Pediatric Developmental Considerations for VAD Insertion PDF

# F. PEDIATRIC DEVELOPMENTAL CONSIDERATION ## Table 6. Developmental Stages AND VAD Insertion Approaches^12,17 | Age | Developmental Stages | Age-Related Behaviors | Emotional Support | Procedural Support or Sedation | |---|---|---|---|---| | 0-18 Months | Trust vs. Mistrust Infancy | M...

# F. PEDIATRIC DEVELOPMENTAL CONSIDERATION ## Table 6. Developmental Stages AND VAD Insertion Approaches^12,17 | Age | Developmental Stages | Age-Related Behaviors | Emotional Support | Procedural Support or Sedation | |---|---|---|---|---| | 0-18 Months | Trust vs. Mistrust Infancy | Major Fears: * Separation anxiety * Fear of strangers > 6 months * Object permanence at 9 months: realizes when parent or object is missing. | Support parents Encourage presence if beneficial Communicates by crying Provide a calm environment preferably not in child's bed Limit the number of providers to minimum needed for success | | | 0- 18 Months, cont. 18 Months - 3 Years Early Childhood | Autonomy VS Shame and Doubt | Major Fears: * Separation anxiety (from parents or primary caregivers) * Loss of control * Egocentric (It's all about me!) | Support parents Encourage presence if beneficial Provide a calm environment preferably not in child's bed/room Simple instructions to child using non-threatening vocabulary (Words matter) Limit the number of providers to minimum needed for success | Distraction: * Bubbles, lighted spinners, music * Child Life Specialist when available * Pacifier (if still using) * Comfort item * Topical anesthetics * Cold and Vibration * Comfort Positioning * Distraction: * Bubbles, Lighted spinners, music, books * Mild sedation/ anxiolysis | | 2 - 5 Years Preschool | Initiative VS Guilt | Major Fears: * Bodily injury/ mutilation * Loss of control * Fear of the unknown, the dark, and being left alone Follows directions but has short attention span | Support parents Encourage presence if beneficial Provide a calm environment preferably not in child's bed/room Offer 2 choices when possible and let the child decide. Do you want to sit on mom's lap or your bed? Simple instructions to child using non-threatening vocabulary (Words matter) | Child Life Specialist when available * Comfort item * Topical anesthetics * Cold and Vibration * Comfort Positioning * Distraction: * Bubbles, Lighted spinners, Music, Books * Mild sedation/ anxiolysis * Moderate sedation with monitoring | | 3 - 5 Years, cont. 6 - 12 Years School Age | Industry VS Inferiority | Major Fears: * Bodily injury and mutilation * Loss of control * Not being able to live up to expectations of important others * Death Capable of following directions and can be involved in treatment | Praise often for cooperation Limit the number of providers to minimum needed for success * Support parents * Encourage presence if beneficial * Provide a calm environment preferably not in child's bed/room * Offer choices when possible and engage child in treatment * Simple instructions to child using non-threatening vocabulary (Words matter) * Praise often for cooperation * Limit the number of providers to minimum needed for success | * Child Life Specialist when available * Comfort item * Topical anesthetics * Cold and Vibration * Comfort Positioning * Distraction: * Bubbles, Lighted spinners, Music, books * Mild sedation/ anxiolysis * Moderate sedation with monitoring | | 13 - 18 Years Adolescence | Identity VS Role Confusion | Major Fears: * Very conscious of body image and appearance * Fearful of something happening that will make him/her different from peers * Increasingly capable of abstract thought and reasoning * Taking more responsibility for decisions | Prepare ahead of time with accurate information Provide and guard PRIVACY Include and encourage to participate in discussion re: his or her condition honestly and explain consequences of decisions or procedures | * Made possible by Childrens Hospital * Child life Specialist when available * Sucrose * Pacifier * Comfort item * Topical anesthetics * Cold and vibration * Comfort * Positioning * Distraction: * Videos, music, guided imagery, breathing techniques * Massage/ pressure * Mild sedation/ anxiolysis * Moderate sedation with monitoring | The image is a table describing the different developmental stages of children and how to approach inserting a vascular access device (VAD). It also explains the fears of each age group.