The Hospitalized Child: Chapter 3

Chapter 3: The Hospitalized Child

• This section explores factors influencing a child's reaction to hospitalization, their fears/stressors, and responses based on developmental stage.

Core Concepts in Maternal and Child Health Nursing

• Factors affecting responses to hospitalization
• Major sources of fears and stressors of hospitalized children
• Responses to hospitalization

Factors Affecting Responses to Illness and Hospitalization

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

Major Sources of Fears/Stressors for Hospitalized Children

• Separation Anxiety
• Loss of control, influencing stress, threat perception, and coping skills due to physical restrictions, altered routines, and dependency
• Fear of bodily injury/pain, which is prevalent and can have long-term consequences

Stages of Separation Anxiety

• Protest: Occurs within hours to days, with aggressive reactions, loud crying, and rejection of others
• Despair: Lasts an indefinite time, marked by withdrawal, uncommunicativeness, and potential physical deterioration
• Denial/Detachment: Occurs after prolonged separation, where the child ignores parents, shows increased interest in the environment and forming new relationships

Children’s Responses to Hospitalization: Infants (0-12 months)

• Separation anxiety begins after 6 months
• Inconsistent care and disrupted routines lead to mistrust and decreased control
• Fear of bodily injury and pain

Children’s Responses to Hospitalization: Toddlers (1-3 years)

• Separation anxiety peaks, reacting with goal-directed behaviors
• Reacts with negativism, resistance, or regression from prolonged loss of autonomy
• Poor body image, reacting intensely to both painful and painless procedures, becoming restless, but able to communicate about pain near the end of this period

Children’s Responses to Hospitalization: Preschoolers (3-6 years)

• Separation anxiety is less obvious but intensifies with increased stress; they may express anger or refuse cooperation
• Egocentric and magical thinking impacts feelings of control, with fantasies of punishment related to illness
• Illness perception is influenced by cognitive abilities and external events with poorly developed body integrity, and a mutilation focus, while locating pain and using a pain scale

Children’s Responses to Hospitalization: School-Age (6-12 years)

• Can generally cope but has difficulty with added stressors and increased needs for security and guidance
• Middle-late school-age children are more worried about separating from peers and activities more than parents
• Loss of control from altered family roles, physical disability, and fear of death can be seen
• Demonstrating concern for disability, uncertain recovery, and privacy, while communicating pain intensity and location

Children’s Responses to Hospitalization: Adolescents (12-18 years)

• Separation from parents is welcomed, but peer group contact loss is a severe threat for status, control, or acceptance
• Anything hindering independence and self-assertion results in control loss
• Reactions to physical limitations include uncooperativeness and withdrawal
• Sensitivity to loss of control leads to concerns about body image and privacy, exhibiting self-control but reluctance to disclose pain

Communication Strategies: General Guidelines

• Comfort them with the nurse and objects
• Allow them to express their fears and concerns
• Speak clearly and in a quiet and calm voice at all times
• Be honest and set clear boundaries

Communication Strategies: Infants

• Hold, rock, and talk to them often
• Use a calm, soft, high-pitched voice
• Swaddle and secure them when upset, and always be responsive to cries

Communication Strategies: Toddlers

• Communicate with direct, short instructions
• Limit choices
• Tell them what you are doing
• Use play and comfort objects
• Give explanations just before the procedure
• Do procedures in the treatment room
• Use simple terminology and allow crying
• Restrain them, use a bandage, and offer a reward
• Praise the child

Communication Strategies: Preschoolers

• Offer choices whenever possible
• Speak in simple sentences
• Be brief, concise and allow them time to ask questions
• Explain what is happening
• Use toys and show them equipment or tools that will be used

Communication Strategies: Schoolers

• Set appropriate limits
• Reassure them, ease anxieties and promote conversation
• Use medical play, show them videos and photos
• Explain in clear words
• Grant composure and privacy

Communication Strategies: Adolescents

• Body image is very important, promote independence and let let them have privacy
• Use books or videos
• Talk to them about their interests
• Avoid any technical jargon
• Avoid all negative social behaviours

Nursing Care of the Hospitalized Child: Major Goals

• Prepare the child for hospitalization
• Reduce separation
• Maintain the child's sense of control
• Reduce the child's pain
• Encourage them, to participate in activities
• Maximize benefits of being hospitalised