Chapter 36: Nursing Care of Ill Children & Families

A child’s perception of illness evolves according to their cognitive development, moving from magical thinking or viewing sickness as punishment in younger years, toward understanding external causes like germs in the grade-school age,. Hospitalization is highly stressful for children, posing risks of Posttraumatic Stress Disorder (PTSD) and manifesting behavioral regression, such as an older child acting like a toddler,. Core psychological concerns for hospitalized children include the fear of bodily harm or mutilation, fear of the unknown, loss of control, and anxiety related to separation from parents and routines,. Physiologically, children have greater metabolic demands, requiring significantly more calories per pound of body weight for maintenance and growth (an infant needs 120 kcal/kg/day, compared to 30 to 35 kcal/kg/day for an adult),. They are also prone to systemic responses, with symptoms like nausea and vomiting frequently accompanying any illness, and they are at greater risk for fluid loss due to a higher ratio of extracellular water,. Nursing interventions integrate the nursing process with the six competencies of Quality and Safety Education for Nurses (QSEN),. Essential strategies include promoting open, unrestricted visitation, practicing family-centered care and primary nursing to reduce the lasting psychological effects of separation anxiety (which progresses through protest, despair, and detachment phases),. Preparation for elective procedures must be age-appropriate, such as informing a 4-year-old child 4 days in advance. Procedures should be performed in a dedicated treatment room, keeping the child’s bed a "safe area," and providing the child with a sense of control by offering choices whenever possible,. The nurse’s role extends to managing sleep, as loss of NREM stage IV sleep can lead to apathy and slower recovery, and preventing sensory deprivation or sensory overload, especially in high-tech environments like the neonatal intensive care unit,. Finally, play is considered the child's "work",and therapeutic play (energy release, dramatic play, and creative activities like drawing) is a critical tool used to help children express their fears, communicate hidden concerns, and master traumatic experiences.