Pediatric Nursing Interventions for Separation

Pediatric Nursing

Nursing interventions for separation anxiety in childhood

Separation anxiety disorder (SAD) is a serious matter that concerns children and their caretakers. SAD can affect children of any age, although it is most common in children of preschool age (Pincus, Eyberg, & Choate, 2005). As the most prevalent of anxiety disorders in children, nurses are likely to encounter children with SAD whether they are pediatric nurses or not (Justus et al., 2006). Pediatric nurses may be part of a child's treatment for SAD, while other nurses may need to address a child's disorder while treating the child or the child's parent (Justus et al., 2006). For this reason, it is important for all nurses to be aware of SAD and how they can intervene when they encounter a child who requires intervention.

As its name implies, children with SAD experience extreme anxiety when separated from a parent of loved one (Fontain, 2003). Most often the loved on is a parent. However, other cases may include a different relative or primary care giver (Thomson, 2006). A child may be worried that something bad will happen to the parent, or that the child himself will be hurt, kidnapped or killed in the parent's absence. Manifestation of SAD may be acute or insidious. An acute onset may occur from a specific incident, such as a car accident or illness of the parent or child. Such incidents make the child concerned that they will lose the parent, that the parent will die, or that the child will die if the parent leaves (Fontain, 2003; Justus et al., 2006). Justus et al. (2006) cite that children may also develop SAD when they are ill or in danger, such as when they are going into surgery.

Symptoms and signs vary child to child. Signs of SAD may not be immediately recognized for what they are, especially in young children who lack the communicative abilities to express their fears (Pincus et al., 2005 Sometimes a child may become physically ill when separated from their loved one, resulting in vomiting, headache, stomachache or other ailments common of stress reactions (Fontain, 2003; Hillard, 2006). Children with SAD want their parent to stay with them at all times, even where impractical or illogical, such as at school or when sleeping (Hillard, 2006). The affected child might follow a parent at close distance, shadowing them as they go about other tasks. Additionally, the child might throw a tantrum, cry inconsolably, or act disruptively in a parent's absence (Pincus et al., 2005). Children who can explain themselves verbally are likely to express worry that their parent could die at any time, not come back, or that someone might hurt them while their parent is away (Pincus et al., 2005).

Nurses have many options when handling a child with SAD, each contingent on the individual situation. If a child is being treated, nurses must attend to any needs that will make it easier for that treatment to occur. Justus et al. (2006) find that the unfamiliar faces, foods, and routines of the hospital contribute to anxiety. Further, they find that preschool children feel especially vulnerable when they are facing surgery and are separated from a trusted adult for only a short time (Justus et al., 2006). If a child is at the hospital because of a parent's treatment, SAD is likely related to the child's concern for their parent. Nurses should be vigilant to not say anything remotely negative about the parent's health in front of the child, and should not refer to future hospital visits is possible. Distracting a child while their parent is treated may lessen stress for a SAD child (Hillard, 2006).

Nurses may also want to incorporate preventative methods into their routines, especially if they are pediatric nurses. Encouraging work in this area has been done at Mount Sinai Hospital, where nursing departments participated in the incorporation of supportive methodology in handling children who are in treatment (Justus et al., 2006). If a child may need long-term care requiring extended or overnight stays in hospital, nurses can use Comfort Theory methods and other means of familiarizing the hospital environment. If a child feels at ease with nurses and the hospital environment they are less likely to cling to parents and exacerbate medical conditions through anxiety (Justus et al., 2006). General stress reduction techniques apply to children with SAD, and may include aromatherapy, deep breathing, and relaxed lighting or music may help (Hillard, 2006).

SAD may disappear without any long-term treatment (Fontain, 2003). However, ongoing problems with anxiety may necessitate treatment. Pincus et al. (2005) express concern that no interventions have been tested to specifically address SAD in young children. Yet, other treatments proven for common anxiety often help SAD patients. Nurses involved with treatment of a child's SAD should be aware of the psychological background of the child, including what factors evoke anxiety for the specific child (Pincus et al., 2005). Due to the nature of the disorder, outpatient treatment is recommended over inpatient, since being apart from a parent can negatively impact a child with SAD (Pincus et al., 2005; Thomson, 2006). Therapy might include parenting style changes, bravery exercises, and coaching (Pincus et al., 2005). Treatment should focus on a child being able to continue or return to normal activities, such as school or visiting friends. Anti-anxiety medicine and anti-depressants are a few of the prescription options, though that would be contingent on a doctor's recommendations (Thomson, 2006).