IMPACT OF HOSPITALIZATION ON CHILD AND FAMILY
Parents Response to Hospitalization
The parents of a hospitalized child experience an increase in stress as a result of a number of factors which
include a) lack of information b) fear of procedures and treatments c) lack of information.
Specific Causes of Parental Anxiety
1) Fear of the strange environment in the hospital.
2) Fear of separation from the child and fear that the nurses are able to do so much they may take the
child’s love from them.
3) Fear of the unknown and what will happen to the child immediately and in the future.
4) Fear that the child will suffer.
5) Fear that the condition is infectious and may spread to other members of the family.
6) Fear of unbearable financial obligations incurred through the illness.
7) Fear that society will look upon the illness as a reflection of something wrong with the parents.
The Child’s Response to Hospitalization
Babies under six months of age tend to show less anxiety than in later months.
Children from around six months to four years show the maximum adverse effect of separation and the stress of
hospitalization.
Nurse’s Role in the Relieving the Parent’s Anxiety and Child’s Stress
Play
According to Erikson, to work through problems, utilizing play is one of the most self-healing measures found
in childhood.
Group Activities
Group activities help to reduce the stress of hospitalization for many children. Group activities are especially
meaningful to a child who has to remain hospitalized during holidays or his birthday.Active Participation
The child who is forced to comply with treatment and hospitalization without any involvement in his own care
suffers a loss of control and lowered self-esteem.
Self Care
Self care helps to maintain and improve coordination, muscle tone and circulation, and it foster positive self-
esteem and a sense of self-control.
Impact of Hospitalization on the Child’s Stage of Development
Neonate (Birth to 1 Month)
Primary Concerns
Bonding-prolonged illness ad hospitalization interrupt the early stages of the development of a healthy
mother-child relationship and family integration, thus early stages of the development of trust are missing.
Sensory and motor deprivation – tactile, visual, auditory, kinesthetic, Sensory overload.
Reactions
Impairment of parent-infant attachment/bonding.
Impairment of infant’s ability to respond to parents/family members.
Impairment of parent’s ability to love and care for the baby.
Risk of infant emotional and physical well-being.
Risk of stress within the family constellation.
). Nursing Intervention
Provide care within a family centered context.
Provide for continual contact between baby and the parents (eye contact, touch, talk).
Minimize isolation and strangers by explaining and re-explaining procedures to parents. equipment,
Actively involve parents in caring for their baby provide for rooming in.
Foster neonate-sibling relationship as appropriate.
Identify areas of infant deprivation or over stimulation. Plan a schedule of appropriate stimulation (i.e.
hold and rock every 3 to 4 hours, eye contact
Provide sensory motor stimulation as appropriate.
1
Allow individually to begin to emerge.
Provide consistent caretaker.
Mid-Aged Infant (4 to 8 Months)
Primary Concerns
Separation from mother and family members, as the infant now recognizes mother as a separate person
form self. Infant rejects strangers.
Development of self-quieting behaviours.
Reactions
Separation anxiety – carrying, terror, somatic upset, blank facial expression, extreme preoccupation.
Emotional withdrawal and preoccupation.
Nursing Interventions
To adjust schedule and home routines.
Encourage mother’s presence and nurturing of her baby.
Old Infant (8 to 12 Months)
Primary Concerns
Beginning definition to self-infant is aware of a growing ability to influence his or her environment.
Separation-infant becomes more possessive of mother and clings to her at the time of separation.
Reactions
Passiveness toward environment.
Separation anxiety – tolerance is limited; fear of strangers, excessive crying, clinging, and over
dependence on mother.
Toddler (1 to 3 Years)
Reactions
1) Protest
Has urgent desire to find mother.
Expects that she will answer cries, “I want mommy.”
Frequently cries and shakes crib.
Rejects attention of nurses.
When with mother, child show of distrust with anger or tears.
2) Despair
Feels increasingly hopeless about seeing mother.
Becomes apathetic, anorectic, listless, looks sad.
May cry continuously or intermittently.
Use comfort measures–thumb sucking, fingering lip, tightly clutching a toy.
3) Denial
Represses all feelings and images of mother.
Does not cry when she leaves.
May see more attached to nurses – will go to anyone.
Finds little satisfaction in relationships with people.
Accepts care without protest,
4) Regression-temporarily ceases use of newly acquired skills in an attempt to retain or regain control
of a stressful situation.
Minimize stress of separation by providing for parental presence and participation in care.
Identify defense mechanisms apparent in the child and help child through the stressful situation by
accepting, showing love and concern.
Set limits for the child.
Provide opportunity and encouragement for child to verbalize.
Encourage activities with other children
2
.
School Aged Children (5 to 12 Years)
Primary Concerns
May fear loss of recently mastered skills.
May worry about separation from school and peers.
Mutilation fantasies are common.
Increased concerns related to modesty and privacy.
Nursing Interventions
Help parents to prepare the child for elective hospitalizations.
Obtain thorough nursing history, including information regarding health and physical developments,
hospitalizations, social and cultural background, and normal daily activities, use this information to
plan care.
Provide order and consistency in the environment
Establish the enforce reasonable policies to protect the child.
Respect the child’s need for privacy.
Adolescent
Primary Concerns
Physical illness, exposure and lack of privacy may cause increased concern about body image and
sexually.
Separation from security of peers, family, and school may cause anxiety.
Nursing Interventions
Assess the impact of illness on the adolescent by considering factors such as timing, nature of illness, new
experiences imposed, changes in body image, and expectations for the future. Be aware of misconceptions.
Introduce the adolescent to the hospital staff and to the regular routines soon after admission.
Obtain a thorough nursing history that includes information about hobbies, school, family, illness,
hospitalization, food habits, sexuality, and recreation.
Encourage adolescents to wear their own clothes, and allow them to decorate their beds or rooms to express
themselves.
Explain clearly all procedures, routines, expectations, and restrictions imposed by illness.
Be a good listener. Maintain a sense of humor. Be honest and respectful with the adolescent and family.
Encourage continuation of education.
