Anxiety (Pediatric Inpatient)

Clinical Description

Care of the hospitalized child experiencing feelings of apprehension, uneasiness, uncertainty or dread about possible future events and the ability to deal with the events.

Key Information

Anxiety is a subjective, individual experience ranging from vague discomfort to feelings of panic. It is a normal response to threatening situations.

Increased parental anxiety and concern has been directly correlated to increased anxiety and concern in children.

Studies show a decrease in a child’s anxiety when provided with coping strategies prior to a procedure or surgery.

Anxiety can become excessive and difficult to control; negatively affecting day-to-day living, physical comfort and medical diagnosis symptoms.

Clinical Goals

By transition of care

A. The patient will achieve the following goals:

Anxiety Reduction or Resolution

B. Patient, family or significant other will teach back or demonstrate education topics and points:

Education: Overview
Education: When to Seek Medical Attention
Education: Self Management

Correlate Health Status

Correlate health status to:
- history, comorbidity, congenital anomaly
- age, developmental level
- sex, gender identity
- baseline assessment data
- physiologic status
- response to medication and interventions
- psychosocial status, social determinants of health
- barriers to accessing care and services
- child and family/caregiver:
- safety risks
- family interaction
- plan for transition of care

Anxiety

Signs/Symptoms/Presentation

acting out
agitation
anger
apprehension
crying
distress
fear
helplessness
hypervigilance
increased dependence
irritability
joking
nervousness
panic
regressive behavior
restlessness
sense of impending doom
social withdrawal
worry

Physical symptoms

dry mouth
muscle tension
shortness of breath
skin flushed
skin rash
sleep disturbance
urinary frequency
urinary urgency

Vital Signs

heart rate increased

Problem Intervention

Promote Anxiety Reduction

Maintain a calm and reassuring environment; minimize noise; provide familiar items; offer choices; follow home routine.
Encourage parent/caregiver presence and participation to enhance ability to support the child.
Support expression and identification of feelings and worries; compassionately acknowledge and validate concerns.
Utilize existing coping strategies and assist in developing new strategies (e.g., music, deep breathing, relaxation techniques, massage, diversional activity, play, pet therapy).
Identify thoughts and feelings that led to current anxiety onset to enhance understanding of triggers.
Reframe anxiety-provoking situations; provide a new perspective; engage in problem-solving.
Utilize anticipatory guidance to enhance sense of control.
Consider referral for a comprehensive assessment if there are concerns about the number, severity and duration of symptoms; degree of distress; functional impairment or excessive substance use.

Associated Documentation

Complementary Therapy
Supportive Measures
Family/Support System Care

Education

CPG-Specific Education Topics

Overview

risk factors
signs/symptoms

When to Seek Medical Attention

unresolved/worsening symptoms

Self Management

coping strategies
resources for support

General Education Topics

General Education

admission, transition of care
orientation to care setting, routine
advance care planning
diagnostic tests/procedures
diet modification
opioid medication management
oral health
medication management
pain assessment process
safe medication disposal
tobacco use, smoke exposure
treatment plan

Safety Education

call light use
equipment/home supplies
fall prevention
harm prevention
infection prevention
MDRO (multidrug-resistant organism) care
personal health information
resources for support

References

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Bert, F.; Gualano, M. R.; Camussi, E.; Pieve, G.; Voglino, G.; Siliquini, R. Animal assisted intervention: A systematic review of benefits and risks. European Journal of Integrative Medicine. 2016;8(5), 695-706. doi:http://dx.doi.org/10.1016/j.eujim.2016.05.005 [Metasynthesis,Meta-analysis,Systematic Review]
Capurso, M.; Ragni, B. Psycho-educational preparation of children for anaesthesia: A review of intervention methods. Patient Education and Counseling. 2016;99(2), 173-185. doi:http://dx.doi.org/10.1016/j.pec.2015.09.004 [Metasynthesis,Meta-analysis,Systematic Review]
Capurso, M.; Ragni, B. Psycho-educational preparation of children for anaesthesia: A review of intervention methods. Patient Education and Counseling. 2016;99(2), 173-185. doi:http://dx.doi.org/10.1016/j.pec.2015.09.004 [Metasynthesis,Meta-analysis,Systematic Review]
Chow, C. H.; Van Lieshout, R. J.; Schmidt, L. A.; Dobson, K. G.; Buckley, N. Systematic review: Audiovisual interventions for reducing preoperative anxiety in children undergoing elective surgery. Journal of Pediatric Psychology. 2016;41(2), 182-203. doi:10.1093/jpepsy/jsv094 [Metasynthesis,Meta-analysis,Systematic Review]
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Disclaimer

Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.