Family-Centered Care of the Child During Illness and Hospitalization
Family-Centered Care of the Child During Illness and Hospitalization
- Stressors of hospitalization and children’s reactions
- Separation anxiety
- Protest phase
- Behaviors observed during later infancy include
- Crying
- Screaming
- Searches for parent with eyes
- Clinging to parent
- Additional behaviors observed during toddlerhood
- Verbally attacks strangers (e.g., “Go away”)
- Physically attacks strangers (e.g., kicks, bites, hits, pinches)
- Attempts to escape to find parent
- Attempts to physically force parent to stay
- Behaviors may last from hours to days.
- Protest, such as crying, may be continuous, ceasing only with physical exhaustion.
- Approach of stranger may precipitate increased protest.
- Despair phase
- Observed behaviors include
- Is inactive
- Withdraws from others
- Is depressed, sad
- Lacks interest in environment
- Is uncommunicative
- Regresses to earlier behavior (e.g., thumb sucking, bed-wetting, use of pacifier, use of bottle)
- Behaviors may last for variable length of time.
- Child’s physical condition may deteriorate from refusal to eat, drink, or move.
- Detachment phase
- Observed behaviors include
- Shows increased interest in surroundings
- Interacts with strangers or familiar caregivers
- Forms new but superficial relationships
- Appears happy
- Detachment usually occurs after prolonged separation from parent; it is rarely seen in hospitalized children.
- Behaviors represent a superficial adjustment to loss.
- Effect of hospitalization on the child
- Post-Hospital Behaviors in Children
- Young Children
- They show initial aloofness toward parents; this may last from a few minutes (most common) to a few days.
- This is frequently followed by dependency behaviors:
- Tendency to cling to parents
- Demands for parents’ attention
- Vigorous opposition to any separation (e.g., staying at preschool or with a babysitter)
- Other negative behaviors include the following:
- New fears (e.g., nightmares)
- Resistance to going to bed, night waking
- Withdrawal and shyness
- Hyperactivity
- Temper tantrums
- Food peculiarities
- Attachment to blanket or toy
- Regression in newly learned skills (e.g., self-toileting)
- Older Children
- Negative behaviors include the following:
- Emotional coldness followed by intense, demanding dependence on parents
- Anger toward parents
- Jealousy toward others (e.g., siblings)
- Risk factors that increase children’s vulnerability to the stresses of hospitalization
- “Difficult” temperament
- Lack of fit between child and parent
- Age (especially between 6 months and 5 years of age)
- Male gender
- Below-average intelligence
- Multiple and continuing stresses (e.g., frequent hospitalizations)