Care of the Hospitalized Child

• Hospitalization can be traumatic for children
• Children react based on their developmental level
• Hospital experience can lead to feelings of distrust and lack of control
• Children feel lack of control and perceive hospital experience as a threat
• Separation anxiety occurs in ages 6-36 months
• Functions of play

  • Creativity
  • Sensorimotor development
  • Intellectual development
  • Socialization and moral development
  • Self-awareness
  • Distractibility from stress, anxiety, and tension
• Types of play for various age groups

  • Infant
  • Toddler
  • Preschool
  • School age
  • Adolescent
• Providing a safe environment

  1. Teaching parents about safety measures

  2. Pain management strategies and pharmaceutical interventions
• Reactions

  • Stranger anxiety: anxiety with presence of stranger
  • Regression: behavior associated with younger developmental stage
  • Sleep deprivation
• Factors affecting hospitalization

  • Bed selection
  • Visiting hours
  • Parents at the bedside
  • Child’s age
  • Nature of the disease process
  • Parental employment
  • Availability of extended family members
  • Trust in the hospital safety system
  • Presence of a Child Life Specialist
  • Cultural and ethnic norms and practices
  • Sibling reactions to hospitalization
  • Meals
  • Safety with alarm systems
  • Sensory impairment
• Functions of medical play

  1. Accomplish therapeutic goals

  2. Express emotions and fears

  3. Master the unknown

  4. Express fear and anger

  5. Learning opportunity
• Providing a Safe Environment

  1. Teaching parents:

  2. How to use the call bell

  3. Symptoms or clinical signs to report

  4. How and when to call for help

  5. How to use side rails on cribs

  6. Supervised ambulation

  7. Never walk barefoot

  8. Do not sleep with infants or young toddlers in beds
• Pain Management


  1. Pain assessment considers three areas:

  2. Physiologic indicators

  3. Behavioral aspects of pain

  4. Results of pain tool assessments

  5. Assessment of pediatric responses to pain

  6. Response to pain and assessments of pain differ based on age

  7. Pain tools:

  8. Objective: infants

  9. Subjective: pre-schoolers, school-age children, and adolescents

  10. Pharmaceutical interventions:

  11. Double-check infant & young children’s pain medication doses with second nurse

  12. Involve the parents in the assessment and management of pain

  13. Understand pain is a unique experience and expressions vary

  14. Document non-pharmaceutical and pharmaceutical interventions

  15. Use topical anesthetics as appropriate

  16. Be aware of how cultural considerations influence pain
• Hospital Procedures With Children in Mind

  1. Hospitalized child may require IV hydration or IV medications through peripheral or central line

  2. Safety steps for IV:

  3. Prevent accidental bolus of fluids or drugs

  4. Prevent medication infiltrations

  5. Prevent strangulation in young child

  6. Prevent tissue injury by assessing and reporting child who is crying inconsolably or is fussy
• Feeding Considerations for Sick and Hospitalized Children

  1. Family to bring food from home

  2. Allow child to select foods from hospital food service

  3. Before and after procedure, children are NPO

  4. Progress to clear fluids, then full liquid, then soft diet, then regular diet

  5. Adhere to prescribed diet

  6. Provide gastrointestinal feeds as prescribed

  7. Monitor intake and output
• Discharge Procedures

  1. Provide teaching and discharge instructions about all care required after the hospitalization

  2. Teach specific skills, dressing changes, medication administration

  3. Remind about follow-up visits

  4. Provide the parents with:

  5. A follow-up appointment

  6. Referrals to specialists or specialized services

  7. Prescriptions

  8. All the child’s belongings from the room
• Child Abuse
• Child abuse defined as intentional injury or maltreatment
• Child maltreatment: abuse of children younger than 18 years, by parent, person in custodial role, or caregiver
• Neglect is a common form of child maltreatment globally
• Neglect: failure to provide for basic needs when means are present
• Mandatory reporters of child abuse include healthcare providers
• Child abuse

  Intentional injury or maltreatment
• Child maltreatment

  Abuse of children younger than 18 years, by parent, person in custodial role, or caregiver
• Neglect

  Failure to provide for basic needs when means are present
• Mandatory reporters of child abuse

  • Healthcare providers
  • Law officers
• Types of child maltreatment

  • Physical abuse
  • Emotional abuse
  • Neglect
  • Sexual abuse
• Factors associated with higher prevalence of child maltreatment

  • Living in poverty
  • Previously reported to Child Protective Services (CPS)
  • Composed of adolescent parents with young children
• Mandatory reporters of child abuse and neglect

  • Health-care providers
  • Childcare custodians
  • Law officers and correctional personnel
  • Commercial film developers
• Child Protective Services

  1. Determines who caused the abuse

  2. Provides assessment, interventions, treatment referrals
• The Child Abuse Prevention and Treatment Act (CAPTA) definitions

  1. Acts of commission: intentional harm via physical, emotional, or sexual abuse

  2. Acts of omission: inadequate nutrition, shelter, warmth, appropriate seasonal clothing, safety, and education

  3. Both are child abuse and must be reported to authorities

  4. Unintentional abuse or injury- occurs due to lack of education on child rearing or basic needs, or lack of resources
• Munchausen’s Syndrome by Proxy
• Types of Abuse
• Fatal Abuse
• Human Trafficking
• Prevention of Child Abuse
• Medical and Nursing Management of Child Abuse
• Nursing Considerations and Care
• Identify specific needs of the pediatric patient and caregivers while hospitalized
• Identify different types of child abuse