This document discusses the stressors and reactions that hospitalized children of different ages may experience. It outlines John Bowlby's three stages of separation anxiety for infants and toddlers: protest, despair, and detachment. Symptoms of separation anxiety are described for infants, toddlers, preschoolers, scholars, and adolescents. The document also addresses parental and sibling anxiety when a child is hospitalized, as well as the role of nurses in supporting hospitalized children and their families.

1. Stressors and reactions of ill
hospitalized child
NIDHI CHAUHAN
M.SC NURSING PREVIOUS YEAR
GOVT. COLLEGE OF NURSING, JODHPUR

2. Introduction

4. Separation Anxiety / Anaclitic
Depression
 The major stress from middle infancy
throughout the preschooler years,
especially for children ages 6-30
months.
 John bowlby describes 3 stages of
separation anxiety as:-
1. Stage of protest
2. Stage of despair
3. Stage of detachment

6. Infant
 Separation anxiety disturbance in the development
of basic trust
 4-8month – depression and withdrawal
 Interference of growth and delayed development
 8-12 month– limited tolerance to separation
Evidenced by excessive cry and over dependence on
mother

7. Toddler
Protest
Frequent crying,
Shaking crib,
Rejecting nurses attention,
Urgent desire to find mother
Showing sign of distrust with
anger and tears.
Despair
Helpless
Apathetic
Anorectic
Looks sad cry continuously
Use comfort measures-thump
sucking
Tightly clenching the toys

8. Preschooler
Demonstrate separation anxiety by
refusing to eat, experiencing difficulty in
sleeping, crying quietly for their parents,
asking about parents.
Express anger by breaking toys.

9. Scholar
Concerned with fear, worry, fantasies, modesty
and privacy
Defense mechanism used is Regression,
separation anxiety, negativism Depression,
Suppression denial, phobia- unrealistic fear

10. Adolescent
 Concerned with problem of privacy
 Separation from peers, family, and school
 Interference with body image and independency or self
concept or sexuality
 Anger and uncooperative behavior
 Defense mechanism used are denial or withdrawal
rejection and depression

11. “
”
Loss of control

12. Infancy- Trust vs. Mistrust

13. Toddler- Autonomy vs. Shame and
Doubt

14. Preschooler –Initiative vs.
guilt

15. Scholar –Industry vs.
Inferiority

16. Adolescent- Identity vs. Role
confusion

17. Parental anxiety
 Factors affecting anxiety:-
 Seriousness of the disease
 Previous experience of illness
 Medical procedures
 Available support system
 Cultural and religious belief
 Communication pattern

18. Sibling anxiety
Being cared by outsiders like relatives,
neighbors
Receiving little information about ill sibling
Lack of parental affection
Separation anxiety
Fear of loosing love from parents

19. “
”
Play activities of
hospitalized child

20. Infants

21. Toddler

22. Preschooler

23. Scholar

24. Adolescent

25. Role of nurse
1 • Flexible visiting hours to reduce the separation anxiety
2 • Family centered care to make the child feel secure
3 • During the separation, nurse provide support by physical presence
4 • Provide favorable environment to reduce anxiety
5 • Encourage rooming-in
6 • Try to continue home routine of the ill child
7 • Provide warmth and support