Ma'am Hannah Lecs

• The meaning of illness to children

  The response of children to illness depends on their cognitive ability, past experiences, and level of knowledge
• Early school age children

  • Generally know quite a bit about the workings of their major body parts
  • Are usually able to name the function of the heart, lungs, and stomach
  • Are not able to see the body as a system until the age of 10 to 11 years
• Younger children


  • May think the cause of illness is magical or that it occurs as a consequence of breaking a rule
  • May think getting well again is possible only if they follow another set of rules, such as staying in bed and taking medicine
• By fourth grade children


  • Are generally aware of the role germs play in illness but may be fooled by thinking that all illnesses are caused by germs
  • May see a passive role for themselves in getting well because illness comes from outside influences
• By eighth grade children


  • Are able to voice an understanding that illnesses can occur from several causes, such as being susceptible to chickenpox because they did not get a vaccine
• Illness in a child

  Is a stress, especially if it includes hospitalization
• Explanations of procedures can sound confusing if the words sound alike or have double meaning
• Explanations of procedures do not always relieve children's stress
• Differences in responses of children and adults to illness

  Children are not just small adults, it is important when evaluating how children react to illness, perceive an illness, or react to health care
• Inability to communicate

  • Very young children do not have the vocabulary to describe symptoms
  • Children younger than 5 years of age have a great deal of difficulty describing a headache
  • Dizziness and nausea can be equally bewildering because young children do not know the words to express these phenomena
• By the time children reach school age

  • Most can describe symptoms with accuracy
  • They may intensify their concerns if they believe someone expects symptoms to be more serious
  • They may minimize symptoms if they are afraid that an illness will interfere with an activity they want to do
• It is important to evaluate a child's symptoms as much by observation as by a child's report
• Inability to monitor own care and manage fear


  • School-age and younger children cannot monitor their own care because they may not know which medicine or procedures they are scheduled to receive
  • If they do know, they may be confused about the time
• Fears children have

  • Infant fears separation above all else
  • Toddler and preschooler enlarge their fears to include separation, the dark, intrusive procedures, and mutilation of body parts
  • The school-age child and adolescent may be concerned about the loss of body parts, loss of life, and loss of friends
• Children in a strange environment, such as a hospital, have not learned coping skills as yet and so require proportionally more support and active intervention to manage their stress and fears
• Hospitalization, particularly if it follows trauma from unintentional injury, can result in posttraumatic stress disorder (PTSD) or the development of characteristic symptoms, such as difficulty falling asleep, outbursts of anger, difficulty concentrating, difficulty completing tasks, or experiencing symptoms such as stomach aches or headaches
• Nutritional needs of children

  • Children have greater metabolic demand, breathe in more air per pound of body weight than adults do, have a higher surface to body mass ratio and are at greater risk for insensible fluid loss when they are sick
  • Children need more nutrients (calories, protein, minerals, and vitamins) per pound of body weight than adults because their basic metabolic rate is faster, and they must take in not only enough to maintain body tissues but also enough to allow for growth
• Fluid and electrolyte balance

  • In the adult, extracellular water (the water held in plasma and outside body cells) represents approximately 23% of total body water; in a newborn, extracellular water is closer to 40%
  • This means that an infant does not have as much water stored in the cells as an adult and so is more likely to lose a devastating amount of body water with diarrhea or vomiting
• Systemic response to illness

  • Because a child's body is continually growing, young children tend to respond to disease systemically rather than locally
  • The child with pneumonia may be brought to an emergency department not because of a cough but because of accompanying systemic symptoms such as fever, vomiting, and diarrhea
  • Nausea and vomiting occur so frequently in children with any type of illness that these symptoms do not have the diagnostic value that they may have in adults
• Age-specific diseases

  • Most adults have achieved immunity to common infectious diseases
  • Children, however, are very susceptible to illnesses such as measles, mumps, and chickenpox
• Research has raised awareness about the psychological trauma children and their parents face when hospitalized
• This trauma can have lasting effects after discharge, undermining the child's recovery and the overall well-being of the family
• The effects of hospital separation and children: decreasing separation anxiety

  • Social/emotional development begins early in infancy
  • Babies display sadness, happiness, and anger at a young age, and they begin to change their facial expressions to register changes in their emotions around 5 months
  • During this period, infants also become attached to parents and caregivers
  • When in the presence of strangers, infants fix their eyes on them, become restless, perhaps thrash arms or legs, and begin to cry
  • This activity peaks at approximately 9 months of age
  • The timing of separation anxiety can vary widely from child to child
  • Within the hospital setting, that anxiety may be relieved by establishing a primary nurse
• Toddlers and preschoolers


  • Can be as affected by separation as infants and even express their feelings better, louder, and longer
  • Being hospitalized may be the first time they are away from parents in a strange setting or away from home overnight
  • The effect of separation can become especially intense in young children before they are able to understand time because statements such as "Mom will visit again tomorrow" or "Dad will be here by 6 o'clock" are meaningless unless they know what "tomorrow" or "6 o'clock" means
• School-age children and adolescents


  React better than younger children to the separation imposed by hospitalization because they have experiences they can use for comparison
• Reducing the ill effects of separation and hospitalization to the extent possible should be a high priority for all healthcare
• Nurses play a major role in this on both direct care and management levels
• Even despite the best preparation by parents or nurses, not all of these effects of hospitalization can be prevented
• Preparing the ill child and family for hospitalization

  Involves disseminating developmentally appropriate information, facilitating communication and developing trusting relationships with healthcare professionals
• Depending on the age of the child, there may be anxiety if the child is told about an approaching hospitalization too far in advance


  • As a rule, therefore, children between 2 and 7 years of age should be told about a scheduled ambulatory or inpatient hospitalization as many days before the procedure as the child's age in years
  • Children older than 7 years of age can be told as soon as the parents are aware of it
• On the day of hospital admission, it is important for you to ask the parents what preparation they have done to ensure the child and family accurately understand the child's condition and upcoming procedures
• Based on that, you can provide further health teaching and clear up any misunderstandings as necessary
• Admitting child and family

  • Children and parents need to be admitted as a single entity to encourage parents to feel that they are true partners in care
• Admitting child and family


  1. Child and parents arrive at reception area

  2. Demographics obtained

  3. Child and parents brought to hospital unit
• First impressions count when admitting child and family
• Assess child's level of preparation

  Be aware of what the child describes verbally and note any facial expressions or nervous manifestations
• Admitting child and family

  1. Interview parents upon hospital admission for a nursing history

  2. Obtain information needed to plan nursing care
• Note any medication or food allergy on the child's plan of care and, if pertinent, post this information in the child's chart and per hospital protocol
• Explain all equipment used and allow the child to touch and handle the equipment as much as possible to help reduce fear
• Promoting a positive hospital stay


  • One nurse gives as much care to the same child as possible (primary nursing)
  • Allows children to have one main nurse to call their own
  • Allows parents to establish a meaningful contact with the hospital staff
  • Maintains continuity of care, planning, and implementation