Importance of care in children
Children are not just small adults. This is important to keep in mind when evaluating how children react to illness, perceive an illness, or react to the health care. Their body images, as evidenced in their drawing, are different from those of adults. The special care of hospitalized child is important because of following factors.
Inability to Communicate
Very young children do not have the vocabulary to describe symptoms. The school Problems-I age children can describe symptoms with accuracy. They may intend their concerns, however, if they feel that someone expects symptoms to be more serious. They may minimize symptoms if they are afraid that illness will interfere with an activity. A child's symptoms should be determined as such by observation and by the child's report.
Inability to Monitor Own Care and Manage Fear
Adults who are hospitalized often ask about medication or procedures they are scheduled to undergo while the children are unable to monitor their own care this way. Children have fears of separation, the dark, the unknown, intrusive procedures, and mutilation of body parts that adults do not.
There are major physiologic differences in the way illness affects children compared to adults. Children need more nutrients (calories, protein, minerals and vitamins) per kg of body weight than adults, because their basic metabolic rate is faster and they must take in compared to the enough nutrients to maintain body requirement of 120 k/cal/kg body wt./day compared to the adults who require 30-35 k/cal/kg body wt./day.
Fluid and Electrolyte Balance
In the adult, extracellular water comprises approximately 23 per cent of total water but in a newborn and infant, extracellular water is closer to 40 per cent. infant does not have as much water stored in the cells as an adults and thus is m' likely to lose a devastating amount of body water with diarrhoea or vomiting.
Systematic Response to Illness
Because their body systems are immature, children tend to respond to disease systematically rather than locally. Systemic reaction can delay diagnosis and therapy and cause increased fluid and nutrient loss, (circumstances, that compound an initial illness) and can result in hospitalization.
Because of their growth requirement and their immaturity, children are susceptible to some diseases that do not affect adults e.g. as infants are growing, a lack of vitamin D will cause rickets but the same does not affect adults. Most adults have achieved immunity to diseases; children, however, are susceptible to childhood diseases such as measles. Polio, severe diarrhoea, dehydration, malnutrition.
Some hospitals have care-by-parent or family participation units where parents actually live in the hospital with the child. The nurse's responsibilities in such a setting are to prepare the parent to meet the child's needs in the hospital, to help the child maintain a schedule similar to the one at home, to interpret medical procedures and scheduled diagnostic tests, and to do health teaching and anticipatory guidance as necessary. In the family unit the nurse can observe the parents, their skills, attitudes and techniques, and any problems in parent-child relations that may be apparent.