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)