The Hospitalized Child (Separation Anxiety & Atraumatic Care)

The hospitalized child faces three main stressors, separation from family, loss of control, and bodily injury and pain, and atraumatic care is the nursing approach that prevents or minimizes all three. Separation is the major stress from about 6 to 30 months of age, and toddlers are most affected. Separation anxiety moves through three stages: protest, with crying, clinging and searching for the parent; despair, when the child turns quiet, withdrawn and uninterested, which is easy to mistake for settling in; and detachment after prolonged separation, when the child seems adjusted but ignores the returning parent. Fears change with age, from strangers in infancy and separation and loss of control in toddlers, who often regress, to bodily injury and magical thinking in preschoolers, loss of control in school-age children, and privacy and peers in adolescents. Atraumatic care means rooming-in, home routines, familiar objects, and painful procedures in a treatment room, never the bed. Before a needle procedure the nurse applies a topical anesthetic at least an hour ahead, prepares the child honestly, and uses play, distraction and a parent's lap instead of restraint.