Essentials of Pedriatric Nursing

"Enforced dependency is a chief characteristic of the sick role and accounts for the numerous instances of toddler negativism. For example, rigid schedules, different clothes, altered care giving activities, unfamiliar surroundings, separation from parents, and medical procedures usurp toddlers' control over their world. Although most toddlers initially react negatively and aggressively to such dependency, prolonged loss of autonomy may result in passive withdrawal from interpersonal relationships and regression in all areas of development."
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"Adolescents' struggle for independence, self-assertion, and liberation centers on the quest for personal identity. Anything that interferes with this poses a threat to their sense of identity and results in a loss of control."
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"Because separation is such an important issue surrounding hospitalization for young children, children who are active and strong willed tend to fare better when hospitalized than youngsters who are passive."
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"Feelings of loss of control result from separation, physical restriction, changed routines, enforced dependency, and magical thinking."
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"The dependent role of the hospitalized patient imposes tremendous feelings of loss on older children. Principle interventions should focus on respect for individuality and the opportunity for decision making. Although these sound simple, their efficacy lies with nurses who are flexible and tolerant. It is also important for the nurse to empower the patient while not feeling threatened by a sense of lessened control.

Enabling children's control involves helping them maintain independence and promoting the concept of self-care. Self-care refers to the practice of activities that individuals personally initiate and perform on their own behalf in maintaining life, health, and well-being (Orem, 2001). ...Whenever possible, these activities are encouraged in the hospital. Other approaches include jointly planning care, time structuring, wearing street cloths, making choices in food selections and bedtime, continuing school activities, and rooming with an appropriate age-mate."
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--Wong's Essentials of Pediatric Nursing 8th edition by Marilyn J. Hockenberry and David Wilson