Background: Hospitalization is well known as a stressful and traumatic event for both child patients and their parents. Hospitalization has the negative impact on child behavior problems. During the COVID-19 pandemic, child patients and their parents face the prevention protocol, which might emerge the feeling of physical restriction, separation, and daily routine changes. This situation may worsen the child behavior problems and parent’s psychological distress. Further, parents’ presence or companion would be a source of protection and guarding for the children, which lead to the feeling of safe during hospitalization. Parental participation in hospital care might have positive effects to child behaviors during hospitalization. However, the associations of parental participation and parent’s psychological distress on child behavior problems among hospitalized children, particularly during COVID-19 pandemic, in Indonesia is unclear yet.
Purposes: This study aimed to examine whether parental participation and parent’s psychological distress influence child behavior problems among hospitalized children during COVID-19 pandemic in Indonesia.
Methods: The cross-sectional, descriptive and correlational study design was used. A convenience sample of 156 parent-child dyads were recruited from August 17 to December 25, 2020. Child Behavior Checklist 1.5–5 and 6–18 were used to measure current behavior problems of hospitalized children by the parent’s report. The Index of Parents Participation and the Hospital Anxiety and Depression Scale were used to assess parental participation and psychological distress during their child’s hospitalization. Data were analyzed by using descriptive statistics, Mann-Whitney U test, Kruskal Wallis H test, Spearman correlation, and generalized linear model.
Results: Toddlers and preschoolers had significant higher scores for aggressive behavior (mean rank = 82.3 for toddlers and 102.5 for preschoolers; H = 15.954; p < .001), externalizing behavior (mean rank = 88.9 for toddlers and 104.7 for preschoolers; H = 25.881; p < .001), and internalizing behavior (mean rank = 81.9 for toddlers and 95.0 for preschoolers; H = 7.936; p = .019) compare to schoolers (mean rank = 65.5 for aggressive behavior, 60.3 for externalizing behavior, and 69.1 for internalizing behavior). Whereas schoolers had significant higher scores for attention problem (mean rank = 91.0; H = 11.281, p = .004) than toddlers (mean rank = 66.9) and preschoolers (mean rank = 66.9). Further, 20.5% of parents reported the borderline abnormal of anxiety syndrome and 18.6% reported the abnormal level of anxiety syndrome during their child hospitalization. For the level of parent’s depression, 18.6% of parents reported the borderline level of depression syndrome, while 10.9% of parents reported the abnormal level of depression syndrome during their child hospitalization. Around two-thirds of the parents (66%, n = 103) reported a moderate level of participations (scores 17 – 32) in child hospital care. Moreover, parent’s anxiety was associated with an increase in child’s anxious/depressed, somatic complaints, aggressive behavior, internalizing behavior, externalizing behaviour, and total behavior problem. However, parent’s depression and parental participation were not. The more anxiety parents feel during child hospitalization, the greater child behavior problems during hospitalization are expected to appear. However, there was no effect between parental participation and child behavior problems in this sample.
Conclusion: Parent’s anxiety was a significant predictor for the increase of total behavior problem, internalizing behavior, externalizing behavior, anxious/depressed, somatic complaints, and aggressive behavior among the hospitalized children during the COVID-19 pandemic in Indonesia. However, parent’s depression and parental participation were not associated with any child behavior problem syndrome scales. Findings suggest that identification and early intervention for parent’s anxiety is important to prevent or decrease child behavior problems during hospitalization. In addition, further study to clarify whether these associations would be different between pandemic and non-pandemic periods is also important to provide a better understanding of child behavior problems during hospitalization.

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