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1. Unit- VII Care of child &
family during hospitalization
Presented by
Mr. Zaigham Abbas
Lecturer

2. Objective
Explain the impact of hospitalization on the child and
family and related Nursing Care Approaches:
Stressor and reaction related to developmental stage.
Stressor and reactions of the family of the child who is
hospitalized.
Nursing care of a child who is hospitalized.
Nursing care process of child and family with
hospitalization
Medication administration to children (clinical).

3. Introduction
• Hospitalization creates physical and psychological stress
for children, their parents and siblings
• Parents may provide comfort or they may create
additional stress for child if they are anxious
• Most care and supportive services are focused on
patients, however reducing parents stress will make
them supportive for staff in favor of their hospitalized
child.

4. Risk factors
• “Difficult” temperament
• Lack of fit between child and parent
• Age (especially between 6 months and 5 yrs)
• Male gender
• Below-average intelligence
• Multiple and continuing stresses (e.g., frequent
hospitalizations)
• Urban Vs rural children
• Childs’ Pain experience

5. Stressors of pediatric population
• More serious and complex problems
• Fragile newborns
• Children with severe injuries
• Children with disabilities who have survived
because of increased technologic advances
• More frequent and lengthy stays in hospital

6. Stressors of hospitalized child
• Separation anxiety
• Loss of control and loss of autonomy
• Physical harm includes pain, injury to the body .

7. Recreation towards separation anxiety
• Children alone in the hospital display severe behavior
problems
• Three phases of separation anxiety can be seen
• Protest phase
Cry and scream, run for their parents
• Despair phase
Crying stops; withdraw, depressed, regress , non
communicative
• Detachment/ Denial phase
Superficial adjustments / and relationship May
seriously affect attachment to parent after discharge,
however this is rare

8. Minimizing separation
What hospital can do?
• Allow at least one parent, ( rooming in )
• Involve father in the care
• Primary nurse or consistent staff
• Positive attitude of staff with parents and children
• Use of appropriate words , eye contact , establish
rapport
What parents can do? need to bring favorite articles, toys,
piece of cloth
• For older children family photographs, radio etc
• School age, school lesson, allow calling friends , favorite
activates like Ludo

9. Reaction of child to body injury
• O-6 months: Cry, body movement, grimace
• 6-12 months: Resistance, uncooperative, grimace
• 1-3 years: Aggressive behavior
• 3-5 years: verbal Abuse/hit parents
• 5-12 years: Fear of disability, concerns for privacy, use
words to describe pain
Muscle rigidity, may behave like young child
• >12 years: Fear of effects on body image, they question

10. Preventing body injury
• All children fear body injury except early
infancy
• Manipulate procedural techniques
• Prepare children for painful procedures
(use of doll or teddy bear).
• Use of bandages for preschoolers
• For schools children and adolescence ask to
draw what they think will happen to them
• Explain according to their cognitive level

11. Reaction toward loss of control
• Feeling of LOC result from separation, physical
restrictions, rigid hospital schedules, unfamiliar
environment, child magical thinking, altered daily rituals
and altered family roles
• Infants’
may develop mistrust later in life
trust is developed if consistent loving
Caregivers, Daily routines
• Toddlers
Loss of control may contribute to:
Regression of behavior, Negativity,
Temper tantrums in toddlers

12. Conti…
Preschooler
• Egocentric and magical thinking
• typical of age, May view illness or hospitalization as
punishment
School Age
• Striving for independence and productivity, Fears of
death, or permanent injury, Boredom
Adolescents
• Struggle for independence and liberation, Separation
from peer group. May respond with anger, frustration.
Need for information about their condition

13. Minimizing loss of control
Promote freedom of movement
• Preserve parent child contact
▫ Allow physical examination in parents lap hugging
while otoscopy, ↑ mobility and , Sensory stimulation if
freedom impossible
Maintain child's routine
• Collect baseline data, such as food preferences
• Time structuring for school child (Procedure time,
TV time lesson time)
Encourage independence
• Allow decision making , do not threaten by loss of
control be flexible, continuation in daily routines and
rituals.
Promote understanding

14. Sibling reactions
• Fear of contacting illness
• Missing elder or your sibling
• Unclear/ doubts about sick child
• Perceived changes in parenting
• experience loneliness, fear, and worry
• They feel anger and jealousy
• Guilt
• They should be given correct information
through parents

15. Altered family roles
• Working parents affect on their job
• Anger and jealousy between siblings and ill child
• Ill child obligated to play sick role
• Parents continue pattern of overprotection and
indulgent attention

16. Parental Response to Stressor of
Hospitalization
Disbelief, anger, guilt
• Especially if sudden illness
Fear, anxiety
• child’s pain, seriousness of illness
Frustration
• Especially r/t need for information
Depression
• Encourage them for relief for brief periods
• Let them ventilate and cry , tell them it is Ok to
cry

19. Caring of Family of Hospitalization
• Assess
• Seriousness of child illness
• Family's previous experience
• Medical procedure
• Need for home care
• Encourage rooming in
• Positive attitude, unrestricted visiting hours
• Include them in child care
• Support Verbally and nonverbally
• Provide information about disease treatment and
sibling reactions, recreation

20. Normalizing the hospital environment
• Maintain child’s routine, if possible
• Time structuring
• Self-care (age appropriate)
• School work
• Friends and visitors

21. Pain
“Pain is whatever the experiencing person says it is,
existing whenever the person says it does.”
• This includes VERBAL and NONVERBAL expressions of
pain
• Facts : Children are under treated for pain as health
professionals fear of the child becoming addicted or
getting respiratory depression with pain medication
• Fallacy : newborn don’t feel pain
• PRN means no or limited need for pain medication

22. Principles of pain assessment
• Use a pain rating scale (Faces)
• Not all pain rating scales are reliable or appropriate for
children
• Should be age appropriate
• Consistent use of same scale by all staff
• Familiarize child with scale
• Evaluate behavioral and physiologic changes
• Secure parent’s involvement
• Take the cause of pain into account
• Take action and evaluate results

23. Non-pharma interventions
• Based on age
• Swaddling, pacifier, holding, rocking
• Distraction
• Relaxation, Cutaneous stimulation
• Provide pain medication

24. References
Hockenberry,J.M.. (2005). Wong's essentials of
pediatric nursing (7th. ed). Elsevier: Mosby.
Wong, D.L. (1999). Whaley and Wong’s Nursing
Care of Infants and Children. (6thed).
St.Louis: Mosby.