child in the hospital/healthcare setting

• Nurses can use play therapy as a way to distract or comfort children during painful procedures.
• Children may experience anxiety when they are separated from their parents or caregivers.
• Separation anxiety is common among young children who have not yet developed a sense of independence.
• regression is the most common coping mechanism of all ages
• regression begins within hours of hospitalization or time in urgent care
• children are mainly hospitalized for respiratory issues
• giving children options and allowing them to make choices encourages individualism and relieves anxiety
• a normally continent child becoming incontinent after being hospitalized is an example of regression
• factors that affect a child's response to the hospital setting include their stage of development, support people available, and their own experiences with previous hospitalizations
• signs of regression in children include increased dependency, thumb sucking/ use of a bottle, loss of bowel and bladder control, and desire for immediate gratification
• regression should not be punished
• the phases of separation anxiety are protest, despair, and denial/detachment
• during the protest phase, the child may be aggressive; this is proof of a caring parent-child relationship
• during the despair phase, the child may seem depressed and withdrawn, refuses to play, eat, and drink, and may be mistaken as "well-adjusted"
• during the denial/detachment phase, the child may seem resentful or angry toward the parents, repress their feelings, and superficially cling to others they're less familiar with
• parents should never sneak out or lie when they have to leave, this increases separation anxiety
• keep the same nurse around and incorporate the child's daily routine as much as possible to create trust
• posthospital behaviors like regression, resentment, dependency, and anorexia are common and can last from 7-10 days
• nursing interventions for regression:

  approach them at the appropriate developmental stage

  provide developmentally appropriate activities

  encourage the expression of feelings

  teach parents

  provide positive reinforcement
• nursing interventions for separation anxiety:

  allow the child to protest

  encourage room-in

  provide their own security object