# Situation: A nurse on the pediatric ward cares for children with congenital and developmental conditions and supports their families. A 6-year-old autistic boy with pneumonia is admitted to a quiet single room with his mother at the bedside. He uses picture cards at home and has screamed and covered his ears at every infusion pump alarm. He now needs an intravenous cannula, and the nurse caring for him has not met him before. All of the following are planned. Which should the nurse do FIRST?

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> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A nurse on the pediatric ward cares for children with congenital and developmental conditions and supports their families.

A 6-year-old autistic boy with pneumonia is admitted to a quiet single room with his mother at the bedside. He uses picture cards at home and has screamed and covered his ears at every infusion pump alarm. He now needs an intravenous cannula, and the nurse caring for him has not met him before. All of the following are planned. Which should the nurse do FIRST?

## 보기

1. Tell him just before touching him which hand will be used
2. Apply the ordered topical anesthetic cream to both hands
3. Show him a picture sequence of the cannula insertion steps
4. Ask his mother what sounds and touches upset or calm him **✔ 정답**

**정답: 4**

## 해설

Every other preparation depends on knowing this child: which sensations trigger distress, what calms him, and how he best understands. The nurse therefore first assesses his individual sensory profile and communication needs by asking the parent, then uses that information to prepare him with his own picture system, apply the anesthetic, and warn him before each touch.

## 심화 해설

Nursing Process: Assessment Before Intervention

The correct first action is to assess the child's individual sensory and communication profile by asking the mother what sounds, touches, and approaches upset or calm him. This reflects the foundational principle of the nursing process: assessment must precede any intervention, because every subsequent action depends on understanding this specific child's triggers and preferences.

In a child with autism spectrum disorder, hospitalization itself is often an overwhelming sensory and cognitive experience [2]. Children with ASD may demonstrate atypical sensory processing, meaning that ordinary clinical stimuli such as infusion pump alarms, adhesive tape, cold antiseptic, or even light touch can provoke intense distress, screaming, or physical resistance [1][2]. This child has already shown a clear behavioral cue—screaming and covering his ears at every infusion pump alarm—indicating auditory hypersensitivity. However, the nurse has never met him and does not yet know his full sensory profile, including which tactile sensations he tolerates, which sounds soothe him, and how he best receives information.

Watch out! The other three options are all appropriate interventions, but they are dependent actions that require assessment data first. Showing a picture sequence of cannula insertion assumes the child uses and understands that particular visual communication system. Applying topical anesthetic cream to both hands assumes the child tolerates cream texture, occlusion, or having his hands touched. Telling him just before touching him which hand will be used assumes verbal warning alone is effective and does not itself trigger distress. None of these can be safely or effectively individualized without first learning the child's baseline sensory and communication needs from the parent.

Key point! The parent is the most reliable source of information about the child's unique responses. Parents of children with ASD often serve as expert interpreters of their child's behavior, knowing which specific sounds, textures, or routines provoke distress and which strategies promote calm [2][4]. Asking the mother directly is a rapid, low-cost, and high-yield assessment that informs all subsequent care planning.

| Priority Step | Rationale | Example in This Scenario |
| --- | --- | --- |
| 1. Assess sensory profile | Identifies triggers and calming strategies before any touch or procedure | Ask mother what sounds, touches, and approaches upset or calm him |
| 2. Individualize communication | Uses the child's own system to prepare him predictably | Show picture sequence of cannula insertion steps |
| 3. Minimize pain and sensory load | Reduces noxious input that can escalate distress | Apply topical anesthetic cream to both hands |
| 4. Provide immediate warning | Gives the child a predictable cue before physical contact | Tell him just before touching him which hand will be used |

The scoping review by Fernández-Guarido and colleagues emphasizes that individualized therapeutic environments—tailored to the child's specific sensory processing patterns—are central to effective pain management in children with ASD [1]. This individualization cannot occur without first gathering information from those who know the child best. Similarly, nursing strategies identified in integrative reviews consistently prioritize understanding the child's unique communication style and sensory sensitivities before implementing procedural interventions [4]. Sensory training for healthcare providers has been shown to improve knowledge and perceived competence in caring for neurodivergent children, reinforcing the value of a deliberate, assessment-driven approach .

The nurse's first move is therefore not to act, but to listen and learn. By asking the mother about the child's sensory triggers and calming strategies, the nurse builds the foundation for a plan that respects the child's individual needs and reduces the likelihood of escalating distress during intravenous cannulation.References (research sources)

- [1]Individualized Therapeutic Environments for Pain Management in Children with Autism Spectrum Disorder: A Scoping Review.Research articleFernández-Guarido M, Diéguez-Poncela MP, Ruiz-Azcona L. (2026) · DOI: 10.3390/children13080979

- [2]Caring for the child with an autism spectrum disorder in the acute care setting.Research articleScarpinato N, Bradley J, Kurbjun K, Bateman X, Holtzer B, Ely B (2010) · DOI: 10.1111/j.1744-6155.2010.00244.x

- [4]Strategies used by the nursing team in the care of autistic children and adolescents: An integrative review.Research articleAndré TG, Moreira NG, Lucca M, Dutra HS, Carlos DM, Fernandez-Garcia AO (2025) · DOI: 10.1016/j.pedn.2025.04.006

## 임상 시나리오

Sensory Assessment Before Pediatric ProceduresAutism-friendly cannula insertion starts with the parent
In a child with autism spectrum disorder, the first step before any procedure is to assess the individual sensory profile. Ask the parent which sounds, touches, and approaches upset or calm the child. This child has already shown auditory hypersensitivity by screaming at every infusion pump alarm.

Every other preparation is a dependent intervention. Picture sequences, topical anesthetic, and verbal warnings all require knowing how this child best understands and what he tolerates. Without assessment data, these actions may increase distress rather than reduce it.

CautionDo not assume the child uses a specific picture system or tolerates touch on both hands. Confirm communication preferences and sensory triggers with the parent before touching the child or applying any preparation.

## 핵심 개념

- **Sensory processing** — The way the nervous system receives and interprets sensory input; children with autism may be hypersensitive to sounds, touch, or other stimuli.
- **Nursing process** — A systematic framework of assessment, diagnosis, planning, implementation, and evaluation; assessment must precede interventions.
- **Auditory hypersensitivity** — An exaggerated response to sounds, such as covering ears or screaming at alarms, common in children with autism spectrum disorder.
- **Picture communication system** — A visual support using images or cards to help a child understand sequences, expectations, and upcoming procedures.
- **Topical anesthetic cream** — A medication applied to skin to reduce pain from needle insertion; application requires knowing the child's tolerance and cooperation.

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