected by semi-structured interviews of 4-6-year-old volunteering children (n = 82) in Finland. Thirty-four children were interviewed in hospital, and 48 in kindergarten. The children were chosen through a purposive sampling method, in which volunteers were asked to take part in the study. The data were analysed with quantitative and qualitative methods. Results:The most frequent child-reported coping strategies were: the presence of parents and other family members (81/517, 15.7%), the help of the hospital personnel (58/517, 11.2%), positive images and humour (57/517, 11%), play (57/517, 11%) and the child's own safety toy (45/517, 8.7%). The children interviewed in hospital mentioned significantly more often play (P = 0.000) as their coping strategy than children interviewed in a kindergarten. Children interviewed in kindergarten expressed significantly more often the presence of parents (P = 0.032) and the help of the doctor (P = 0.012) as their coping strategy than the children interviewed in the hospital. Conclusions:The results showed that children have many coping strategies, especially ones in which the children themselves play an active role. Besides, the traditional methods for alleviating fear, children need possibilities to use coping methods in which they have an active role giving them a feeling of some control over the hospital environment and medical procedures.

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