Child's Response to Hospitalization

• This section explores factors influencing a child's reaction to hospitalization, fear, stressors, and responses based on their developmental stage.
• Comprehending these is essential for planning appropriate care for children at risk or with acute/chronic problems.

Factors Affecting Responses to Illness and Hospitalization

• Developmental stage of the child
• Nature of the illness or injury
• Anxiety level of the child and parents
• Type of relationship between parents and the child
• Past experiences with hospitalization, medical treatment, and surgical procedures
• Support systems available
• Socio-cultural factors like gender, race, culture, and age

Major Sources of Fears/Stessors

• Separation Anxiety
  • Protest: the child reacts aggressively with loud crying and rejection of others, lasting hours to days
  • Despair: child becomes withdrawn and uninterested, lasting a variable amount of time
  • Denial/Detachment: occurs after prolonged separation, child ignores parents and seems to form new relationships
• Loss of control: influences stress and affects coping skills
• Physical restrictions, altered routines, and dependency contribute
• Fear of bodily injury/pain can have long-term consequences

Children's Responses to Hospitalization

• Infants (0-12 months): separation anxiety begins after 6 months
• Inconsistent care leads to mistrust and decreased sense of control.
• Toddlers (1-3 years): separation anxiety peaks
• React with negativism and resistance due to loss of control potentially leading to passive withdrawal
• Poor concept of body image; restless when in pain; communicate their pain by the end of this period
• Preschoolers (3-6 years): separation anxiety is less serious than toddlers
• Magical thinking can cause them to feel out of control and fantasy hospitalization or illness as punishment
• A cognitive view of illness occurs during this stage. Mutilation concerns are at their greatest and can locate pain and use a pain scale
• School Age (6-12 years): better able to cope with separation generally but find it difficult with added stressors
• Concern for separation from usual activities; feeling of control lessened due to concerns with disability. Privacy is significant at this age
• Adolescents (12-18 years): separation from parents is welcomed, but peer group contact loss is a severe threat. Concerned with body image and try to react to pain with self control

Communication Strategies

• General guidelines:
  • Allow the child to feel comfortable with the nurse, communicate with objects.
  • Speak clearly in a quiet, unhurried voice, offering choices and being honest

Age-Specific Communication

• Infants: hold, rock, and talk to them often, even during care
• Use a calm, soft, high-pitched voice, swaddling the infant when upset, and being responsive to cries
• Toddlers: provide short, clear instructions in a positive manner and offering 2 choices is possible including the name of objects
• Use play for demonstration, comfort objects, give explanations before procedure and simple terminology
• Ensure proper restraint, band aid application, and reward to create a positive experience
• Preschoolers: seek choice opportunities and use simple sentences. Describe the procedures, use play to explain, and allow handling of equipment.
• Schoolers: set limits, reassure, encourage thinking through medical play. Use photos, books, and videos in simple explanation and allow composure with privacy
• Adolescents: be mindful of body image, encourage independence and provide privacy
• Use videos or books, but be sensitive to conversational interest

Nursing Care of the Hospitalized Child

• Goals:
  • Prepare the child for hospitalization, minimize separation, maintain a sense of control.
  • Reduce pain to an acceptable level, and provide opportunities for developmentally appropriate activities.
  • Maximize the benefits of hospitalization.