Separation Anxiety Pediatric Nursing Review

Let’s do a quick review over separation anxiety that occurs in young children and highlight what you need to know as a nurse and for exams.

What is it? It’s anxiety that occurs in a child when the child is separated from its main caregiver. Hence, the caregiver is out of the child’s sight. This is a normal phase of child development. Almost all young children experience some form of this anxiety, but it varies in severity and duration.

Who is considered a “caregiver”? The caregiver is someone the child has developed an intense bond with. This is the person who is with the child majority of the time and provides for all of its needs. The child views this person as its security and comfort and does NOT like to be away from them. Typically, this tends to be the mother.

When separated from the caregiver the child will become very distraught. The separation trigger can be as simple as going to another room without the child for a second or leaving the child with another caregiver for a while. However, when the caregiver reappears and the child is placed in the caregiver’s arms, magically the child is put at ease and the anxiety goes away.

Lecture

Stages of Separation Anxiety

*be familiar with how the child presents in each stage

Protest: when the caregiver’s absence is detected this stage starts

• The child starts crying very loudly, is hard to console (may push you away), looking or running to where the parent was last seen.

Despair: depressed no longer crying but withdrawn/quite, not playing or wanting to eat….but will cry and run to the caregiver once they return.

Detachment: rare to get to this stage

• In order to cope, the child will detach themselves from the caregiver.
• The child may seem happy and that they have coped but they haven’t.
• This affects the child and caregiver relationship.

When does it start and end? It tends to be in full effect (especially with intensity) around 10-12 months, but it can start to appear around 8 months (varies among children) or even earlier. It tends to end around 2-3 years.

Why does it start around this time? Around this time of 8 months, the milestone of object permanence has been reached. This is when the child knows that objects (like people) still exist when they are no longer visible. Hence, when they can’t see their caregiver they know that they still exist, but they are not with them and this causes a lot of distress. Therefore, when the child was younger like a very small baby, they were okay with being with other caregivers and didn’t protest it because they didn’t understand object permanence.

Nursing Considerations for the Pediatric Patient with Separation Anxiety

(hospitalized child and education for caregivers)

Comfort

Consistency with alternative caregivers or nursing caregivers and how the caregiver departs (helps develop familiarity and trust)

Objects of familiarity to keep with them, especially when hospitalized

Maintain the presence of the caregiver with the child during hospitalization and procedures, if possible

Focus attention elsewhere until caregiver returns

Organize separation times when the child will tolerate it the best….avoid when child is very tired, hurt, hungry, or sick

Reassure the child the caregiver will return

Train…practice separation periods…start short and then increase time…this helps the child understand that you will return

Test your knowledge with this developmental milestones quiz.

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