Nursing Role in Child Health: Supporting Ill Children - PDF

UNIT 6 The Nursing Role in Supporting the Health of Ill Children and Their Families Roelin Richard P. Sual  Topics to be covered: The meaning of Illness to Children Care of the child with an Illness and their family in the Hospital. Nursing responsibiliti...

UNIT 6 The Nursing Role in Supporting the Health of Ill Children and Their Families Roelin Richard P. Sual  Topics to be covered: The meaning of Illness to Children Care of the child with an Illness and their family in the Hospital. Nursing responsibilities for care of the child who is ill and their family. Promoting safety for the child who is ill. Promoting adequate sleep for child who is ill. Promoting adequate stimulation for child who is ill. Promoting Play for child who is ill.  The meaning of Illness to Children Children's response to illness depends on how they think, what they've experienced before, and how much they know. As they grow, their understanding of illness changes based on their cognitive development—how they think and process information.  Young Children (Preschool to Early School- Age) Young children, like those in preschool or early grade school, usually know the names of body parts like the heart, lungs, and stomach. However, they don't fully understand how the body works together as a system. They may think that illness happens because of magical reasons or because they broke a rule (like not eating their vegetables). They may also believe that if they follow certain rules, like resting or taking medicine, they can get better.  School-Age Children (Early to Mid-Grade School) As children get a little older (around 6 to 10 years old), they start to understand more about how their body works. They know that the heart pumps blood, and the lungs help you breathe. But they still don’t fully understand how all parts of the body work together as a system until they are around 10 or 11 years old. At this age, children may begin to understand that germs can cause illness, and they may believe that if they follow healthy habits (like washing hands), they can prevent getting sick. They may feel like they don’t have much control over getting better and think that taking medicine or resting is all they need to do.  Older Children and Adolescents (Ages 12+) By the time children reach their early teens, they start to think more logically and understand illness better. They can see that illness can be caused by germs, but also by other things like vaccines or lifestyle choices (e.g., eating healthy or exercising). They now understand that the body works together as a system.  Nursing Implications Understanding how children think about illness at different ages is important for nurses. Children at different stages need different kinds of explanations and support. For example: For young children, nurses should use simple language and offer comfort (like a favorite toy) to help them feel less scared. For older children, nurses can explain more about germs and how the body works, but still in ways that are easy to understand. For adolescents, nurses can give more detailed explanations about illness and treatment, since they are better able to understand complex ideas.  continuation.... When a child is sick, it can be very stressful, especially if they need to stay in the hospital. How a child understands their illness depends on their age, and this affects how nurses should explain things and provide care. Words that sound the same but have different meanings, like “drawing” (a picture vs. blood), can also confuse children. This is why nurses need to be careful with their words. If the explanation isn’t clear, it might not help reduce the child’s stress or fear. In summary, children’s understanding of illness changes as they grow, and nurses should adjust their explanations to match the child's age and developmental level to help them feel less afraid and more informed.  DIFFERENCES IN RESPONSES OF CHILDREN AND ADULTS TO ILLNESS It's important to remember that children are not just "small adults" when we think about how they react to illness or healthcare. For example, their understanding of their body is different from adults. Children may not know which body parts are essential and which are not. If a preschool or early school-aged child is told their tonsils are being removed, it could make them scared. A better way to explain it might be to say that the doctors are going to "fix" their tonsils instead. This approach helps reduce fear and makes the idea less threatening for the child.  DIFFERENCES IN RESPONSES OF CHILDREN AND ADULTS TO ILLNESS Inability to Communicate Inability to Monitor Own Care and Manage Fear Nutritional Needs Fluid and Electrolyte Balance Systemic Response to Illness Age-Specific Diseases  DIFFERENCES IN RESPONSES OF CHILDREN AND ADULTS TO ILLNESS Inability to Communicate Young children under 5 often can’t describe symptoms like a headache, dizziness, or nausea because they don’t have the words for it. As children reach school age, they can describe symptoms more accurately. However, they may exaggerate or downplay symptoms depending on how serious they think the illness is or if it will affect something they want to do. It’s important to observe a child’s behavior as much as listening to their report. For example, a crying preschooler might have a symptom they can’t explain, and a school-aged child who tenses their stomach might be in pain, even if they don’t say so.  DIFFERENCES IN RESPONSES OF CHILDREN AND ADULTS TO ILLNESS Inability to Monitor Own Care and Manage Fear Unlike adults, children can’t keep track of their medications or procedures because they may not know what’s scheduled or when. They also have unique fears, like separation from parents, the dark, or medical procedures. As they get older, school-aged children and teens may worry about losing body parts, life, or friends. Adults usually have past experiences to help them cope, but children in a hospital setting haven’t learned how to manage stress yet. Without support, this can lead to post-traumatic stress disorder (PTSD) or other issues like trouble sleeping, anger, or physical symptoms. Trauma-informed care helps reduce stress and leads to better health outcomes for children.  DIFFERENCES IN RESPONSES OF CHILDREN AND ADULTS TO ILLNESS Nutritional Needs Children are very different from adults, both psychologically and physiologically. They have higher metabolic needs, breathe in more air per pound of body weight, and have a higher surface area compared to their body mass. This makes them more prone to fluid loss when they’re sick. Because children grow rapidly, they need more nutrients (like calories, protein, vitamins) per pound of body weight than adults. For example, infants need 120 kcal per kg of body weight each day, while adults only need 30 to 35 kcal. If a sick child can’t eat due to nausea or vomiting, they might need IV fluids in the hospital, something that wouldn’t be necessary for an adult in the same situation.  DIFFERENCES IN RESPONSES OF CHILDREN AND ADULTS TO ILLNESS Fluid and Electrolyte Balance In adults, about 23% of body water is in the extracellular space (plasma and outside cells), while in newborns, it's closer to 40%. This means infants have less water stored in their cells and are more likely to lose a dangerous amount of water from diarrhea or vomiting.  DIFFERENCES IN RESPONSES OF CHILDREN AND ADULTS TO ILLNESS Systemic Response to Illness Young children often respond to illness in a more general way, affecting their whole body, not just one area. For example, a child with pneumonia might go to the emergency room not just because of a cough, but because of symptoms like fever, vomiting, and diarrhea. These symptoms are common in children with many types of illnesses, making it harder to diagnose the exact cause. Systemic reactions like these can delay treatment and lead to more fluid and nutrient loss, making the illness worse.  DIFFERENCES IN RESPONSES OF CHILDREN AND ADULTS TO ILLNESS Age-Specific Diseases Most adults are immune to common infections, but children are more vulnerable to diseases like measles, mumps, and chickenpox. Children between 6 months and 5 years old who have a fever and no brain or metabolic issues are often diagnosed with a febrile seizure.  Care of the Child With an Illness and Their Family in the Hospital Preparing for hospitalization involves sharing age- appropriate information, fostering communication, and building trust with healthcare providers (Nadeau et al., 2016). While emergencies like febrile seizures, appendicitis, poisoning, or asthma attacks prevent advance preparation, planned hospitalizations (e.g., elective surgeries) allow for preoperative orientation. Parental preparations depend on the child’s age and prior experiences.  Care of the Child With an Illness and Their Family in the Hospital For children aged 2–7, tell them about the hospitalization as many days in advance as their age (e.g., a 2-year-old, 2 days before). Children over 7 can be informed as soon as possible. Avoid sudden silence or spelling out words, as this can cause anxiety. On admission day, ask parents about their preparations to ensure understanding of the child’s condition and procedures. Provide additional health teaching and clarify any misunderstandings as needed.  Care of the Child With an Illness and Their Family in the Hospital Many hospitals offer orientation programs for children or school groups, discussing what to expect during hospitalization. These programs, led by nurses, help reduce fear and prepare children for potential emergencies. Nursing Care Planning Tips for Effective Communication  Nursing Responsibilities for Care of the Child Who Is Ill and Their Family PROMOTING GROWTH AND DEVELOPMENT OF THE CHILD WHO IS ILL. “Children may sustain a delay in growth and development because of an illness, injury, and/or hospitalization.”  Nursing Diagnoses and Related Interventions Nursing Diagnosis: Risk of altered growth and development related to the effects of illness, injury, and/or hospitalization. Outcome Evaluation: - Child demonstrates only limited signs of regression to previous stage; is able to continue doing the activities most recently accomplished. - Illness/injury represents a crisis event, and, in a crisis state, children, like adults, can grow from the experience or, in contrast, can be overwhelmed and regress.  The Infant Who Is Ill/Injured To support infant growth and development:  stick to their home routine for security and trust.  Swaddling (up to 4 months) can help, and private NICU rooms improve parent satisfaction by reducing noise and stress (Tandberg et al., 2019).  Avoid introducing new foods during illness unless the child has failure to thrive or is underweight.  Support breastfeeding or provide guidance on expressing and storing milk for its nutritional and immune benefits.  Offer age-appropriate play and stimulation.  The Toddler or Preschooler Who Is Ill/Injured Illness can limit children’s independence, so:  encourage autonomy in toddlers and preschoolers by letting them make choices about their care. For example, instead of asking, “Do you want your medicine?” ask, “Which medicine do you want first, the white or pink one?”  Toddlers and preschoolers may resist hospital cribs. Explain that “all beds here have side rails” and monitor them to prevent climbing. If needed, use a high-climber crib or a bed for safety.  Avoid changing eating habits during illness. Let toddlers and preschoolers self-feed at a small table, and supervise group meals to ensure they eat their own food. Eating with a parent can help.  Avoid starting toilet training during illness, but continue if already begun, expecting possible regression.  The School-Aged Child Who Is Ill/Injured Ill school-aged children need to maintain a sense of industry and independence. Explain procedures and involve them in care planning to promote self-care and control. Self-care involves activities individuals do to maintain their health and well-being (Orem, 2001). Hospitalized children may feel socially isolated from family, friends, and school. Continue schooling as possible, and use technology to stay connected and learn (Maor & Mitchem, 2020). Maintaining routines provides security. Encourage moral and spiritual practices for comfort. Let them perform self-care and, if at home, help with household tasks to NURSING INTERVENTIONS TO MEET CHILDREN’S SPIRITUAL NEEDS  The Adolescent Who Is Ill/Injured Illness can challenge an adolescent’s sense of identity. Encourage them to continue activities, self-care, and hygiene to maintain stability and self-esteem. Hospitalization may disrupt peer relationships, so suggest electronic communication and welcoming visitors to stay connected. Adolescents may prefer staying in an adolescent unit or a room without childish decor. Parents may feel anxious, but adolescents might not want them present all the time. Adolescents often hide fears, so listen carefully and offer support. Address body image concerns by explaining surgeries and procedures clearly. Connecting them with peers who’ve had similar experiences, under professional supervision, can also help.  PROMOTING NUTRITIONAL HEALTH OF THE CHILD WHO IS ILL/INJURED Nurses help ill children by ensuring they get the right nutrition to heal, fixing any nutritional deficiencies, and encouraging families to follow the care plan. This includes measuring fluid intake and output, and providing feedings through tubes or intravenous nutrition if needed.  Nursing Diagnoses and Related Interventions Nursing Diagnosis: Malnutrition risk, less than body requirements, related to lack of adequate nutritional intake or increased caloric expenditure. Outcome Evaluation: Child will exhibit no further weight loss and, if malnourished, will increase weight as appropriate for age. The child will maintain adequate nutritional status as evidenced by weight within the normal range for age. AREAS TO CONSIDER WHEN PLANNING NUTRITION FOR ILL CHILDREN  Encouraging Fluid Intake Increasing oral fluids is crucial for children at risk of dehydration. Follow the healthcare provider’s instructions, which should specify the total daily amount, type of fluid, and serving size based on the child’s age and weight.  Encouraging Fluid Intake  Offer small, full glasses of fluid frequently, as young children judge by container size, not amount.  Choose their favorite fluids if appropriate, and include popsicles and Jell-O as fluid sources.  Clear fluids (e.g., water, ginger ale) are easier to drink than thicker ones (e.g., milkshakes).  For mouth sores, offer soothing drinks like milk or Pedialyte popsicles, and avoid acidic or carbonated drinks.  Ice chips count as half their volume in fluid.  Support breastfeeding if applicable.  Use straws if allowed, and make drinking fun with games like “Simon Says” or board games that encourage fluid intake. Gaming can also teach healthy eating habits (Uzsen & Basbakkal, 2019).  Encouraging Food Intake Calorie counting tracks the calories a child eats daily. Record all foods, snacks, and drinks, specifying amounts (e.g., "half a slice of whole wheat toast," not "some toast"). A dietitian will analyze the list to determine caloric intake.  Promoting Safety for the Child Who Is Ill A prime consideration of nursing interventions is to keep children safe during illness care.  Nursing Diagnoses and Related Interventions Nursing Diagnosis: Injury risk related to procedures or therapy necessary for care. Outcome Evaluation: Child remains free of injury, such as a fall from bed or injury from medical equipment. Promoting child safety is a key responsibility for healthcare providers. When caring for an ill child at home, assess home safety, offer guidance, and plan for emergencies. For example, ensure a child in a wheelchair can call for help (e.g., counter-level or cell phone) and create an evacuation plan for emergencies like fires.  Nursing Diagnoses and Related Interventions Safety on a children’s unit or in a clinic is the responsibility of all those in the healthcare setting. Important steps to follow to make a child’s healthcare environment safe include: Know the whereabouts of all children in your care. Ensure that doors or gates are provided near stairways or elevators. Ensure that doors of healthcare facilities have working alarms to prevent children from exiting and to prevent intruders from entering. Be sure windows are covered by screens or guards to prevent falls.  continuation... Check that the side rails of beds and cribs are in good repair, raised appropriately, and locked. Always raise bedside rails after a child has received preoperative or sedative medication. Test a crib rail after it is raised to ensure the lock has caught so that the rail will remain raised. Keep bedside tables or stands away from cribs to prevent them from being used for climbing. Provide high climber cribs or enclosed cribs for small children to prevent them from climbing out of bed.  continuation... Fasten the seat belt restraint for infants in high chairs. Never leave an infant in a high chair (at home or in a hospital) without someone close enough to reach the child because infants can easily squirm out of a high chair restraint. Ensure that electrical cords or appliances such as hair dryers are not used in bathrooms, where they could come in contact with water. Be careful of the placement of television/call cords or window blind cords so they cannot lead to strangulation. Never leave a child alone in a bathtub; they could turn on the hot water and scald themselves or slip under the water and drown.  continuation... Never leave equipment or items that would be harmful to eat within the reach of children. Adhere to all fire precaution measures. Closely follow standard infection precautions to prevent the spread of infections.  Promoting Fire Safety Fire safety is crucial for children at home and in hospitals. Ensure a fire action plan is in place and known by everyone. Install smoke detectors on each home level and place children’s bedrooms downstairs for easier evacuation and self-care. Use free fire department decals on windows to help locate children during emergencies. For electrical safety, avoid using damaged or ungrounded equipment, and use three-pronged plugs. Do not overload circuits. Cover unused outlets with safety caps to prevent toddlers from inserting objects or fingers.  Adhering to Standard Infection Precautions Follow standard infection precautions in all healthcare settings to protect children, families, and staff (CDC, 2021b). Sick children, especially those with weakened immune systems, are more vulnerable to infections like MRSA. Prevent spread by practicing proper handwashing, disposing of tissues and waste safely, and limiting exposure to others.  Promoting Adequate Sleep for the Child Who Is Ill Ill children need plenty of rest to help their bodies heal and grow. However, they may have trouble sleeping due to pain, discomfort, medications, or a strange hospital setting. Children recovering from trauma may have nightmares, which also disrupt sleep. Encourage parents to stay with their child for comfort, but note that parents may also struggle to get enough sleep themselves, which can affect their ability to support their child.  SLEEP PATTERNS Sleep is affected by anxiety, health, habits, medication, and environment. Children first enter non-rapid eye movement (NREM) sleep, making up 80% of sleep time, progressing through stages I to IV over 20–30 minutes. Rapid eye movement (REM) sleep follows. Infants spend most sleep time in REM, while adolescents have the least.  SLEEP PATTERNS NREM sleep, especially stages III and IV, supports body restoration, cell repair, and growth. Growth hormone peaks during this phase, aiding protein synthesis and cell maintenance, while stress hormones are low. REM sleep’s purpose is less clear but may help with vision coordination, tension release, and memory integration. Vital signs drop during NREM sleep but rise during REM, possibly preventing them from falling too low.  STAGES OF SLEEP IN CHILDREN Stage Description Nursing Implications Non–rapid A feeling of drifting or falling. Often A child can be awakened eye movement described easily from this early sleep (NREM) stage I as twilight sleep. Temperature and heart by the slightest noise or rate decrease slightly; silent presence electroencephalogram (EEG) waves show of another person in the peaked, frequent (alpha) waves. room. Reduce noise level in the room to promote sleep. NREM stage II Sleep deepens. Temperature and heart rate It is more difficult to wake a decrease slightly more. child from sleep when in this stage. NREM stage III Sleep deepens still further. An EEG tracing It is very difficult to wake a reveals mixed spindle and slow (delta) child from stage III sleep. Use waves. Temperature and heart rate patience to wake a child fully decrease further. This period lasts about 10 before min. providing medicine  STAGES OF SLEEP IN CHILDREN Stage Description Nursing Implications NREM stage IV Approximately 20–30 minutes after Children may be confused beginning and unable to orient to fall asleep, a child enters stage IV sleep. themselves readily if Respirations and heart rate slow even awakened from stage IV more, sleep. Use patience until and blood pressure and temperature a child is fully awake, decrease; EEG shows slow, steady (delta) particularly if asking a waves. Children remain at a stage IV sleep question. level for approximately 30 minutes and then progress back through stages III and II until they then pass into a phase of REM sleep Rapid eye Eyes move in rapid, involuntary motions. Dreaming occurs during movement Respirations are irregular; body turnings, REM sleep. Although children movements, and penile erections may appear to be close to waking occur. because of the active eye Lasts 10–30 minutes and then a new sleep movements, they are really cycle with NREM sleep begins. very soundly asleep. Children may  SLEEP DEPRIVATION Infants need sleep for brain development. Sleep disturbances can affect heart function and increase apnea (Barbeau & Weiss, 2017; Eichelberger & Nelson, 2020). Lack of sleep in children, like adults, can cause trouble concentrating, disorientation, and misperception after about 4 days. REM sleep loss leads to irritability and poor focus, while lack of stage IV NREM sleep causes fatigue, apathy, and slower recovery. This can happen to adolescents during exams or younger children during illness if frequent treatments disrupt sleep.  Nursing Diagnoses and Related Interventions Nursing Diagnosis: Disturbed sleep pattern related to timing of medication, discomfort, or sleep disorder. Outcome Evaluation: Child sleeps through the night without interruption (when therapeutic regimen allows); is alert and active during the day; is able to take a nap during the day if that is part of their usual sleep schedule. Sleep is vital for ill children. Ensure they can rest by managing pain, keeping their bedtime routine, and creating a sleep-friendly environment (dim lights, quiet, familiar items). Many units schedule quiet naptimes with limited interruptions. For older children, engaging daytime activities can help improve nighttime sleep.  Managing Chronic Sleep Problems Some children have chronic sleep issues like night terrors, bedwetting, sleepwalking, sleep talking, or sleep apnea, which can worsen with illness and increase sleep deprivation (Eichelberger & Nelson, 2020). Sleepwalking, common in children, often happens during deep NREM sleep and may increase during illness due to stress. Gently wake and reassure sleepwalkers, then return them to bed. Use side rails for safety and reassure parents it’s usually harmless and temporary.  Managing Chronic Sleep Problems Sleep talking occurs during REM sleep, often when dreaming. Night terrors, more common in toddlers, cause children to wake screaming shortly after falling asleep. Comforting them helps everyone return to sleep, and they usually don’t remember it in the morning. Sleep apnea, pauses in breathing during sleep, is more common in obese children and linked to SIDS or failure to thrive (Moon, 2016). Infants with sleep apnea may use monitors to track breathing.  Promoting Adequate Stimulation for the Child Who Is Ill Children constantly interact with their internal environment (body) and external environment (surroundings) using their five senses and central nervous system. This helps them respond to changes and meet basic needs. Illness can disrupt this ability, leading to: Sensory deprivation (not enough stimulation) or Sensory overstimulation (too much stimulation). In short: Illness can mess with how kids sense and respond to the world, causing sensory issues.  Sensory deprivation - Happens when children lack enough sensory, social, physical, or cognitive stimulation. This can lead to confusion, difficulty making decisions, and depression. Some children are more at risk, such as:  Ill children confined to homes or hospitals, replacing active activities with screen time.  Children with hearing, vision, or nerve issues (e.g., from chemotherapy) who may lose touch, taste, or spatial awareness, causing withdrawal.  Children on medication that reduces awareness of their environment.  Sensory deprivation To help, provide diverse, accessible activities and use orientation cues (e.g., mentioning the time or day) to keep them engaged. In short: Lack of stimulation can harm kids’ development, but varied activities and clear communication can help.  Sensory overload Happens when children get more stimulation than they can handle. Like sensory deprivation, it can cause confusion, trouble making decisions, and extreme tiredness. It’s hard to tell the difference between the two without careful assessment. For example: ICU lights that never turn off and constant noise (machines, alarms, voices) can overwhelm children. In NICUs, excessive noise can affect premature babies’ brain function, causing issues like changes in cortisol levels, apnea, and heart rate fluctuations.  Sensory overload To reduce overload:  Keep noise levels low (45 dB during the day, 35 dB at night).  Use indirect lighting, limit conversations, and create "quiet times" by covering incubators. In short: Too much stimulation can overwhelm kids, but reducing noise and light can help.