Psychosocial and Behavioral Emergencies
Psychosocial care is tested as concrete, observable nursing behavior rather than abstract theory. Anchor practice in family-centered, developmentally appropriate care: explain procedures in the child's language, offer choices, use child life specialists, and minimize separation from caregivers. Stranger and separation anxiety peaks in toddlers; adolescents need privacy and confidentiality. Pain and anxiety should be treated pharmacologically and non-pharmacologically - untreated pain is a safety and quality issue, and procedures should not be performed with inadequate analgesia.
Behavioral and psychiatric emergencies
Agitation may be psychiatric, but always screen for hypoglycemia, hypoxia, head injury, ingestion, and sepsis first. A child expressing suicidal ideation requires direct, nonjudgmental questioning, removal of dangerous items, continuous observation (often 1:1), and notification of the provider and caregivers; never leave the patient alone. Aggression is de-escalated verbally first, with environmental modification and limit setting. Physical or chemical restraint is a last resort, requires a provider order per policy, continuous monitoring of airway, breathing, circulation, and vital signs, documentation of the indication, and frequent reassessment with discontinuation as early as possible.
Abuse, neglect, and ingestions
Every nurse is a mandated reporter. Objective documentation (exact quotes, measurements, wound descriptions, photographs per policy) supports the report; you do not need proof, only reasonable suspicion. Consider sentinel injuries in infants, delay in seeking care, inconsistent histories, and unusual sexual behavior or injury. Intentional ingestions in adolescents need both medical management and behavioral health evaluation. Screen for adverse childhood experiences and social determinants.
Rule of thumb: always ask "could this behavior have a medical cause?" before assuming a psychiatric one - and always ask the adolescent privately about safety.