Question

The parents of a 4-year-old boy explain to the clinic nurse that for weeks the child has been irritable and listless and even though he has developed a poor appetite, has gained weight. What signs and symptoms should the nurse look for, and what condition should the nurse suspect? What nursing interventions and parent education are appropriate?

Answer 1

By assessing the child, the nurse has to suspect childhood depression.

Depression is a disorder which can occur to anyone at any age. It is a misconception that children may not get depression due to their age constraint. Depression among children is more common and which may vary from moderate to severe and there will be the presence of symptoms unnoted.

In the present case, the child is suffering with irritability and listless since weeks. Also he has a weight gain despite of lack of appetite which shows reduced physical activity. So in this case, the nurse has to look for more symptoms such as :

1. Sad and tearful often

2. Feeling irritated( already present) and angry

3. Lack of concentration

4. Changes in appetite ( already present)

5. Weight gain (already present)

6. Problems with sleep

7. Lethargic or fatigue ( present)

8. Lack of energy or enthusiasm (present)

9. Is not interested in playing or doing other things she used to enjoy.

If these symptoms were present but was not recognised by the parents, when the nurse starts asking for it they may identify. And if it is present, then the child can be diagnosed with childhood depression.

The nursing interventions are :

° Encourage open expression of feelings and explain them the connection between feelings and behaviour.

° Assess the child for precipitating event when feelings of

sadness arose.

° Encourage the child to be a part of their personal care and activities. Use routines to establish feelings of control.

° Assist the child to determine family members and others who are positive and supportive.

° Help the child to identify the activities that are interested and also to interact with others.

° Provide nutritious foods, sandwiches, and high-calorie liquid
supplements frequently.

° Give easy-to-carry drinks that are high in vitamins, minerals, and calories.

Parent education

It is a stressful task to deal with a depressed child, and also it needs lot of time and effort . The first step is to make sure that the parents are available whenever the child needs them.

Tell the parents that they should listen to the child always and be supportive to them.

Advice the parents to show their love completely to the child and how much ever possible.

Instruct the parents to be aware about the following points.

1. Ensure that the child is getting a nutritious diet and adequate sleep and rest each day along with a moderate amount of physical activity.

2. Be patient and kind even if the child shows temper tantrum, acts grumpy or pushes others away.

3. Remove all situations that stresses and irritates the child.

4. Encourage the child to take part in activities upon their interest.

5. Ensure that the child is taking medicines on time and the parents should be aware about the possible side effects and how to handle it.

6. They should follow the therapist's instructions and suggestions as it will help for the fast recovery of the child.