# 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 this toddler cope with separation anxiety? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541743 > language: ko > 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 this toddler cope with separation anxiety? ## 보기 1. Provide the child with new toys and activities to serve as distractions 2. Place the child in a room with other children of similar age for socialization 3. Assign a consistent primary nurse to provide care and establish a trusting relationship **✔ 정답** 4. Encourage the child to play independently to promote self-soothing behaviors **정답: 3** ## 해설 Assigning a consistent primary nurse helps establish trust and provides emotional security for the hospitalized toddler experiencing separation anxiety. Other options are less effective as they do not address the core need for a stable caregiver. ## 심화 해설 Understanding Separation Anxiety in Toddlers A 15-month-old toddler is in the developmental stage where separation anxiety peaks. At this age, a child understands object permanence but does not yet have a mature concept of time. When parents leave, the toddler perceives their absence as permanent and threatening, triggering a profound stress response. The inconsolable crying observed for the past 2 hours is a classic manifestation of this developmental crisis, often termed the protest phase of separation anxiety. Why a Consistent Primary Nurse is the Priority The most appropriate intervention is to assign a consistent primary nurse. This strategy directly addresses the core deficit created by the parents' departure: the loss of a secure attachment figure. The foundational importance of this approach is rooted in attachment theory, a central concept in Infant Mental Health and Early Childhood (IECMH). Research in this field emphasizes that the well-being of an infant is inextricably linked to the "developing relationship" with a caregiver [1]. A consistent nurse can serve as a temporary, reliable "secondary attachment figure," providing a safe base from which the child can begin to regulate their emotional state. This continuity of care fosters a sense of safety and predictability, which is physiologically calming for a dysregulated toddler. Analyzing the Incorrect Options - Option 1: Providing new toys and activities. While distraction can be a useful tool for momentary redirection, it is a superficial solution for deep-seated separation distress. A child in the protest phase of separation anxiety is not seeking novel stimulation; they are seeking a specific person to restore a sense of security. New toys do not fulfill the relational and emotional need for a trusted caregiver's presence. - Option 2: Placing the child with other children. Toddlers at 15 months engage primarily in parallel play, not interactive socialization. Placing a distressed, crying child in a room with peers will not provide comfort and may even escalate the anxiety of other children. The child's developmental need is for a one-on-one, secure adult relationship, not peer interaction. - Option 4: Encouraging independent play. This intervention is developmentally inappropriate for a toddler in acute distress. The capacity for self-soothing is limited at this age and develops through repeated experiences of co-regulation with a trusted adult. Expecting a hospitalized, frightened child to self-soothe without first establishing a trusting relationship is an unrealistic demand that can intensify feelings of abandonment. Clinical Application and the Nurse's Role The nurse's role is to bridge the gap created by parental absence. A systematic approach to care, such as assigning a primary nurse, is a direct application of creating a supportive "environment" that mitigates the negative impacts of hospitalization . By consistently responding to the child's cries with a familiar face, voice, and gentle touch, the nurse engages in co-regulation. This process helps the child's developing nervous system move from a state of hyperarousal (crying, panic) to a calmer state. This intervention is not merely about providing comfort; it is a critical nursing action that prevents the potential long-term traumatic effects of unmitigated stress in early childhood, a period where the quality of the caregiver relationship is paramount for optimal development [1].References (research sources) - [1]Phenomenological research in the field of Infant Mental Health and Early Childhood (IECMH) -A mapping review.Research articleSorsa M, Dahl B, Røseth I. (2026) · DOI: 10.1002/imhj.70073 ## 임상 시나리오 Managing Toddler Separation AnxietyBuilding a Secure Base During Hospitalization The priority intervention for a hospitalized toddler (15 months) in the protest phase of separation anxiety is assigning a consistent primary nurse. This directly addresses the loss of the parent by providing a reliable secondary attachment figure. Continuity of care creates predictability and safety, which helps regulate the child's physiological stress response. The nurse should prioritize physical proximity, gentle touch, and a calm tone to foster trust. CautionAvoid rotating staff assignments for patients in this age group. Do not mistake the detachment phase (where the child appears calm but has resigned) for resolution; this indicates emotional withdrawal and requires continued consistent support. ## 핵심 개념 - **Separation Anxiety** — Distress experienced by a child when separated from primary caregivers, peaking between 10-18 months, characterized by stages of protest, despair, and detachment. - **Attachment Theory** — A psychological model describing the dynamics of long-term interpersonal relationships, emphasizing the infant's need for a secure base with a primary caregiver to develop healthy emotional regulation. - **Primary Nursing** — A care delivery model where a single nurse assumes 24-hour responsibility for planning and coordinating care for a specific patient, promoting continuity and a trusting relationship. ## 같은 주제 문제 - [A 15-month-old toddler is hospitalized for pneumonia. 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