The Pediatric Department Affects the Child Development

Developmental Problems Associated with Extended Stays in Pediatric Units

Spending time in hospitals is never an ideal situation for a parent or a child, especially if the patient is there for an extended period of time. If a child is spending time in a pediatric unit, there are many factors that can affect their development and healing process. These things can be as simple as the lighting, the space they are given, and the way they interact with other patients and medical staff (Rohde).

Children are constantly changing and developing. While being a patient in a pediatric unit, they should not have to compromise these normal development changes and altered healing process due to being hospitalized.

Eye Development

When a child is born, some of their senses are not fully developed. In order for them to develop normally they must be exposed to numerous settings. The least developed sense of a child when they are born is sight (Shu, pg. 75). A newborn has 20/600 vision. As they grow and develop, they may reach perfect vision of 20/20. The bottom number of this means “someone with perfect vision can see detail at 20 feet” (Shu, pg.76). The top number represents the person rested is able to see that amount of detail at 20 feet (Shu, pg.76). An infant is also very nearsighted, meaning you are able to “see objects near to you clearly, but objects farther away are blurry” (Mayo Clinic). This may not resolve completely until a child is 10 years old. The lens of the eye is a muscle that develops the relaxes and contracts in order sharpen the focus on objects you are looking at. This muscle contracts to focus on objects up close and relaxes to allow the lens to thin and focus on things far away (Buettner, pg. 7). The eyes must develop equally in order to work in sync because “each eyeball autoregulates many rapid adjustments for brightness, focus, and internal pressure” (Buettner, pg.4).

In current layouts of pediatric units, there are many issues that can affect the developing and healing child. The first main issue is the lighting available in many pediatric units. When designing a pediatric unit, many synthetic lights are put in place (Buettner). Indeed, it is important to have the units properly lit, but too much synthetic lighting can damage the development of the lens of adolescent patients. During their first three years of life, children are developing all aspects of their eyes including the lens, retina, and optic nerve. Synthetic lighting also makes it more difficult for children to acclimate to the proper natural day and night cycle. With this inability to adapt to the time of day, this may affect their sleep decreasing their ability to heal.

Lighting is also a factor of pediatric units that needs to be changed. One way this can be done is by allowing the patient to be able to control light levels. This can help with the development of the patient’s eyes, allowing for time away from too many synthetic lights. Younger eyes perceive lights differently than older eyes (Buettner). Another way this can be done is by adding more windows in patients’ rooms and common areas. This can help with eyes being exposed to natural lighting as much as possible. Natural light allows for the eyes to continue growing at a normal rate. Lighting can also go along with normalizing the setting. At Rady Children’s Hospital in San Diego, they have stars that appear on the ceiling at night (source). These are lighting elements that help make the unit feel like a nighttime space and help improve sleep.

Ear Development

Another sense that is not fully developed at birth is hearing. “Sound is created by pressure waves moving through matter, and hearing is the perception of that sound” (Olsen, pg.10). The last 12 weeks while in the womb, the fetus does experience active listening, becoming most familiar with the mother voice (Shu, pg. 75). However, once born, the infant must develop sensitivity to higher and lower frequencies. One factor that can inhibit a child’s development of hearing is over stimulation due to background noises.

Another issue present in pediatric units is the noise levels. Hospitals have many people doing various different actives throughout the day and night, with all these people comes raised noise levels. These different noises from nurses communicating to beeping of machines in patients’ rooms can cause the patient to stay up during the night or impair their sleep. Sleep is a crucial component for children not only for the healing process but also for their own development.

Another element needed for a more beneficial pediatric unit is reduced noise levels, especially night time levels. (Waiting for inter library loans for articles on sleep in hospitals and hospital noises). Sleep is important for children because this is when they grow, “because they are developing physically at a great rate, and growth hormone is released and cells multiply faster during sleep” (Shu, pg.100). Sleep is also important for brain development and with brain development comes faster and more efficient healing. If a child is not getting enough REM or rapid eye movement sleep, their brain may not be able to develop at a normal rate. “During the REM phase of the sleep cycle, the body is relaxed…processing and storing the mass of new information taken n during his waking hours” (Shu, pg. 100). To help decrease the amount of noise in pediatric units, some hospital have put “Yacker Trackers” in rooms and hallways. This is essentially a stoplight for noise levels, once reaching a yellow or red, the noise levels need to be lowered because they could be disrupting others.

Social Development

With the need for sleep comes the need for privacy. Studies have shown that Patients, parents and caregivers are more likely to be honest with medical staff when they know that others cannot hear them. It is important that the whole family is able to be a part of the caring team, this is known as family centered caring. It allows for a partnership between the families and the medical providers to communicate in confidence. This also allows for medical staff to provide the best possible care and treat the current problems. Some patients may benefit from have a fully secluded room for them and their families, while other pediatric patients may benefit from having a roommate that may have similar diagnosis. This allows for the children to have a companion during undesirable circumstances. With these different situations, having a roommate or accommodating room for family members, many pediatric units are not laid out in an ideal way to maximize space and allow for visitors.

Another aspect that many pediatric units lack to is the availability of indoor/ outdoor space. Incorporating pieces of nature into pediatric units can help build a positive distraction. This can help to reduce the stress and anxiety of being in a hospital for pediatric patients and have a positive impact on healing. Indoor/ outdoor space can also help to restore homeostasis of patients if they are able to use the horizon as a reference.

Anxiety can slow down the bodies healing mechanism as it has to excerpt more energy on what is causing the anxiety than healing. Having a complex floor plan in a pediatric unit can make children very anxious when trying to navigate around common areas and through the halls of their unit. If there are recognizable and friendly guides that children are able to associate with their unit, they will be more willing to leave their room because they will be eased of the fear of getting lost or not finding their way back.

That last major issue in pediatric units is the lack of common play areas. These are very beneficial to pediatric patients as it can not only help with their social development but also be a method of distraction that can help with their healing process as well. Common play areas should be placed in every hospital’s pediatric unit because play is a meaningful therapy that has many benefits for pediatric patients. Although playing with other children within the hospital, it is also important that family members are part of the hospital experience.

Family-Centered Care

Family-centered care is an important component that should be implemented in pediatric units. Since the patient is someone’s child and loved one, it is important that the family is included in the decision-making. In a pediatric unit this focuses on not only allowing the parent to be involved but also be present at the bedside. Pediatric units and family centered caring has come a long way from what they were when hospitals first opened. The visitation rights for families in the first pediatric units were very restrictive due to “risk of infection, confidentiality, and crowd control” (Westrup). Many family members and parents in of pediatric patients were not allowed to spend the night and asked to leave the hospital rooms during procedures, reports, and nursing rounds. This is a time when much of the information of the patient condition is shared with other medical staff. Families should have the option to hear this information as well. In current pediatric units today, many still have visitation hours that can be restricted to a few hours a day. Many pediatric rooms also provide limited areas for additional people or family members to spend the night with the patient. This can cause extreme stress to parents, making them chose which parent would be staying with the child overnight.

According to the American College of Critical Care Medicine Taskforce, parent should be allowed be allowed to have open visitation 24 hours a day (DATE). Siblings should also be allowed to visit whenever with the parent’s approval. If the pediatric patient is immunocompromised, siblings and parents should be allowed to visit with the approval of the attending physician. This would allow family members less stress knowing that they are able to visit their child around the clock. Less stress produced by the parent, in turn allows to patient to be more at ease as well.

The University of Iowa Hospital and Clinic has put in place a visitation program for pediatric neonatal intensive care units (date). This program allows for the parents to decide if the siblings are able to visit. If they are allowed, the nursing staff are involved in educating the siblings with what to expect with their visit of a sick sibling. This program has received positive feedback in both families and the medical staff. This helps to relieve that stress that can be associated with parents that have more children than just the child that is the patient. It gives families a sense of control (Westrup). Many parents report that some of the highest levels of stress from having a child as a pediatric inpatient comes from altered roles. This sense of control can allow for parents to still feel needed. In a study conducted by Newborn Individualized Developmental Care and Assessment Program, they found that families as a unit have lower levels of anxiety when there is open visitation for all of the family (DATE). This can help lower the levels of stress and anxiety of the pediatric patient as well, knowing that their parents and or siblings are able to come visit whenever needed. Through family centered care and open visitation for family members, there is an “emphasis on the partnership between health professionals and parents with the child and parent being viewed as a single unit” (Lambert, Glacken, & McCarron). This single-family unit allows for children and parents to feel more comfortable in the hospital setting.

Child Transitional Communication Model

Once a pediatric patient feels comfortable in the hospital setting they are able to communicate with the healthcare workers more effectively. There are two different ways that children in a healthcare setting communicate, active participant or passive bystander. The way that the child communicates will determine “the degree to which children’s communication needs were met” (Lambert, Glacken. Pg.573). When a health care provider directed their information towards the parents, rather than to the pediatric patient themselves, the child takes a passive bystander role (L,G pg. 573). This gives this child lack of control, making him or her feel more withdrawn from the situation and more anxious. If the healthcare provider communicated directly with the patient, this leads to the child being an active participant. (__). This is a beneficial method of communication for a pediatric patient because it allows for the child to have some control and is given the opportunity to ask questions and facilitate conversation with the provider.

Proposed Solutions for Pediatric Units

Every pediatric unit should have an area specifically designated for patients to be able to play. Play is an important part of children’s development and should be allowed to happen, even if they are patients in a hospital. Children use play as their “own unique and natural way of learning” (Shu. pg. 100). If children are not allowed an adequate amount of time to play, this could hinder their development. “Play is the main means by which your child can acquire the skills she needs to learn and grow physically, mentally, and socially” (Shu, pg. 100). Play can also be an effective way to distract patients from their actual disease processes. It can be used as a behavioral intervention to shift attention from fear, pain, or anxiety associated with being in a healthcare setting to a more child friendly situation. This in return can allow the body to release endorphins and help with the healing process of the body.

There are several different types of play therapy techniques that can be used in pediatric units to help meet the needs of all of the unique patients. Some of these techniques include medical play and guided imagery (Schaefer and Cangelosi). Medical play can be extremely beneficial to pediatric patients because it can help them to understand what is going on. This can put things that may seem scary to a child, like a shot, a CAT scan, or even surgeries into a play setting allowing the patient to unfold any underlying fears or questions about the situation and feel at ease being able to ask them. This also gives the child the ability to be an active participant in the play, so the issues are directly from the patient and not the parent (Hatcher). Guided imagery is also an effective form of play for patients that are not able to physically get up and play with other due to medical concerns. Guided imagery allowed for the patient to mentally go somewhere else and still have play experiences, even though not physically able to do so.

Another thing all pediatric units should have is a normalized medical setting. The more a patient feels like they are living a normal, age relevant childhood, they will have lowered levels of stress and anxiety(American institute). Ways that a pediatric unit can normalize the healthcare setting is by bringing in outside help. This can be done through things like pet therapy and movie nights.

Another way that pediatric units can be normalized is through making the layout as simple and welcoming as possible. This should be done so you are not overwhelming the patient. Simple things like having different units color coordinated so the patient is able to identify which are they belong in. Having welcoming images on the wall such as animals at eye levels so the patient is able to follow them through the hallway to return to their room (Bean). Many hospitals are very simple colored with a very unwelcoming feel. It is important that pediatric units are as kid and family friendly as possible, so the patient does not feel overwhelmed with the layout, when they are already dealing with a medical prognosis.

The last area that should be changed to help benefit pediatric units is by maximizing the flexibility of the room and furniture. Rooms should be able to accommodate multiple visitors. Some hospitals have put in couches that are able to convert into two chains and a table that can also turn into a bed. It is important to have room for more than one visitor to spend the night. Parents should not have to choose just one individual to stay with the child. Another possible solution to overnight guests in pediatric units is to have pull out couches that turn into at least a full size bed to accommodate more visitors.

While children are patients in pediatric units, they should not have alterations to their development or healing process. With changes to the way a pediatric unit communicates with children, environmental factors such as lighting and noise, and a family centered method of caring, pediatric patients will have a more normal and beneficial stay at a hospital.

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