Pediatric patients have unique needs compared to adult patients. With a wide age range, from newborn to 18 years old, Pediatric nurses have to be creative in dealing with kids.  Read on below for some tricks of the trade that I have learned during my 15 years of Neonatal and Pediatric nursing practice.

Why Pediatrics?

Working in a Pediatric and Pediatric Intensive Care unit was no small feat, especially coming from a geriatrics and Medical-Surgical/Oncology background. I had shifts wherein my one patient was a premature newborn with hyperbilirubinemia in one room. In another was a 300-pounder 18-year-old high school football star. Stating that their needs were diverse was an understatement for sure.

How to Efficiently Take Care of Pediatric Patients?

1. Learn about Erikson’s Stages of Psychosocial Development

In 2021, Orenstein and Lewis summarized this for easy and comprehensive understanding. Once a clinician has a good grasp of this theory, expected behaviors can be anticipated. Differences can be identified. Management and play therapy can be tailored to the individual child’s needs.

Some facts about Erikson’s theory:

• Defines the different stages in a person’s life.
• Out of the eight stages, the first five encompass the children’s age groups.
• This means that kids have to undergo and adjust to so many changes as they get older.
• Clinicians need to reassure parents. It has to be stressed that while there are developmental milestones, each child develops uniquely. This will help them with setting realistic expectations.

2. Know your patients personally.

The rapport is easily established between a nurse and toddler patients using their favorite toys or TV program, for example. It is also important to reiterate that children are NOT smaller versions of adults. Like everyone else, their own uniqueness has to be considered when planning their care.

For example, we had an autistic patient who was only cooperative when Barney was on TV. So for that patient, it was:

Barney. On TV. Every single minute. Of every single day!

3. Involve the parents or the caregivers in care planning and managing the patient/s.

• Parents can provide valuable insights on how to appropriately deal with their respective children.
• Very useful for children with chronic issues.
• Able to integrate home routine into the course of hospitalization.
• Allow them to bring something from home. It may be a favorite toy, a security blanket, or a homemade treat.
• Encourage parents to do as much as they can for their children.

I remember a mother who would always come every morning to the Pediatric Intensive Care Unit. She always did the tracheostomy care on her one-year-old child. She stated that doing that for her child made her feel fulfilled as a mom.

4. Everything is “play.”

• Kids, especially the younger ones, like to play.
• Play is the children’s “job.”
• They learn roles and responsibilities through play.
• Nurses and clinicians need to incorporate play in providing care to children.

For example, I had a three-year-old asthmatic patient who refused to have a nebulizer treatment.                            

What did I do, you ask?

I saw that she had a doll. I asked her if I could also assess her doll. After auscultating the doll’s chest, I recommended that she too needed a nebulizer treatment. Long story short, both my toddler patient and her doll received the nebulizer treatment at the same time.

5. Plan tasks considering each child’s routine.

• Cluster the tasks (e.g. check vital signs and blood sugar, administer insulin, give breakfast tray) to prevent constantly disturbing the patient.
• Inform parents about the need for purposeful hourly rounding and stick with it.
• Provide pain management to mitigate pain and prevent it from getting worse (for post-surgical patients).
• Offer toileting schedules so that it doesn’t disrupt children’s rest and sleep period.

6. Utilize the Child Life Specialist (CLS).

• CLSs are integral parts of the Pediatric team.
• They are very adept at identifying the child’s and the family’s needs.
• Play multifaceted roles. Some of which are:
  • Able to distract kids during intravenous line insertions
  • Calm crying babies by holding them
  • Recommend age-appropriate play therapies for children (videos, books, computer games)
  • Assist in ensuring that school-aged children are able to keep up with their studies. 
  • Serve as liaison between the code team and the parents during emergency life-saving situations.

7. Provide a quiet place or time for school-aged and adolescent patients to complete their school work.

To help kids keep up with their school work and assignments, our unit had a dedicated desktop for school purposes and an iPad for Zoom. There should be the least amount of disruptions to the patients’ daily lives while they are in the hospital. Before Covid 19, we even allowed a few of their classmates to visit and do group work as applicable.

 

8. A time for (school) work and a time for play.

• Our organization had a playroom with books, toys, video, and computer games.
• A computer and a TV monitor are also available for their use.
• Aside from entertainment, they were used for educational purposes:
  • Asthma Management at home.
  • Juvenile Diabetes education
  • Cardiopulmonary resuscitation (CPR) for parents of premature and high-risk babies.
• Educational tools are also available for teach-back and return demonstration.
  • Metered-dose inhalers for Asthma
  • Blood sugar machines, diabetic strips, syringes, vials with sterile water (“practice insulin”), a handbook to record blood sugar levels and insulin administration
  • Infant dummies for CPR practice
• If patients are discharged with healthcare tools, we also allow them or their parents to practice prior to discharge.
  • Tube feeding machine
  • Nebulizer machine
  • Apnea monitors for high-risk infants.

9. Ensure that the patients and their families understand their discharge instructions.

• Start discharge planning upon the day of admission.
• Provide written and verbal instructions as the situation warrants (e.g. teach how to determine how much insulin is needed after the morning blood sugar level has been checked)
• This will prevent parents from getting overwhelmed on the day of discharge. Education will just need to be reinforced at that time since they were already introduced earlier.
• In-person, phone or video interpreters should be offered to patients and parents who are non-native English speakers.

10. Provide virtual options if parents are not able to visit their child/ren

• Encourage parents to visit whenever they can.
• Hospitalization is traumatic for children. Not having their parents by their sides may make it worse.
• If parents are unable to visit or stay with the patient, set up a time for a Zoom call or a Facetime call so that they can bond.
• Provide privacy, as appropriate. Respect their family time together.

The Last Tidbit

It is of utmost importance that we provide safe, quality, and patient-centered care for our Pediatric patients. Identifying their unique needs and getting the family involved are the twin pillars in providing efficient care. More than addressing just the physical need, it is just as significant to also meet their mental, emotional, social, and spiritual needs.

As a Pediatric nurse, one has to be in tune with how kids operate. Be it Barney playing on TV, or having Frozen concerts (maybe now it is Encanto?), or dancing to the latest TikTok craze, you have to be game.

Others may think of it as folly, but the hugs and kisses you receive from your patients more than make up for it. Snot and slobber may come with those kisses, but you would learn to love them all! Consider them as unspecified perks of the job.