Editing Pediatric Nursing (section)

== Family-centered and atraumatic care ==

'''Family-centered care''' treats the family as the constant in the child's life and the caregiver as a partner rather than a visitor. Practically this means encouraging caregiver presence, incorporating home routines, sharing information openly, and negotiating which cares the caregiver wishes to perform.

'''Atraumatic care''' means minimizing physical and psychological distress. Examples include using topical anesthetic before venipuncture, clustering blood draws, performing painful procedures in a '''treatment room rather than in the child's bed''' so the bed remains a safe place, allowing a comfort object, and offering distraction.

=== Separation anxiety ===

Most intense in children from about 6 months through 3 years. The classic stages are:

# '''Protest:''' crying, screaming, clinging, rejecting strangers.
# '''Despair:''' withdrawal, sadness, decreased activity, disinterest in play.
# '''Detachment (denial):''' superficial cheerfulness and apparent adjustment.

'''Application note.''' Detachment is frequently misread as a good sign. A toddler who has stopped protesting and now interacts pleasantly with any staff member may have '''given up on the caregiver's return''', and the nursing priority is to restore caregiver contact.

=== Preparing children for procedures ===

{| class="wikitable"
! Age !! Timing of preparation !! Key approach
|-
| Infant || Immediately before || Caregiver presence, swaddling, pacifier, sucrose, minimize restraint
|-
| Toddler || Just before, a few minutes || Simple concrete words, offer limited choices, allow a comfort object, expect resistance
|-
| Preschooler || Shortly before, up to about an hour || Play with equipment, correct magical thinking, state clearly that the procedure is not punishment, use bandages
|-
| School-age || A few days before || Explain purpose and body function, use diagrams and models, allow a job to do, give privacy
|-
| Adolescent || Several days in advance || Full explanation of rationale and outcomes, respect privacy and body image, allow autonomy and peer contact
|}

=== Pain assessment ===

* '''Neonates and preverbal infants:''' behavioral scales such as NIPS or FLACC (face, legs, activity, cry, consolability).
* '''Roughly 3 to 7 years:''' FACES self-report scale.
* '''About 7 years and older:''' numeric 0 to 10 rating scale.
* '''Nonverbal children with cognitive impairment:''' revised FLACC with caregiver input about individual pain behaviors.

Pain is under-treated in children. Absence of crying does not mean absence of pain; a child in severe pain may lie still to avoid making it worse.

=== Consent and communication ===

* Consent is provided by the parent or legal guardian. The child's '''assent''' should be sought when developmentally appropriate.
* '''Emancipated minors''', and in many jurisdictions minors seeking care related to sexually transmitted infections, pregnancy, contraception, or substance use, may consent for themselves. State law varies.
* '''Emergency treatment necessary to preserve life or limb is not withheld while awaiting consent.'''
* Interview adolescents alone for part of the visit to allow confidential disclosure, while explaining the limits of confidentiality.
* Nurses are '''mandated reporters''' of suspected abuse or neglect. Suspicious findings include injuries inconsistent with the reported mechanism or the child's developmental stage, injuries in various stages of healing, delay in seeking care, patterned burns such as symmetric stocking or glove immersion burns, and posterior rib fractures. '''Report suspicion; proof is not required.''' Document objectively using direct quotations rather than conclusions.