Children's Immobility Management

Children's Immobility Management

• Children with illness or undergoing treatment should be encouraged to engage in as much activity as their condition allows.
• High-protein, high-calorie foods are essential to prevent negative nitrogen balance caused by decreased mobility and gastrointestinal function.
• Appetite stimulation through small servings of preferred foods can be effective in combating anorexia resulting from immobility.
• Supplementary feedings or IV fluids are reserved for serious disability when oral intake is difficult.
• Adequate hydration, an upright position, and remobilization are crucial in promoting bowel and kidney function and preventing complications.
• Passive exercise and movement are recommended for children unable to move, often in consultation with a physiotherapist.
• Using dolls or puppets to illustrate immobilization methods is a valuable tool for educating small children.
• Transporting children outside their room, using specially designed wheelchairs, and providing stimulating activities benefit hospitalized children.
• Allowing children to wear their own clothes, resume school activities, and have family members stay overnight minimizes family disruption.
• Participation in self-care is a useful intervention to help children cope with immobility and maintain autonomy.
• Consultations with various specialists and creating an enabling environment are also beneficial in the home to help children achieve independence and normalization.
• Family support and home care for children with complex or chronic conditions causing immobility can be challenging and often necessitate home modifications and suitable child care.

Effects of Immobilization on Children's Health

• Immobility can lead to primary changes in the musculoskeletal system and secondary alterations in the cardiovascular, respiratory, metabolic, and renal systems.
• Muscle disuse causes tissue breakdown and loss of muscle mass, leading to decreased strength and endurance, which may take weeks or months to restore.
• Immobility in otherwise healthy children can have lasting effects on their developmental progress, and the most frequent reasons for immobility in children are congenital defects, degenerative disorders, and infections or injuries.
• Therapeutic interventions such as traction and spinal fusion can cause prolonged immobilization, but the increasing trend in health care is early mobilization, rehabilitation, discharge, and outpatient treatment.
• Predictable consequences of immobilization include decreased venous return, decreased cardiac output, decreased metabolism, decreased exercise tolerance, bone demineralization, disuse atrophy and loss of muscle mass, catabolism, loss of joint mobility, weak back and abdominal muscles, and decreased muscle strength, tone, and endurance.
• Nursing considerations for these effects of immobilization include using antiembolism stockings or intermittent compression devices for promoting venous return, planning play activities to use uninvolved extremities, performing passive range-of-motion exercises, and maintaining correct body alignment.
• Immobility can also lead to decreased food intake, decline in nutritional state, negative nitrogen balance, impaired healing, hypercalcemia, and decreased production of stress hormones, with corresponding nursing considerations for each.
• The cardiovascular system is affected by immobilization through decreased efficiency of neurovascular reflexes, pooling of blood in extremities in upright posture, diminished vasopressor mechanism, altered distribution of blood volume, and decreased exercise tolerance.
• Nursing considerations for these effects on the cardiovascular system include monitoring peripheral pulses and skin temperature changes, providing abdominal support, using antigravitational pants in severe cases, monitoring hydration, blood pressure, and urinary output, and positioning horizontally.
• Immobilization can have profound physiological effects on a child's growth and development, as homeostatic mechanisms thrive on normal use and need feedback to maintain dynamic equilibrium.
• Inactivity leads to a decrease in the functional capabilities of the whole body, and immobility can impose lasting effects on a child’s developmental progress.
• Therapeutic interventions such as traction and spinal fusion are responsible for prolonged immobilization, but the increasing trend in health care is early mobilization, rehabilitation, discharge, and outpatient treatment.