COMMUNICATION AND STRESSORS IN A CHILD AND THE FAMILY

Introduction

• Overview of the unit discussing communication and stressors affecting children and families.
• Topics include:
  • The communication process with a child and a parent.
  • Assessment and admission procedures for a sick child.
  • Recognition of signs and symptoms of stress across developmental stages: neonate, infant, toddler, child, and adolescent.
  • Description of stressors impacting a child's growth and development at different life stages.

Unit Learning Outcomes

• Upon completion of this unit, you'll be able to:
  • Describe the communication process with a child.
  • Describe the communication process with a parent.
  • Understand the admission process for a child.
  • Conduct a thorough assessment of a child.
  • Recognize signs and symptoms of stress at different levels of child development.
  • Identify stressors affecting children at various developmental stages.
  • Identify stressors impacting the family unit.

Communicating With a Child

• Effective strategies include:
  • Implement basic relaxation exercises to mitigate stress and anxiety in children.
  • Encourage the child to take slow, deep breaths and participate in matching breathing exercises.

Communication with a Parent

• Use communication skills to gather comprehensive medical history, which includes:
  • Inquiry into familial illnesses, miscarriages, stillborn babies, or unexplained deaths.
  • Review of medical records for conducted tests like ultrasounds or prenatal diagnostics.

Admission of a Child

• Admission process distinct from adults due to children's fear of hospital environments:
  • Admission defined as the acceptance of individuals into an institution.
  • Procedures can be negative if conducted without empathy—emotionless and impolite environments can worsen the experience.
• Admission can also serve as a crucial step towards effective healthcare when approached with care.

Initial Reactions to Illness

• Common reactions upon admission include:
  • Fear, anxiety, and uncertainty regarding illness outcomes.
  • The initial impression during admission significantly influences the patient’s perception of overall care.
• Nurses and caregivers should:
  • Understand and address patient fears and feelings, promoting comfort.
  • Provide a welcoming environment to the child and caretaker, introducing oneself, and orienting them to the ward layout and routines.

Importance of a Child-Friendly Environment

• The environment should be tailored for children, featuring:
  • Toys and engaging activities that alleviate the strangeness of the hospital setting.
  • A pleasant demeanor from medical staff to ease fears of the unknown.

Types of Admission

1. Planned Admission

   • Typically for surgical cases.
   • Admission is scheduled, and parents are counseled about the procedures.

2. Unplanned or Non-Emergency Admission

   • Occurs when a patient hopes for outpatient treatment but is later admitted.
   • Staff received information shortly before admission for appropriate preparation.
   • Examples include non-life-threatening conditions like malaria.

3. Unplanned - Emergency Admission

   • Admission under life-threatening circumstances requiring urgent care (e.g., trauma, critical conditions).
   • Conditions warranting this include:
     • Acute respiratory distress, severe asthma attacks, trauma from road traffic accidents, meningitis.

Assessment of a Child

Physical Assessment

• The approach differs from that of adults; each examination may vary according to the individual child's needs:
  • Note: Invasive procedures should be saved for later in the examination.
• Encouragement for comfort:
  • Allow the child to lie in a comfortable position, often on a caregiver's lap.
  • Each child should receive a systematic examination at regular intervals, not restricted to presenting complaints alone.

Approaching the Child

• Building rapport is essential:
  • Allow adequate time for familiarity with the child.
  • Individual sensitivity should inform the examiner's conduct and interaction.
• Recommendations for approach:
  • Use a friendly tone and a gentle, quiet approach;
  • Consider parental involvement per the child’s developmental stage for better communication and assessment outcome.

Sequence of Examination

• There is no rigid order; the sequence should adapt to:
  • Child's age, temperament, and comfort.
  • Preferred order:
  • Start with less distressing examinations (lungs, heart, abdomen before sensitive areas like throat and ears).
  • Minimize pain with anesthetic creams if necessary (EMLA - Eutectic Mixture of Local Anesthetics).
• Ensure respect for privacy, especially for prepubescent children, allowing undressing in a sensitive manner to build trust.

General Examination Overview

• Begin with vital signs:
  • Count respirations first, followed by pulse, blood pressure, and temperature.
  • Record weight at every visit and height measurements monthly during the first year, then every three months in the second year, and semi-annually thereafter.
• Assess child's overall appearance and behavior:
  • Indicators include cooperation, state of comfort, awareness, general activity levels, and behavior during examination.

Skin Assessment

• Skin evaluation features include:
  • Color, texture, and signs of hydration or dryness
  • Check for common issues like erythema, cyanosis, scars, and pigmented lesions (e.g., Mongolian spots, nevi).
  • Understand the implications of skin changes relative to dehydration or anemia.

Lymph Nodes Assessment

• Key characteristics to note:
  • Size, sensitivity, mobility, and location; typically assess submaxillary, axillary, and inguinal nodes.
  • Recognize that lymph node enlargement in children differs from adults and is frequently harmless.

Comprehensive Physical Examination

• Head and face:
  • Examine for size, shape, fontanel features, and the scalp for parasites or abnormal textures.
• Eyes, ears, nose, mouth, and throat:
  • Detailed examination considering developmental norms, such as pupil reaction, symmetry in the face, and tonsil examination techniques to ensure comfort.

Abdomen and Genital Assessment

• Special attention on:
  • Size and distension, tenderness, visible organs, and hernia checks in both male and female genitalia.
  • Recommend specific approaches for examining young boys vs. girls.

Signs and Symptoms of Stress

Neonate

• Increased Crying: Often the initial sign of distress in neonates, indicating discomfort or need.

Infant

• Indicative behaviors of stress:
  • Stretching hands in a specific pattern, sudden yawns or sneezes, arching back, and a tendency to look away from caregivers after prolonged eye contact.
  • Distress indicators may include frantic movements or eventual withdrawal (eyes closed).
• **Calming Techniques for Stressed Infants: **Parents can:
  • Breastfeed, provide physical closeness, use reduced lighting, and offer gentle verbal reassurance.

Toddler

• Signs of stress include:
  • Excessive fears, rigid adherence to routines, heightened sensitivity to loud noises and clothing, and obsessive cleanliness.
  • Personality changes, clinginess, and the emergence of bad habits (e.g., nail-biting).
• Sleep Disturbances: Insomnias, bedwetting, and physiological symptoms like unexplained aches may indicate stress.

Adolescent

• Symptoms of stress in adolescents include:
  • Frequent somatic complaints, sleep issues, increased irritability, isolation from social interactions, and educational challenges.
  • Observable behavior changes like negativity or trouble concentrating on tasks.

Types of Stressors Affecting Children

Neonate, Infant, and Toddler Specific Stressors

1. Physical Discomfort: Pain from varying degrees of illnesses can cause significant distress.
2. Lack of Attention: Insufficient caregiver interaction or neglect can increase infant stress responses.
3. Separation Anxiety: Distress caused from being away from primary caregivers.
4. Environmental Stress: New environments or exposure to conflict can distress infants.
5. Parental Emotion: Infants often sense caregivers' stress, impacting their emotional state.
6. Media Exposure: Content viewed can provoke anxiety or irrational fears.

Children and Family Stressors

• School Stress: Pressure from academic achievement and fitting in socially is prevalent.
• Family Issues: Existential problems at home, including economic issues, mental health disorders, etc., contribute to child stress.

Adolescent Stressors

• Mental health issues in 1 in 5 youth.
• Peer pressure and the need for conformity can lead to destructive behavior patterns.
• Concerns about academic success and the fear of failure can affect self-esteem.
• Parental expectations cause stress when they cross the boundary between encouragement and pressure.
• The impact of social media influencing self-perception, feelings of isolation, and the effects of cyberbullying.

Stressors to the Family

• Tensions arising from monetary concerns, especially in caregiving circumstances, manifest frequently as stress within family dynamics.
• Uneven distribution of caregiving responsibilities can lead to resentment and familial discord.

References

• Fraser, D. M., & Cooper, M. A. (2003). Myles Textbook for Midwives, 14th Edition, New York: Churchill Livingstone.
• Hockenberry, M. J. (2009). Wong’s Nursing Care of Infants and Children, 8th Ed., St. Louis: Mosby.
• Murray, S. M., & McKinney, E. S. (2006). Foundations of Maternal-Newborn Nursing, 4th edition, Saunders, Elsevier.
• Sellers, M. P. (1993). Midwifery, A Textbook and Reference Book for Midwives in Southern Africa, Volume 1, Normal Childbirth, Juta & Co, Ltd.