SEMINAR ON

HOSPITALIZED CHILD

SUBMITTED TO:

MRS. SHAILAJA MAM,

CHILD HEALTH NURSING DEPARTMENT,

OWAISI COLLEGE OF NURSING, HYDERABAD.

SUBMITTED BY,

MS. ASMA BEGUM,

MSC.2 nd YEAR NURSING,

OWAISI COLLEGE OF NURSING,

HYDERABAD.
GENER AL OBJECTIVES:

At the end of the class the students should be able to understand about hospitalized child.

SPECIFIC OBJECTIVES:

1. To introduce the about the hospitalized child?

2. To explain the meaning of hospitalization?
3. To explain Preparation of child and parents?
4. To explain Impact of hospitalization on parents, child and siblings?
5. To lis out and explain Stressors of the hospitalization?
6. To explain nurses role in care of hospitalized child?
INTRODUCTION:

Based on the theory that hospitalization can be an unnecessary stress to children, only those who
cannot successfully be managed on an ambulatory basis are now admitted to the hospital. This was not
always true.

For example most children with head injuries automatically stayed overnight for observation.

Often illness and hospitalization are the first crises children must face. Children during the early
years are particularly vulnerable to the crises of illness & hospitalization because stress represents a
change from usual state of health and environmental routine and children have a limited number of
coping mechanisms to resolve stressors, children’s reaction to these crises are influenced by their
developmental age, previous experience with illness, separation or hospitalization, innate and acquired
coping skills, the seriousness of the diagnosis and the support system available.

MEANING OF ILLNESS AND HOSPITALIZATION TO CHILD:

1. Infant:
•Charge in familiar routine and surroundings response with global reaction.
•Separation from love object.
2. Toddler:
•Fear of separation, desertion, separation anxiety highest in this age group. •Relates
illness to a concrete condition, circumstances or behavior.
3. Preschool
•Fear of bodily harm or mutilation, castration, intrusive procedures.
•Separation anxiety less intense than toddlers but strong.
•Causation same as toddler, often considers own role in causation ie, illness as a
punishment for wrong doing.
4. School Age:
•Fears physical nature of illness
•Concern regarding separation from age mates and ability to maintain position in peer
group.
•Perceives an external cause for illness, although located in body.
5. Adolescent:
•Anxious regarding loss independence. Control, identity concern about privacy.
•Perceives malfunctioning organ or process as cause of illness. Able to explain illness.
PREPARING THE ILL CHILD AND FAMILY FOR HOSPITALIZATION:

Many childhood illness, such as febrile convulsions, appendicitis and asthma attacks strike
suddenly making advance preparation for hospital admission impossible. However, when hospitalization
is planned ahead of time, for orthopedic second stage surgeries, preparation is possible. As a rule,
parents eagerly seek guidance from nurses or what and how much to tell their children about an
anticipated admission. The preparation a parent makes for a child obviously varies according to the
child’s age and individual experience. No matter what the child’s age however, parents should be
encouraged to above all convey a positive attitude. The nurse can provide further health teachings and
clear up all misunderstandings.

1) Preparing the infant :

•As because the infant cannot understand explanations, preparation has to be minimal.

•Special items such as favorite toy, blanket, should be packed.

•This objects provide care giver should spend a great deal of time with an infant.

2) Preparing the toddler and pre-schooler:

•Three chief fears of the toddler and pre-schooler are fear of unknown, fear of abandonment
and separation and fear of mutilation.

•These children need preparation clearly aimed at alleviating these fears.

•Bringing a favorite toy can be a help.

•Child could be encouraged to play hospital with dolls:

3) Preparing school age and adolescent:

•Both school age and adolescents need factual explanations of what will happen during
hospitalization.

•A hospital orientation program in which facts of hospitalization are discussed.

•Interact the child with another child who had undergone through the same condition.

4) Preparing the child of a different cultural background:

•Make the assurance that proper care will be provided to the child without any differentiation.
5) Preparing disabled and chronically ill child:

•Help children to maintain a contact with their families and school friends during a long
hospitalization period, as they are staying in hospitals for long term care through phone calls, letters &
open visiting.

PREPARING FAMILY CARE GIVERS :

•Planning for hospitalization begins as soon as parents know that hospitalization will be
necessary.

•Easing parental anxiety regarding illness and hospitalization is important because infants and
children can keenly sense a parent’s stress.

•As a part of preparation parents should ask questions about the hospitalization so that they
become familiar with the situations. It will help to reduce anxiety.

•Advise parents to ask about the diagnostic procedures required length of hospital stay, etc.

CHILDS REACTIONS TO HOSPITALIZATION AND PROLONGED ILLNESS:

•Illness threatens both physiological and psychological development of children.

•Sickness causes pain, restraint of movement, long sleep less periods, restrictions of feeds.
Separation from parent home environment, which may result emotional trauma.

•Hospitalization and prolonged illness related growth and development and cause adverse
reaction in the child based on stage of development.

Reactions of neonates:

•Interrupts the early stages of development of a mother child relationship and family
integration.

•Impairment of bonding and trusting relationship.

•Inability of parents to love & care for the baby and inability of baby to respond to parents and
family members.

Reactions of infants:

•Infant’s reactions are mainly separation anxiety and disturbances in development of basic
trust.

•Emotional withdrawal and depression are found in the infants of 4 to 8 months of age.

•Interference of growth and delayed development is also found.

 •Older infants have limited tolerance due to separation anxiety which is found as fear of
strangers, excessive cry, clinging & over dependence on mother.

Reactions of toddler :

•Toddler reactions are found as protest, despair, denial and regression. •Toddle protest by
frequent crying, shaking crib, rejecting nurses.

•Attention, urgent desire to find mother, showing signs of distrust with anger and fears.

•In despair, toddler become hopeless, looks sad, cry continuously and use of comfort measures
like thumb sucking, fingering lip, and tightly clutching toy.

•In denial, the child reacts by accepting care without protest.

•Toddlers react by regression in an attempt to control stress.

•Found to stop using newly acquired skills & may return to the behavior of an infant during
illness.

Reactions of pre-school child:

•Pre-school child adopts various defense mechanisms to adjust with stress.

•They react by exhibiting regression, projection, displacement identification, aggression, denial

& fantasy.

•They simply shows similar behavior of toddlers.

Reactions of school-aged child:

•Illness threatens both physiological and psychological development of children.

•Sickness causes pain, restraint of movement, long sleep less periods, restrictions of feeds.
Separation from parent home environment, which may result emotional trauma.

Hospitalization and prolonged illness related growth and development and cause adverse
reaction in the child based on stage of development.

1. Reactions of neonates.

•Interrupts the early stages of development of a mother child relationship and family
integration.

•Impairment of bonding and trusting relationship.

•Inability of parents to love & care for the baby and inability of baby to respond to parents and
family members.
 2. Reactions of infants

•Infant’s reactions are mainly separation anxiety and disturbances in development of basic
trust.

•Emotional withdrawal and depression are found in the infants of 4 to 8 months of age.
•Interference of growth and delayed development is also found.

•Older infants have limited tolerance due to separation anxiety which is found as fear of
strangers, excessive cry, clinging & over dependence on mother.

3. Reaction to toddler.

•Toddler reactions are found as protest, despair, denial and regression.

•Toddle protest by frequent crying, shaking crib, rejecting nurses.

•Attention, urgent desire to find mother, showing signs of distrust with anger and fears.

•In despair, toddler become hopeless, looks sad, cry continuously and use of comfort measures
like thumb sucking, fingering lip, and tightly clutching toy.

•In denial, the child reacts by accepting care without protest.

•Toddlers react by regression in an attempt to control stress.

•Found to stop using newly acquired skills & may return to the behavior of an infant during
illness.

4. Reactions of pre-school child.

•Pre-school child adopts various defense mechanisms to adjust with stress.

•They react by exhibiting regression, projection, displacement identification, aggression, denial

& fantasy.

•They simply shows similar behavior of toddlers.

5. Reactions of school-aged.

•School aged children are concerned with fear, worry, mutilation, fantasies, modesty & privacy.

•They react with defense mechanism like regression, negativism, depression, phobia, un-
realistic fear or denial symptoms and conscious symptoms and conscious attempts of mature behavior.

6. Reaction of adolescent

•Adolescents are concerned with lack of privacy, separation from peers or family & school
interference with body image or independence or self concept & sexuality.
 •They react with anxiety related to loss of control & insecurity in strange environment.

•They may show anger and demanding or un co-operative behavior.

•They may adopt mental mechanisms like intellectualization about disease, rejection of
treatment, depression, denial/withdrawal.

EFFECTS OF HOSPITALIZATION IN CHILDREN AND FAMILY:

1) Stressor’s of hospitalization and children’s reaction Major stressors of hospitalization

includes, separation, loss of control, bodily injury, and pain children’s reactions to these crisis are
influenced by their developmental age, their previous experience with illness, separation or
hospitalization their innate and acquired coping skills, the seriousness of the diagnosis and the support
system available.

a) Separation anxiety:

•The major stress from middle infancy throughout the pre-school years, especially for children
ages 16 to 30 months is separation anxiety, also called anaclitic depression.

•During the phase of protest children react aggressively to the separation from the parent. They
cry & scream for their parents and in-consolable by others.

•During the phase of despair the crying stops and depression evident, less active, un-interested
in play •Third stage is detachment also called denial, the child is finally adjusted to the loss, becomes
interested with the surroundings and forms new relationships.

•This behavior is a sign of resignation and i9s not a sign of contentment.

•The child detaches from the parent in an effort to escape the emotional pain of desiring the
parent’s presence and copes by forming shallow relationship with others being increasingly self
centered, and attaching primary importance to material objects.

•Health team member understand the meaning of each stage of behavior and should label as
positive or negative.

•Eg. The loud crying of the protest phase as a bad behavior during quite withdrawn phase of
behavior, health team member may think that child is settling in. Detachment behavior as a proof of
adjustment & child is considered as ideal patient. Early childhood Separation anxiety is the greatest
stress imposed by hospitalization during early childhood.

•Children in the toddler stage demonstrate more goal oriented behaviors.

•They may demonstrate displeasure on parent’s return or departure by temper tantrums or

regression to primitive levels of development.
 •Temper tantrums, bed wetting or other behaviors are expression of anger or response to
stress.

•Pre-schoolers are more secure interpersonally than toddlers, they can tolerate brief period of
separation from their parents and are more inclined to develop trust in other significant adults.

•The stress of illness usually renders pre-schooler less able to cope with separation.

•They may show separation anxiety by refusing to eat, experiencing difficulty in sleeping, crying
quietly for their parents withdrawing from others.

•They will express indirectly by breaking toys, hitting other children. Later childhood and
adolescence.

•In school age child being away from family higher than any other fear associated with
hospitalization.

• Hospitalization increase their need of parental security and guidance.

•Middle and late school age children may react more due to separation from usual activities
and peer groups than to the absent of their parents.

•Feelings of loneliness, boredom, isolation and depression are common.

•School age children have irritability and aggression towards parents withdrawal from hospital
personnel, inability to relate to peers, rejection of siblings, subsequent behavioral problems in school.

b) Loss of control:

•The major areas of loss of control in terms of physical restriction, altered routine or rituals,
and dependency.

1. Infants:
•In hospital setting, routines may be established to meet hospital staffs need instead of infant
needs.
•Inconsistent care and deviation from infant’s routine may lead to mistrust and decreased
sense of control.
2. Toddlers :
•Toddlers are striving for autonomy, and this goal is evident in most of their behaviors.
•When their ego-centric pleasures meet with obstacles toddlers react with negativism,
especially temper tantrums.
•Loss of control results from altered routines and rituals.
•It can cause regression to toddlers.
•Enforced dependency is a chief characteristic of toddler during sick role most toddlers react
negatively and aggressively to this.
•Prolonged loss of autonomy may result in passively to this.
 •Prolonged loss of autonomy may result in passive withdrawal from interpersonal relationships.
And regression in all areas of development.
3. Preschoolers:
•Pre schoolers also suffer from loss of control caused by physical restriction, altered routines,
and enforced dependency.
•Their specific cognitive abilities which make them feel omnipotent and all powerful; also make
them feel out of control.
•This loss of control is a critical influencing factor in their perception of and reaction to
separation, pain, illness hospitalization.
4. School age:
•Because of their striving for independence and productivity school age children are particularly
vulnerable to events that may lessen their feeling of control and power.
•Altered family roles, physical disability, fears of death, abandonment, or permanent injury,
loss of peer acceptance, lack of productivity and inability to cope with stress according to
perceived cultural expectation may result in loss of control.
•One of the most significant problems of this age is boredom.
•When physical or enforced limitation curtails their usual abilities to care for themselves,
school age children generally respond with depression, hostility and frustration. Adolescents
•Adolescents struggle for independence, self assertion, and liberation centers on the quest for
personal identity. Anything that interferes with this poses a threat to their sense of identity and
result in loss of control.
c) Bodily injury and pain:
In caring for children nurses must have an appreciation of a child’s concerns about
bodily harm and reactions to pain at different developmental periods.
1. Infants:
•Infants may express pain by squirming, writhing, jerking and failing some infants may cry
loudly, where as others are easily calmed by gentle hug.
•Older infants react intensely with physical resistance and un-cocooperativeness. They may
refuse to lie still or try to escape with motor activity they have achieved.
2. Toddlers:
•Toddlers reaction to pain are similar to those seen during infancy. They will react with
intense emotional upset and physical resistance to any actual or perceived experience.
Behaviors indicating pain include grimacing clenching teeth or lips, opening their eyes wide,
rocking, rubbing & acting aggressively.
•Young children become restless and overly active is a consequence of pain.
•They usually able to localize the specific painful area.
3. Pre-schoolers:
•Reactions to pain tend to be similar to those seen in toddler hood.
•Physical and verbal aggressions are more specific.
•Instead of showing total body resistance, preschoolers may push the offending person
away, try to secure the equipment and lock them safely some times they may verbally abuse
the nurse.
 •pre-schools can locate pain & can use appropriate pain scales.
4. School age:
•They will have a fear of illness itself, disability & death.
•Fear of intrusive procedures in genital area.
•School age children verbally communicate their pain in respect to location, intensity and
description.
•By 9-10 years of age they show less fright or over resistance and aggression are less likely
at this age unless the adolescent is totally up prepared for a procedure.
•They are able to describe pain experience & can use any of the pain assessment tools.
•They may be reluctant to disclose their pain.

PLAY ACTIVITIES FOR ILL HOSPITILIZED CHILD :

FUNCTIONS OF PLAY IN THE HOSPITAL:

•Provides diversion & bring about relaxation.
•Helps the child feel more secure in strange environment.
•Helps to lessen the stress of separation & the feeling of home sickness.
•Provides a mean for release of tension & expression of feelings.
•Encourages interaction & development of positive attitude towards others.
•Provides an expressive outlet for creative ideas or interests.
•Provides a mean for accomplishing therapeutic goals.
•Places child in active role & provides opportunity to make choices & be in control.
 Play in infancy:
•Pleasure by touch & manipulation. 5-6 months – infant repeat activities 9 months –
repetitive games (pat-a-cake) 12 month - recognition & acknowledgement of other Play in
2nd year.
 2 to 3 year – fascination with working part of toys talking on phone involve parents
 Third year – child taught to share Conflict below parents & child.
 Pre-school – competition, mastery of tasks Genders roles (House, Doctor)
 School – Foot ball, basket ball.

NURSING CARE OF HOSPITISED CHILD AND FAMILY (PRINCIPLES AND PRACTICE):

1. PREVENTING OR MINIMIZING SEPARATION :

• Primary goal is to prevent separation particularly in children younger than 5 years of age.
• Welcome the presence of parents at all time throughout the child’s hospitalization.
• Many hospitals developed a system of family centered care.
• During the time of separation behavior, nu8rse provide support throught physical presence.
• If behaviors of detachment are evident, the nurse maintains the child’s contact with the
parents by frequently talking about them, encouraging child to remember them etc.
• When helping parents with the fears of separation, nurses should suggest the way of leaving
and returning.
• Parental visits should be frequent.
 • If the parents can’t room-in they can leave a favorite article from home the children gain
comfort and re-assurance from them.
2. MINIMIZING LOSS OF CONTROL:
•Feelings of loss of control results from separation, physical restriction, changed routine,
enforced dependency and magical thinking.
•Promoting freedom of movement during procedures can be completed by placing child in
parents lap.
•Mechanical freedom can be provided by transporting child in wheel chairs, or beds with
mechanical freedom.
•Maintaining child’s routine: One technique that can minimize the disruption in child’s routine is
time structuring.
•It include scheduling the child’s day to include all those activities that are important to the
child and nurse such as treatment procedures, school work, exercise, television etc. together
nurse, parent and the child then plan a daily schedule with times and activities written down.
•Encouraging independence; promoting children’s control involves maintaining independence
and the concept of self-care can be most beneficial. Self care refers to the practice of activities
that individuals personally initiates and perform on their own behalf individuals personally
initiates and perform on their own behalf in maintaining health and well being. Self care
activities are encouraged in hospitals other approaches include jointly planning care, time
structuring, making choices in food selection & bedtime etc.
•Promoting understanding- Anticipatory preparation and providing information help greatly to
lessen stress and prevent lack of understanding. Informing children about their rights foster
greater understanding any may relieve the feelings of powerlessness.
3. PREVENTING OR MINIMIZ ING FEAR OF BODILY INJURY :
•Preparation of children for painful procedures decreases their fears.
•Manipulating procedural techniques also minimizes fear.
•For children, who is fear of mutilation of body parts, the nurse repeatedly stress the reason for
a procedure and evaluate child’s understanding.
•Employ pain reduction techniques.
STRATEGIES TO COPING & NORMAL DEVELOPMENT:
•During hospitalization care of the child focuses not only on meeting physiologic needs, but also
on meeting psychosocial and developmental needs.
•Several strategies may be used to help children adapt to the hospital environment, promote
effective loping & provide developmentally appropriate activities.
•These strategies include child life programs, rooming in, therapeutic play, and therapeutic
recreation.
a) Child life programs:
•If focus on the psychosocial need of hospitalized children.
•Professional child life specialists, para professionals, & volunteers staff these departments
are involve actively .
•A child life specialist plan activities to provide age appropriate play time for children either
in playroom or child’s room.
 •Some of the activities are designed to assist children in working through feeling about
illness. Eg: Playing with medical equipment.
•Child specialist & nurses formulate plan together to assist children with particular needs
b) Rooming-In:
It is the practice of having a parent stay in the child’s hospital room & care for the
hospitalized child.
•Some hospitals provide cots, others have special built-in beds & in some institutions
parent stays in a separate room on the unit.
•Parent who is rooming in may want to perform all of the child’s basic care or help with
some of the medical care.
•Communication below nurse & parent is important so that the parent’s desire for
involvement is supported.

C) therapeutic play:

•Play is an important part of the childhood.

•The stress of illness & hospitalization increase the value of play.

•Not only is normal development facilitated by play, but play sessions can provide a means for
the child to learn about health care, to express anxieties to work through feelings & to achieve a sense
of mastery over control over frightening or little understood situations.

•Play presents an opportunity to deal with the fears & concerns of health experiences are called
therapeutic play.

•Through therapeutic play the nurse may assess the child’s knowledge of his or her illness.

•A common technique involves using body line drawing or stories & asking the child to draw or
talk about illness or injury means to him/her.

•Child may be asked to draw a picture or make a story enabling the nurse to assess fears &
other emotions.

•The same techniques may be used in a slightly different way to teach the child about surgery
or plan activities that allow child to express fears & gain mastery over the situation.

•A variety of technique may be used to promote therapeutic play. Specific techniques are
chosen to reflect the child’s developmental stage.

•Toddler, play is important for toddler. Through play the explore the environment & learn to
identify with significant people in their lives.

•Play is also an acceptable way for toddlers to release tensions caused by stress or aggressive
impulses.
 •Toddlers should be approached slowly & the initial approach should be made in their parent’s
presence, if possible to decrease feelings of stranger anxiety.

•Playing a variation of peek-a-boo or hide & seek using the curtain surrounding the toddlers crib
or bed help to promote realization of that objects out of sight, such as parents, do return.

•The use of transitional objects, such as a familiar blanket or stuffed animal, can temporarily
substitute for the security of parents.

•The toddler who is restrained can be read familiar stories. Repetition of stories promotes a
sense of stability in the unfamiliar hospital environment.

•A doll is familiar toy that can be used to recreate a stressful environment, thereby providing an
opportunity for the child to express & work through feelings.

•Other developmentally appropriate toys for toddlers include familiar objects from home such
as measuring cups or spoons, wooden puzzles, push & pull toys.

•Playing with safe hospital equipments (bandages, syringes without needles etc) help toddlers
to over come the anxiety associated with these items. Pre-schooler The nurse can intervene to reduce
the stress produced by pre-schoolers fear through the use of some kinds of play.

•A simple body outline or doll can be used to address the child’s fantasies & fears of bodily
harm. Playing with safe hospital equipment may help preschoolers to work through feelings such as
aggression.

•Pre schoolers like crayons & coloring books, puppets, felt & magnetic boards, play dough, &
recorded stories.

•Both pre-schooler & school age children may enjoy play with a toy hospital. School age child
Although play begins to lose its importance in the school age years, the nurse can still use some
techniques of therapeutic play to help the hospitalized Child deal with stress.

•School age children often regress developmentally during hospitalization, demonstrating

behaviors characteristics of an earlier state, such as separation anxiety & fear of bodily injury.

•Body outlines & occasionally dolls can be sued to illustrate the cause and treatment of the
child’s illness.

•Terms for body parts that are suitable for older children should be used drawings provide an
out let for expression of fears & anger.

•School age children enjoy collecting, organizing objects & often ask to keep disposable
equipment that has been used in their care. They may use these items later to relive the experience with
their friends.
 •Games, books, crafts, computers, provide an outlet for aggression & increase self esteem in
the school age child.

•The type of play used should promote a sense of mastery & achievement.

THERAPEUTIC RECREATION:

•Many of the special play techniques used with younger children are not suitable for
adolescents.

•Adolescents do need a planned re-creation program to assist them in meeting developmental

needs during hospitalization.

•Peers are important and the isolation of hospitalization can be difficult.

•Telephone contact with other teenagers & visits from friends should be encouraged.
•Interactions with other teenagers ate a pizza party or a video game or movie night can help
adolescents feel normal.

•Physical activities that provide an outlet for stress are recommended. Even adolescents on bed
rest or in wheelchairs can play a modified form of basket ball.

•The independence of adolescence is interrupted by illness. Nurses can provide choices for
teenagers to assist them in regaining control.

•Giving them options & letting them choose an evening recreational activity can promote their
feelings of independence.

•Passes to leave the hospital for special activity may be possible. The nurse in corporate play
activities into the daily life of each pediatric patient because play is a part of child’s total needs.
•The nurse must consider, when planning activities for child, the age, interests diagnosis &
limitations imposed by illness

•An acutely ill child who is unable to play actively with toys may enjoy listening to stories.
•Telling a story rather than reading draws children into emotional involvement with it.

•The story teller can ask questions pass comments & can make the child a part of it.

•Other activities children can do are watching a plant grow, watching an anthill or gold fish in a
tank or watching supervised television programmes.

•In the play area, children who are permitted out of bed should be free to develop mental,
motor & social skills and to express themselves. In a variety of art media such as finger painting
or molding with clay.
 •Domestic play re-assures them that their own homes are still there & that they are missed.
•Children usually select toys such as doctor, syringes with which they can imitate the activities
seen around.

•Old cloth in such play can be used to restrain hands of a doll in case of fractures to make
bandages to promote healing.

•Puppets are used to demonstrate procedures to children.

•Such activities help children work out feelings about hospitalization.

•Children also enjoy play telephone because they can pretend that they are calling home.

•They also can enjoy clay, paints, pounding boards on which they can express their anger.

•They enjoy tricycles, wagons, through the use of which they develop or exercise their large
muscles.

•Children play areas cannot be kept clean & orderly as judged by adult standards.

•It the nurses are too concerned about the physical appearance of play area during play time
the children feel that the unit personnel do not approve o f their play.

•Children should be taught to take care of toys & a place must be provided to store their toys.
•Much can be learned from watching children play in a relaxed environment. Their approaches
to play & their relationship with peers, parents, adults should be observed and recorded.

•Also to be noted are the degree of their activities attention span, ability to tolerate frustration,
verbal abilities, concept formations.

•In addition, nurse is able to note their comments about home, hospitalization, general
attitudes & behavior.

•It will help the nurse to understand how well the child is coping with the situations & crisis.

•If the child handle it well, the experience may be of help in mastering problem situations.
•Nurse should have an opportunity to participate with children play activities.

•Story telling-telling stories with themes.

•Water play during bath.

•Television-by instructing them about programs.

•Needle play.

•Pre-post operative teaching.

•Art.

CONCLUSION:
Nurse is not only meant for providing care to the patient she should also shoulder some
of the responsibilities in respecting the patient need..The philosophy of the nurse about the
nature of caretaker-nurse-child relationships influences the quality of child care..The role of
nurse in maintaining the psychological wellbeing of children and their caregivers and helping
them grow during the crisis of illness is a critical and complex contribution to recovery and
health.

BIBLIOGRAPHY:

1. PARUL DUTTA, PEDIATRIC NURSING, FIRST EDITION, NEW DELHI INDIA,JAYPEE

BROTHERS,2007 .
2. ADELE PILLITTERI, CARE OF THE CHILD AND FAMILY,CHILD HEALTH NURSING, LIPPINCOTT
3. NICKI L POTTIS,BARBARA, PEDIATRIC NURSING, CARING OF CHILDREN AND FAMILY, 2ND
EDITION.
4. BEHRMAN, KLIEGMAN, JENSON NELSON,TEXT BOOK OF PEDIATRICS, VOL 1,18TH EDITION.
5. DOROTHY R MARLOW,BARBARA, TEXT BOOK OF PEDIATRICS NURSING, 6TH EDITION,
PHILADELPHIA, SOUNDERS COMPANY, 2005.
6. WONG’S , TEXT BOOK OF ESSENTIAL OF PAEDIATRIC NURSING, 7TH EDITION,ELSEVIER
PUBLICATION, 2007, NEW DELHI.

WEBSITES:

1. CHILD HOSPITILIZATION, PARAIBA BRAZIL, AVAILABLE FROM

http://www.ncbi.nlm.nih.gov/pubmed/
2. WWW.WKIPAEDIA.COM
3. WWW.SLIDESHARE.NET