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)