# A 15-month-old toddler is hospitalized for pneumonia. The child has been crying inconsolably for the past 2 hours since the parents left. Which nursing intervention would be most appropriate to help the child cope with separation anxiety?

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> subject: Growth & Development

## 문제

A 15-month-old toddler is hospitalized for pneumonia. The child has been crying inconsolably for the past 2 hours since the parents left. Which nursing intervention would be most appropriate to help the child cope with separation anxiety?

## 보기

1. Encourage the child to play with other children in the playroom to provide distraction
2. Assign a consistent primary nurse to provide continuity of care and establish trust **✔ 정답**
3. Give the child a favorite toy from home and explain that the parents will return soon
4. Place the child in a room closer to the nurses' station for frequent monitoring

**정답: 2**

## 해설

Assigning a consistent primary nurse establishes trust and emotional security, which is most therapeutic for separation anxiety in toddlers. Other options are less effective as they do not address the core need for a stable attachment figure.

## 심화 해설

Understanding Separation Anxiety in Hospitalized Toddlers

A 15-month-old toddler is in the stage of development where separation anxiety peaks. When parents leave, the child perceives their absence as permanent and reacts with protest, which manifests as the inconsolable crying described in the scenario. This is not misbehavior; it is a developmental crisis fueled by the stress of an unfamiliar hospital environment and illness.

Why Consistent Caregiver Assignment is the Priority

The most appropriate intervention is to assign a consistent primary nurse. The provided evidence highlights that separation from parents in a high-stress medical environment constitutes a significant psychological stressor for children, creating an "unaccompanied" state that deviates from the standard of Family-Centered Care (FCC) [1]. When parental presence is restricted, the child's sense of safety and trust is shattered. A consistent primary nurse directly addresses this deficit by becoming a temporary, reliable substitute attachment figure. Continuity of care allows the nurse to learn the toddler's unique cues, routines, and non-verbal communication, which is essential for building trust and reducing the fear of abandonment. This intervention aligns with the core principle of mitigating psychological distress by providing a stable, predictable presence in the parent's absence [1].

Analysis of Other Options

- Encouraging play with other children is not developmentally appropriate. A 15-month-old engages in parallel play, not interactive play, and is typically fearful of strangers. Forcing social interaction in a state of acute distress will likely escalate anxiety rather than distract from it.

- Giving a favorite toy and explaining parents will return is a supportive measure but insufficient as a primary intervention. A toddler lacks the cognitive ability to understand abstract concepts of time and "soon." While a transitional object from home is comforting, it cannot replace the need for a secure human connection to navigate the immediate crisis of perceived abandonment.

- Placing the child closer to the nurses' station is a safety measure for frequent monitoring but does not provide the one-on-one emotional support required to cope with separation anxiety. Observation alone does not meet the child's need for physical comfort and emotional security.

The foundational step in helping an unaccompanied child cope is rebuilding a trusting relationship through consistent, familiar care, which directly counteracts the trauma of separation from the primary attachment figure [1].References (research sources)

- [1]Psychological impact and intervention strategies for unaccompanied patients in pediatric intensive care units: a narrative review.Research articleYang T, Hu Y, Bao Y. (2026) · DOI: 10.21037/tp-2025-aw-767

## 임상 시나리오

Managing Toddler Separation AnxietyBuilding Trust Through Consistent Caregiver Assignment
For a hospitalized 15-month-old, separation from parents is a profound psychological stressor. The priority intervention is assigning a consistent primary nurse to serve as a reliable substitute attachment figure, directly mitigating the fear of abandonment and establishing trust.

Avoid relying on verbal explanations about the parents' return, as toddlers lack the cognitive development for object permanence and time comprehension. Similarly, encouraging group play is developmentally inappropriate; toddlers engage in parallel play and will not be distracted from attachment loss by peers.

CautionWhile a comfort item from home is beneficial, it is an adjunct, not the primary solution. The core intervention must be a consistent, trusting human relationship to resolve the emotional crisis, not just environmental modification or increased monitoring.

## 핵심 개념

- **Separation Anxiety** — A developmental stage peaking in toddlers where the child exhibits distress due to separation from their primary attachment figures, perceiving their absence as permanent.
- **Primary Nursing** — A care delivery model where a consistent nurse is assigned to a patient throughout their stay to establish trust, ensure continuity, and provide holistic care.
- **Object Permanence** — The cognitive understanding that objects or people continue to exist even when they cannot be seen, heard, or touched; still developing in a 15-month-old.
- **Parallel Play** — A typical play pattern for toddlers where they play alongside, but not directly with, other children; interactive group play is not developmentally expected at this age.

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