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Children face a loss of control, limits on their mobility, powerlessness, pain, and discomfort, to name a few emotions and negative consequences occurring while ill. It is the nurse’s responsibility to help children cope with medical procedures and their illness. The best way to facilitate this is through an atmosphere of trust. Trust is best created and fostered through strategies that are researched to be effective.
There are strategies that occur across developmental stages and these will be addressed first before discussing specific strategies based on the developmental age groups. These age groups will be divided into infant, toddler, preschool, school age, and adolescence in this course. These groups will be explored below for the best nursing interventions using evidence-based practice. Therapeutic play will be addressed in the section following this one.
General Nursing Care of Pediatric Patients Across the Developmental Spectrum
There are some interventions and principles that hold true for children of all ages. To provide the best nursing care to pediatric patients, pediatric nurses should strive to incorporate these principles into their practice regardless of the age of the developmental stage of the child.
Children grasp information best when it is appropriate to their cognitive level of development.
Offer choices to every child when performing even routine tasks such as obtaining his/her blood pressure. This will promote a sense of control in the child.
“What arm would you like me to use to check your blood pressure?”
Create a daily schedule so that the child is aware of what to expect throughout his/her day.
Use humor and laughter to lighten up the air with children.
Use time-out coupons, for example three per procedure that the child can use to halt the procedure for 2 minutes (9). This gives control to the child to better cope with the procedure.
A pre-surgical tour of the hospital can lessen anxiety and promote cooperation.
Children need a regular schedule in the hospital that mirrors home life as much as possible, but that is also consistent from day to day in the hospital setting. Research has shown that without a regular schedule for children of all ages, a child can feel confused and insecure adding to emotional upheaval, stress, and adaptability (9).
Nurses should stoop down to the child’s level physically. Eye to eye contact is important to develop a trusting relationship. The use of a short stool works well to get at their eye level.
Introduce yourself and ask the child personal questions.
“What is your favorite toy?”
“Who is your favorite cartoon character?”
Nurses should smile at their pediatric patients. Children of all ages appreciate this approach from babies to adolescents. Who doesn’t like a friendly, calm approach?
Regardless of the age of the child, use his/her name. It soothes children and parents alike. It shows respect for individuality and lessens anxiety in children and parents. Never refer to a child by his/her diagnosis.
Children of all ages from toddlers through adolescence love to help. Through their role in their own care, it can alleviate stress and build trust. For example you could ask the child to hold your otoscope until you need it. Teach them the tools of the trade. At the same time you are educating about a possible career choice for one of them.
“I need your help to stay very still. Can you do that?”
This activates the child to engage in your activity with helpfulness.
Consider using a therapeutic dog in the hospital setting as a distraction and calming technique when appropriate (9). Animal assisted therapy has shown to improve the level of anxiety in parents and children. Check with your facility for approval of canine therapy. Or perhaps get permission for the child’s dog to visit in the playroom.
Give children the same time and respect you would give to adult patients (10). This includes decision-making even when they are not able to make decisions on their own. This will enhance their sense of control over their own health.
Secrecy and dishonesty increases a child’s sense of anxiety and fear and undermines trust with the nurse (10).
Nurses should coach children to ask more questions and thereby increase satisfaction with their healthcare providers and more compliance with their disease processes (10).
Never talk down to a child for example in a singsong voice. This is demeaning to him/her.
Encourage parents to bring in posters, photographs, and other items from home to personalize the bedside. This may help the child to feel more comfortable in the hospital setting.
Choose roommates for children, if possible, to promote socialization and foster growth in children. Sometimes nurses can advocate for children with similar disease processes or hobbies to room together in the hospital. This promotes a sense of community facilitating recovery and belonging.
Remind children that their illness is not punishment. Explore this confusion in your pediatric patients. Sometimes children do not have the words to express their fears that they did something wrong to cause their illness or hospitalization.
Use words and sentence length that matches the child’s level of understanding. A common way to measure this is the number of words in a child’s sentence should equal his/her age plus one (6).
Use crayons and paper freely. First demonstrate by drawing yourself and encourage child’s expression.
Give children time to feel comfortable with you. Speak to the parents first.
Help children understand they can face their fears. Promote courage.
“I know you’re scared and I’m here to help you.”
Give hope and courage to children through praise by stating how “brave” and/or “good” they are.
Communicate with puppets, dolls, or stuffed animals first before asking questions directly of a young child.
If a child is ticklish when you are examining his/her abdomen, place the child’s hand down first on his own abdomen and place your hand on top of his. Then slowly deviate off of his hand to examine the abdomen.
Parents should not be asked to restrain their child. This interferes with the trust relationship the child has with his/her parent (6).
Allow children to pick a toy out of the toy box to play with during the procedure and then afterwards they can pick a gift out of the box and return the toy.