Nursing care for autism requires extra patience and compassion. Taking care of a child with autism can be emotionally and physically demanding for nurses. Without careful attention, you can have difficulty in getting the trust and cooperation of pediatric patients with autism disorders.
Autism Spectrum Disorders or ASD are a cluster of disorders characterized by impaired social skills, communication difficulties, cognitive delays, and repetitive behaviors. Stereotypically, most people see autism as a single mental disorder. In reality, there are several conditions under ASD and each condition displays different symptoms.
Autism Spectrum Disorders
The following are the conditions under ASD:
• Asperger’s Syndrome – This condition is characterized by impaired social skills and obsession with a single object or topic. They tend to have rituals or repetitive behaviors. They also have communication difficulties and coordination problems as evidenced by awkward or clumsy behavior. Children with Asperger’s Syndrome usually have higher than average intelligence as they are talented or skilled in particular areas or subjects.
• Rett Syndrome – This condition only affects girls as a result of a genetic mutation. At around 16 to 18 months of age, a child with Rett Syndrome suddenly stops responding socially. Communication and coordination skills are impaired. As the child approaches toddler years, head growth will be impaired and become evident at two years of age.
• Pervasive Developmental Disorder, Not Otherwise Stated (PDD-NOS) – Symptoms of autism under this condition vary widely as children that cannot be classified in other ASDs are diagnosed with this disorder. However, most common symptoms include impaired social skills, late age onset of other symptoms and repetitive behaviors.
• Childhood Disintegrative Disorder – This the most severe condition in ASD but it is also the least common one. In this condition, thechild loses intellectual and social skills usually at age two to four years old. In most cases of CDD, the affected child develops a seizure disorder.
Tips in Caring for Autistic Children
According to the Center for Disease Control and Prevention, an estimate of 1 in 150 eight-year old children in the US has some form of autism disorder. This makes it highly likely for nurses to come across patients with autistic conditions in their ER or ward. In this event, you need to be knowledgeable on how to provide proper (and sometimes creative) nursing care.
Here are some recommended tips and strategies that you can employ:
1. Secure a non-stimulating environment
If you need to do a physical examination to pediatric patients with autism, place them in a quiet room. Preferably, there should be no medical equipments inside so that there are less distractions for them. Dim the lights and regulate room temperature to promote a relaxing environment.
2. Talk with the child’s parents first
Before approaching the patient, talk with the child’s parents first to get a baseline expectation on how the patient would react to you. By doing your research, you can also plan on the best way to approach the patient. Ask the parent about the child’s past medical history, activities that help sooth him and the best way of communication fit for him. Let the child observe as you talk with the parent to initially establish trust with the patient.
3. Do physical assessment away from the child but progressively moving centrally
Start first with visual inspection. As the child shows cooperation, move forward with hands and feet. Then continue doing assessment by progressively moving centrally until you can assess the child’s body or trunk. Autistic children get easily stressed by sudden intimate touch so you need to have a tailored approach in doing physical assessment to them.
Also Read: 9 Funny Signs You Are a Pediatric Nurse
4. If you need to use medical equipment, use them on the child’s parent first
Autistic children get easily stressed with new or unfamiliar objects. If you need to use medical equipment, let the patient see that you are using it on someone else he trusts. With this strategy, the patient will expect that the medical equipment will also be used to him and you can get his cooperation.
5. Lower yourself to the child’s height level when providing care
Sit down with the child or lower down your posture as you provide nursing care to the child. Autistic children cooperate best with people in the same level of their visual perspective. Looking up or down to them may initiate trust issues with them.
6. Be gentle and consistent with your actions and behavior around the child
Autistic children have a strong need for sameness and routines. Anything inconsistent with the first actions or behaviors they observed from you may cause stress and tantrums.
7. As much as possible, limit the healthcare workers caring for the child
The nurses who cared for the child during the first day of hospitalization should be the ones continuously assigned to the patient. The nursing assistant, phlebotomist, respiratory therapist and other healthcare workers who worked with the patient should also be the same personnel assigned to the child if he will need them again. Because of impaired social skills, introducing new people to the autistic child may emotionally stress him so it is important to assign the same team of healthcare workers to the patient.
8. Stick to a schedule
Autistic children work best with structured routines or schedules. Create a schedule when planning nursing care for the patient. If there will be an unavoidable schedule change like adjustments in medication administration, discuss it with the patient first.
9. Reward good behaviors
Positive reinforcement means a lot to autistic children as they will be inspired to become more cooperative as well. Praise or reward them with a simple sticker with every good behavior they display. They will also like the good attention being given to them so they will trust you more.
10. Make the child’s parents part of your nursing care
The child’s parents are the usual companions of children with autism so they know the best approach in getting their child’s attention and cooperation. Involve them in nursing care so they will also learn new strategies in caring for the health of their child.
When caring for children with autism disorders, it is important for nurses to have a level of preparation, knowledge, creativity, patience, and even a sense of humor. Otherwise, thoughtless actions or behavior can result in undue stress on the child.
If you frequently encounter autistic children as your patients, take this opportunity to enhance your nursing skills. Read about autism to understand their behavior and ask advices from your senior colleagues.