Separation anxiety is normal part of a child’s development but can be difficult to deal with in an acute care setting. Babies younger than 6 months old have not yet grasped the concept of object permanence; that a loved one actually exists when they are out of sight. Children older than 5 tend to be minimally affected by separation anxiety. However, for those children in-between, separation anxiety can have a significant impact on their life and activities.
Anxiety produced by separation from loved ones can cause symptoms of physiologic arousal, such as autonomic hyperactivity and increased motor tension. Psychological arousal, including excessive worry, disturbed sleep patterns and refusal to eat can negatively impact therapeutic interventions. As a patient advocate, it is incumbent upon the nurse to find ways to ease separation anxiety in children during hospitalization.
Nurses also need to help parents understand that a child’s anxiety at their departure can be a positive developmental milestone. Separation anxiety is an indicator of a strong attachment between parent and child. Ultimately, this strong attachment will provide a sense of security that will allow a baby to develop into an independent toddler. In the meantime, parents can work together with the nurse to minimize the pain and discomfort of separation anxiety:
Some babies have an extraordinary attachment to an inanimate object, such as a toy, blanket, stuffed animal or bottle. Not only are these objects a sign of healthy development, but they serve a valuable purpose. These transitional items help the child deal with their newly found independence in an unfamiliar world, and ease the pain of separating from their parents. Such attachments are not a sign of unhealthy insecurity, but rather a developmental stepping stone.
These comfort items are particularly helpful in a hospital environment. Stressful situations, such as painful procedures, can be a lot less intimidating if teddy is there for support. Encouraging parents to leave an item of theirs behind with their baby is also an effective strategy to reduce separation anxiety. A large family photo or an unwashed T-shirt works well.
Additional strategies that the nurse can employ to minimize separation anxiety include:
Telling baby what to expect. Children need to develop trust in you as their new caregiver. By forecasting and then doing what you say you’re going to do is very important. Don’t skip an explanation because you think the child is too young to understand. Tone of voice, body language and attitude send a message to children even before they understand your words.
Building anticipation for the return of a parent or caregiver. Emphasize how good it will feel when the parent returns. You could say, “I know you’re going to miss your mommy – you can tell her how much you missed her when she returns, and I bet she’ll give you a really big hug.”
Encouraging parents to always say good-bye. A baby can better adapt to separation if he sees a parent before they go. If he is sleeping or distracted when his parents leave, he may wake up, notice that they are not there, and become more distressed. Tempting as this may be for parents to sneak away to avoid a teary scene; encourage them not to do this. It will only undermine the child’s sense of security. Instead, create a good-bye ritual that will soothe both of them. For example, developing a special good-bye wave can make the child feel more secure and less abandoned.