Separation Anxiety Among Toddlers Due to Long Hospitalization: A Narrative Review

Abstract

Introduction: Hospitalization during early childhood is often associated with emotional stress, especially for toddlers aged 1–3 years who are in the critical phase of forming attachments. Prolonged separation from caregivers during hospital stays can lead to separation anxiety, manifested as irritability, clinginess, sleep disturbances, and developmental regression. These emotional challenges are compounded by the unfamiliar hospital environment and limited parental presence, making it imperative to understand and address the psychological impact of hospitalization on toddlers. Methodology: A narrative review methodology was adopted to synthesize literature on separation anxiety among toddlers due to long hospitalization. A structured search was conducted in databases such as PubMed, CINAHL, PsycINFO, Scopus, and Google Scholar, focusing on articles published between 2015 and 2024. Studies included were empirical, theoretical, or clinical, involving children aged 1–3 years, and written in English. Data were thematically analyzed, and quality appraisal was performed using the CASP checklist. Results: A total of 38 studies were included in this review. The findings highlight the high prevalence and multifaceted nature of separation anxiety in hospitalized toddlers. Contributing factors included prolonged hospital stay, restricted caregiver access, invasive procedures, and environmental unfamiliarity. Studies confirmed that consistent parental involvement, therapeutic play, and emotional support from pediatric nurses significantly reduced toddler anxiety. Innovative strategies such as art therapy, structured family-centered care, and virtual caregiver interaction showed promising outcomes in reducing emotional distress. Discussion: The review emphasizes the urgent need for pediatric settings to prioritize emotional well-being alongside physical care. Toddler separation anxiety is not only distressing but also impedes recovery and long-term development. Pediatric nurses play a vital role in implementing evidence-based interventions, ensuring continuous caregiver contact, and advocating for policies that promote holistic, family-centered care.