Pediatric Sleep: REM, NREM & Sleep Deprivation

Nursing Role in Supporting Ill Children and Their Families

• Children's responses to illness depend on their thinking, experiences, and knowledge.
• Understanding of illness evolves with cognitive development, affecting information processing.

Young Children (Preschool to Early School-Age)

• Usually know body part names but lack understanding of systemic function.
• May attribute illness to magical reasons or rule-breaking.
• Believe following rules can lead to recovery.

School-Age Children (Early to Mid-Grade)

• Begin understanding body functions like the heart pumping blood and lungs helping breathing.
• Still lack full understanding of systemic body function until 10 or 11 years old.
• Understand germs cause illness and can be prevented by healthy habits like handwashing.
• Feel less control over recovery, relying on medicine and rest.

Older Children and Adolescents (Ages 12+)

• Think more logically and understand illness better, including causes like germs, vaccines, and lifestyle.
• Comprehend the body as a system.

Nursing Implications

• Nurses should understand how children think about illness at different ages.
• Nurses must provide age-appropriate explanations and support.
  • Use simple language and comfort for young children.
  • Explain more about germs and how the body works for older children in understandable ways.
  • Provide detailed explanations about illness and treatment for adolescents due to their ability to understand complex information.
• Stress during illness or hospitalization can be high for children.
• How children understand illness affects how nurses should explain things and provide care.
• Simple differences in meanings of words can confuse children, requiring nurses to be careful with their word choice.
• Nurses should adjust their explanations to match the child's age and developmental level to help them feel informed and less afraid.

Responses to Illness: Children vs. Adults

• Children aren't simply "small adults" in healthcare responses.
• Children's body understanding is generally different than it is for adults.
• Children might not know which body parts are essential.
• Explain medical procedures in a way that is less threatening to the child, like "fixing" tonsils vs. "removing" tonsils.
• Children have communication limits.
• Young children under 5 often can't describe symptoms accurately.
• School-age children might exaggerate or downplay symptoms depending on impact.
• Children's behavior observation is key.
• Crying might mean a symptom a child can't explain; tense stomach might mean pain.
• Adults have better coping experiences, but children in hospitals might not manage stress.
• Lack of support leads to PTSD or issues like sleeping problems or anger.
• Trauma-informed care helps reduce child stress.
• Children have different psychological and physiological needs compared to Adults.
• Children have higher metabolic needs and surface area.

Nutritional Differences: Children vs. Adults

• Children grow rapidly, needing more nutrients per pound of body weight.
• Infants specifically need 120 kcal/kg daily.
• Adults only need 30-35 kcal/kg daily.
• If a sick child can't eat, IV fluids might be necessary, which is not always the case with adults.
• Adults have 23% of body water in extracellular space. Newborns are closer to 40%.
• Infants lose water from diarrhea or vomiting easier.

Systemic Response to Illness

• Young children respond in a general, whole-body way to illness instead of one area.
• Pneumonia symptoms include fever, vomiting, and diarrhea, which are hard to diagnose and can lead to fluid and nutrient loss.

Age-Specific Diseases

• Adults are immune to some common infections, but children are more vulnerable to infections like Measles and Chicken Pox.
• Those between 6 months and 5 years old, who also have a fever and no brain issues are also diagnosed with a febrile seizure often.

Care of Ill Child and Family in Hospital

• Preparation involves appropriate information given in an age appropriate time frame, support and trust.
• Emergencies usually take priority.
• Preparation depends usually on the child's and the parents' ages, and prior experiences from them.
• Communicate with younger kids (ages 2-7) with details leading up to the day, and older kids as soon as possible so they feel secure.
• Ask parents about the child's preparation and provide extra teaching while also clarifying procedures.
• Orientation programs help reduce fear and prepare children for emergencies.
• Be careful not to assume anything regarding the level of patient knowledge or their level of preparation so effective communication can take place.

Nursing Responsibilities for Care

• Promote growth and development.
• Illness might delay it due to hospitalization or injury

Nursing Diagnosis and Intervention

• Risk of altered growth related to negative effects of illness, injury, and/or hospitalization is present.
• Child demonstrates limited regression to previous stage while still being able to continue doing accomplished activities.
• Children can grow or regress due to a crisis event.

Nursing Support for Infants

• Support growth and development, and encourage familiar routines for security.
• Swaddling helps.
• Avoid new foods unless necessary due to failure to thrive.
• Support breastfeeding for benefit.
• Age appropriate play and stimulation is key.

Nursing Support for Toddlers and Preschoolers

• To help toddlers and preschoolers, give them choices about their care.
• Provide high climber solutions to prevent climbing, and reinforce and stress safety.
• Keep familiar eating habits to ensure consistency and help with the food.
• Expect possible regression to previous behaviors if toilet training has already started.

Nursing Support for School-Aged Children

• These children need independence and explanation of procedures to plan and gain control.
• Self-care is needed for their health and well-being.
• Hospitalized children feel social isolation from family, friends, and school, so provide schooling if technology stay connected and learn
• Spiritual practices and moral security is key, along with comfort and self-care.

Meeting Children's Spiritual Needs: Nursing Interventions

• Ask about rituals on admission and note them in the care plan.
• Include religious services.
• Give time for families to engage at their choice when warranted.
• Allow volunteering for different communities, providing care for the children.
• Note care from parents and mark in the plan of care to remind others.

Nursing Support for Adolescents

• These children need to continue their activities to maintain stability.
• Support self-care and hygiene due to illness challenging their sense of identity.
• Prevent peer disruptions and suggest electronic communication.
• Offer an adolescent unit and listen carefully to their concerns.
• Give support and address body image during procedures.

Promoting Nutritional Health

• Helping children that are ill involves fixing nutrition deficiencies, and encouraging follow-ups.
• Measures should be carried out, documenting and using feedings.

Risk for Malnutrition: Diagnosis and Intervention

• Ensure that the child will maintain nutritional status and gain weight and avoid loss.

Planning Nutrition: Considerations

• Meaning of food: Infants learn early that food involves love and closeness.
• Opportunity For Socialization: Time is for meal socialization.
• Stress: High levels result in hunger or a loss.
• Custom: Food customs dictate whether food should be together or separate.
• Environment: Reminds them of smells in the kitchen, and allows them to pick food and preparation.

Encouraging Fluid Intake

• Follow all instructions while giving water or electrolyte filled foods, considering their current weight and age.
• If you offer full glasses of fluid, make sure the fluid is still enough for the child that they need for their body size.
• Make sure they like the choices (Popsicles and Jell-O).
• Use water.
• Use milk or Pedialyte only if there are mouth sores that can be alleviated.
• Include ice chips.
• Breastfeeding is recommended.
• Encourage fluids through songs or games.

Calorie Counting

• Track calories consumed via a diary, noting any details that may impact.
• A dietitian should analyze the food list to determine caloric intake.

Promoting Safety

• Keep children safe during care.

Nursing Diagnosis and Intervention

• Note risk and have strategies in place to keep children safe at home.
• Healthcare providers should monitor the safety, giving a plan for home safety from an outside position of helping parents manage.

Pediatric Safety Measures

• Safety and Important steps to follow when children are being cared for:
  • Know where each child is at all times.
  • Ensure access safety access to stairs, and elevators.
  • Ensure safety protocols and alarms.
  • Screens are installed to keep children from exiting.
  • Ensure the side rails are in good condition or a high climber wall is present to keep them climbing.

Prevention for Falls

• Elevate rails and test that the child understands the importance of that being a barrier.
• Keep tables or any high stand at an distance.

High Chair Prevention

• A child always must have a belt when in an highchair, with an adult present always.

Safety Concerns for Water

• In bathrooms, ensure that there are no cords lying around, as well as be extra careful with children near water:
  • Monitor or remove any outlets.
  • Do not leave kids alone without supervision.

General Precautions

• Remove or monitor any equipment or items that could be harmful.
• Adhere to protocols and safety in hospital and outside in a home setting.

Prevent Fires and Burns

• Install systems for fires, with a plan in place and smoke detectors available to monitor all levels of care.
• Electrical safety.
• Monitor for overused plugs.
• Replace any missing plugs to protect electrical safety.

Adhering To Standard Infection Precautions

Sick children may be prone to infections. Hand wash always as well as tissues, following safety from outside.

• CDC can be an important asset to follow standards.

Adequate Sleep Support

• Children might have trouble sleeping that leads to pain.
• Comfort and care from family is helpful.

Sleep Pattern Education

• Note medications and the sleep habits
• Eighty percent of sleep time, goes through the first stages of REM, so the infants more time, while Adolescents have the lowest time.
• Cell function is key, and maintenance that comes from adequate hormone peaks for growth.

Stages of Sleep

• Sleep is categorized into NREM and REM sleep.
• NREM has multiple phases as well as REM.

NREM: Phase 1

• Feeling as if you falling/drifting as temperature and heart rate are low.
  • There will be alpha waves for the brain as electroencephalogram.

Phase II

• Is when the temperature decreases as well as heart rate as the child's state gradually deepens.

Phase III

• Temperature and heart rate decrease and the EEG tracing reveals mixed spindle and slow delta waves.
  • It might be very difficult to wake these kids at the stage, be aware that medications are planned before.

Phase IV

• Body systems begin to show steady (deta) waves.
• This is usually twenty to thirty minutes after sleeping is complete.
• A child will be at the stage for approx. 30 minutes.

REM Rapid Eye Movement

• At this point eyes are moving in rapid motions.
• Irregular respirations show the body turning and this is often the time for dreams.
• Although you see that the child may be waking, they really are sound asleep children may wake afraid and crying because of the sleep.

REM Sleep Differences When Awakened

• Children may have a hard time orientating sleep and also may become confused.
• Sleep can be found to be effective for them however, and important to prevent deprivation.

Sleep Deprivation Reasons

• During sleep deprivation disturbances occur leading too an increase in heart function.
  • Infants need sleep for brain development.
  • Like adults the lack of sleep.
• Both in children, like adults, causes trouble concentrating, disorientation, and misperception after about 4 days.
• Lack in Stage IV REM sleep causes fatigue and poor focus, while in adolescents.
• Lack of sleep can cause a slower recovery, and fatigue to exams or younger children if there is constant disruption.

Disturbed Sleep Pattern: Nursing Diagnosis and Intervention

• Medication is key.
• Ensure the child is sleeping in sleep schedule.

Chronic Sleep Problem Management

• Bedwetting sleep walking, sleep apnea are common in children and can all worsen due to lack of sleep and chronic issues.
• Sleep walking may include, but is not limited, to a period of stress that can be alleviated when the child is reassured to go back to sleep.
• Talking in the sleep can be common during the dreaming state.
• Comfort is important for both.
• Use of monitors may be required with sleep apnea.

Adequate Stimulation

• Help children respond to normal situations by doing the following that are in line with, and respect their basic and changing needs.
• Stimulation can be deprived when there is lack or over flow.
• Both can alter sensory and nervous feedback.

Deprivation

• Sensory or social stimulation should always be readily available.
• If there is a lack it may cause some confusion to some children.
• Those at high danger will be those confined to hospitals, hearing losses, medication, etc.

Deprivation: Prevention

• Provide support for those that are struggling, and make that available.
• Also look for outside resources to keep them engaged.

Overload

• May overload sensory output causing issues.
• Some environments might promote, and overwhelm the environment (NICUs).

Overload: Safety

• Support for children with sensory, and keep levels within normal limits .
• It can be as easy as changing and adjusting the rooms and the levels (lights and conversations).

Explore pediatric sleep stages, REM & NREM characteristics. Understand sleep deprivation impact and interventions for sleepwalking in children. Learn how to foster a sleep-friendly environment for hospitalized children.