CHILDREN IN Hospitalization

BY :
AYU SUSANTI, S. KEP, NERS

DEFINITION
Hospitalization is an illness and should be treated in the hospital, which cause a crisis both for children and families. (Wongs &
Whaley ; 1999)

Hospitalization Reactions

Individual reactions to hospitalization, depending on age of child development, availability of supporting system, they coping skills, and previous experience of ill.

Child Reactions on Hospitalization

1. Infancy (0 - 1 years)

Reactions that often appear at this age are crying, angry, and a lot of movement as an attitude of stranger anxiety.

2. Toddler period (1-3 years)

Hospitalization reactions are related with the stress source, the main stress is separation anxiety.

Behavioral responses according to the stage, the stage of protest, despair, and denial (denial).

Stage of protests, the behavior shown are a powerful cry, scream to call the parent or reject the attention given to others. Stage of desperation, the behavior shown are crying decreases, children are not active, showed less interest in playing and eating, sadness, and apathy.

Stages of denial, the behavior shown are vaguely begin to receive separation, relationships are shallow, and the child begins to accept the environment.

(Supartini, 2001)

To the treatment of pain experienced or because getting invasive procedures, children will cry, biting his lips, and hitting. However, children can demonstrate and communicate the location of the pain.

3. Preschool (3-6 years)

Reaction to the separation shown are refusing to eat, frequently ask, crying although slowly, and uncooperative to the health care workers.

4. School years (6-12 years)

Reaction to injury or pain will be shown with the expression, both verbal and non verbal because the child able to communicate it.

Control their behavior if they feel pain, by biting the lips or bite and hold onto something tightly.

5. Teenagers (12-18 years)

Reactions that often arises on the restrictions of activities are by refuse treatments or measures taken to children or they do not want to cooperate with health workers or withdraw from the family, others patients, and health workers (isolated).

Illness due to injury or surgery caused responses the child frequently ask, withdraw from the environment, and rejecting others.

Stressors that affecting hospitalization of the children The major factors of stressor and often occurs in children who underwent hospitalization are separation, loss of control, physical trauma and pain, they experienced in physical illnesses. (Wongs & Whaley, 1999)

1. Separation
a. Protest phase

Lasts within several hours to a couple days with the following behavior :
Strong crying, will stop when tired.
Screaming and seeking the parents Reject and avoid strangers.

In this phase the approach taken by a nurse or other health care team, involving parents and minimize the painful measures, to avoid a harsher protests reaction from the child.

b. Despair Phase

In this phase the child will show the following behavior : The child will stop crying. Inactive. Pulling away to others. Sadly, no interest to the environment. Do not want to communicate

 The behavior back to the previous

growth such as thumb sucking. Children will refuse to eat, drink, and play. In this phase, nurses more involved parents.

c. Detachment phase

More

interested to the hospital environment. begin to interacting with other people who are not known or nurse. The child looks happy.

2. Loss of Control

The main causes are physical limitations, routine activities such as playing with peers, and to their parents.

Do the nursing actions by reducing the binding procedure, involve parents or peer group in the care of children, playmates and relatives allowed to visit, take the child to the playground in the hospital.

3. Physical Trauma and Pain

Response of children:

Grimace. Shut the mouth. Opens his eyes wide. Angry or aggressive act such as biting, kicking, hitting, and trying to flee.

Giving special attention to the pain response and pain they feel, and explain the action before any procedure is given.

4. Physical Illness

The nurse's roles are to be empathetic, trusting relationships, assist in the fulfillment of physiological needs, and involve parents in the care and treatment.

Other stressor factors are: a. Unrealistic fantasies and anxieties about the darkness, preceded by a scary situation, like a monster, murder, and wild animals and unfamiliar. b. Disruption of social contact if visitors are not allowed to visit. c. A painful procedure. d. The fear of the disability or death.

Todlers Age Adaptation

1.

Adaptif Response
a. Able to do self adaptation (detachment)

In this phase, children has grown up in their intense to get interact with environment , service given to them, children look happier and could accept the situation when their parents or family leave them alone. b. Playing Activity c. Cooperative

2. maladaptive responses a. Separation Stressor Children usually ask their parent to stay with

them and sometimes they hug tightly. Displeasure against those shown with tempertantrum, refusing to eat, urinate, defecate on time. b. Losing Control Stressor

Physical trauma and pain stressor d. Physical illness In this situation the child usually uses the pattern of adaptation and increased attention primarily on the body. Another reactions are very angry, rebellious attitude, and hard feelings againts his parents because they considered to be punished.
c.

Another common coping used by children at their healing process is an adaptation or coping conversion, where the children will feel depends on their parents

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