# Situation: A 5-year-old girl is admitted to the pediatric ward of a district hospital for 2 weeks of intravenous antibiotics. Her parents work in another city and can visit only on weekends. On the tenth day, the girl plays cheerfully with the other children and the nurses and eats well. When her parents arrive on the weekend, she barely looks up from her game and does not cry when they leave. What should the nurse conclude?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629624  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A 5-year-old girl is admitted to the pediatric ward of a district hospital for 2 weeks of intravenous antibiotics. Her parents work in another city and can visit only on weekends.

On the tenth day, the girl plays cheerfully with the other children and the nurses and eats well. When her parents arrive on the weekend, she barely looks up from her game and does not cry when they leave. What should the nurse conclude?

## 보기

1. She has adjusted to the ward and no longer misses them
2. She is in protest, hiding her anger at her parents
3. She is in despair and has given up hope of their return
4. She is in detachment, a sign of prolonged separation **✔ 정답**

**정답: 4**

## 해설

In detachment, the last phase of separation anxiety, the child seems to adjust and interacts with others, but only superficially, and shows little reaction when the parent returns. It follows prolonged separation and is easily mistaken for good adjustment. The nurse increases parental contact and keeps consistent caregivers rather than concluding that the child no longer needs her parents.

## 심화 해설

Clinical conclusion

The child is demonstrating detachment, the final phase of separation anxiety that follows prolonged separation from attachment figures. Her cheerful play, good appetite, and minimal reaction to her parents’ arrival or departure are not evidence of healthy adjustment but rather a superficial engagement with the environment that masks emotional withdrawal from the primary attachment relationship.

Why this is detachment, not adjustment

Separation anxiety in hospitalized young children unfolds in predictable phases when the separation is prolonged. The early phase of protest is loud and visible—crying, clinging, searching for the parent. Over time, if reunion does not occur, the child may move into despair, marked by sadness, withdrawal, and decreased activity. With even longer separation, the child enters detachment.

In detachment, the child appears to have “settled in.” She plays, eats, and interacts with staff and peers. However, the key clinical clue is her response to the parents’ return: she barely looks up and does not cry when they leave. A child who had genuinely adjusted would typically show recognition, pleasure, or at least a change in affect when the parents arrive. The absence of that response indicates that the child has emotionally distanced herself from the parents as a protective mechanism against the repeated pain of separation .

Watch out! Detachment is easily mistaken for good coping. The child’s bright behavior can reassure staff and parents alike, but it represents emotional numbing rather than resolution of the separation experience.

Why the other options are incorrect

| Option | Interpretation | Why it is not the best conclusion |
| --- | --- | --- |
| 1. She has adjusted and no longer misses them | Healthy adaptation to the ward environment | True adjustment would include an appropriate emotional response to the parents’ return. The lack of any reaction is not consistent with a secure, connected relationship. |
| 2. She is in protest, hiding her anger | Early phase of separation anxiety | Protest is characterized by overt distress, crying, and active searching. This child shows no outward distress, which is inconsistent with protest. |
| 3. She is in despair, given up hope | Middle phase of separation anxiety | Despair typically presents as sadness, withdrawal, and reduced activity. The child here is active, playful, and eating well, which does not match the despair picture. |

Clinical implications for nursing care

The appropriate nursing response is not to conclude that the child no longer needs her parents. Instead, the nurse should increase opportunities for parental contact and maintain consistent caregivers to preserve the child’s attachment security. A family-centered approach is essential because separation anxiety is not only a child-level phenomenon; parents also experience distress during a child’s hospitalization, and their involvement supports the child’s emotional recovery .

Early attachment experiences and prior separation history shape how a child responds to hospitalization . Children with a secure attachment are not immune to separation distress, but the quality of the attachment relationship influences the intensity and course of the response. When separation is unavoidable, interventions should aim to reduce the duration and impact of the separation rather than simply waiting for the child to “get used to it” .

Key point! In detachment, the child’s calm is not a sign of well-being. It is a signal that the separation has exceeded the child’s capacity to maintain an active emotional connection, and the nurse must act to restore that connection through structured parental involvement and consistent, nurturing care from staff.

## 임상 시나리오

Detachment in Hospitalized ChildrenRecognizing the final phase of separation anxiety
After prolonged separation, a child may enter detachment, appearing cheerful and interactive but showing little or no reaction when parents arrive or leave. This is a protective emotional withdrawal, not healthy adjustment.

Key assessment clue: a genuinely adjusted child typically shows recognition, pleasure, or affect change at the parent's return. The absence of this response after prolonged separation points to detachment.

CautionDetachment is easily mistaken for good coping. The nurse should increase parental contact and maintain consistent caregivers rather than concluding the child no longer needs her parents.

## 핵심 개념

- **Separation anxiety** — Distress experienced by a young child when separated from primary attachment figures, occurring in predictable phases during hospitalization.
- **Protest** — The first phase of separation anxiety, marked by loud crying, clinging, and searching for the parent.
- **Despair** — The second phase, characterized by sadness, withdrawal, decreased activity, and hopelessness.
- **Detachment** — The final phase following prolonged separation, in which the child appears adjusted and interacts superficially but shows little reaction to the parent's return or departure.
- **Attachment figure** — A primary caregiver with whom the child has formed an emotional bond, typically the parent.

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