MATERNAL- I NFANT BONDI NG AND THE MOTHER´ S PARTI CI PATI ON DURI NG
VENI PUNCTURE: A PSYCHOANALYTI C PERSPECTI VE
Júlia Per es Pint o1 Ver a Lú cia Bar bosa2
Pint o JP, Bar bosa VL. Mat er nal- infant bonding and t he m ot her ’s par t icipat ion dur ing venipunct ur e: a psychoanalyt ic per spect iv e. Rev Lat in o- am En f er m agem 2 0 0 7 j an eir o- f ev er eir o; 1 5 ( 1 ) : 1 5 0 - 5 .
Pr ofessionals discuss accom pany ing m ot her s’ par t icipat ion dur ing painful pr ocedur es as a possibilit y of car e t o m ot h er an d ch ild, bu t t h er e is n o con sen su s on t h is su bj ect . To con t r ibu t e t o t h is t opic, t h is st u dy addr esses t he child’s needs dur ing venipunct ur e in a hospit al envir onm ent and t he m ot her ’s par t icipat ion in t his pr ocedur e, based on aut hor s fr om psy choanaly sis and m ot her - child bonding.
DESCRI PTORS: child, hospit alized; pediat r ic nur sing; m ot her - child r elat ions; obj ect at t achm ent
VÍ NCULO MATERNO I NFANTI L Y LA PARTI CI PACI ÓN DE LA MADRE DURANTE LA
REALI ZACI ÓN DE LA PUNCI ÓN VENOSA: LA ÓTI CA DEL PSI COANÁLI SI S
La p ar t icip ación d e la m ad r e acom p añ an t e j u n t o al n iñ o d u r an t e la r ealización d e p r oced im ien t os dolor osos es discut ida por pr ofesionales com o una posibilidad de cuidado al binom io, per o no hay un consenso sob r e est e t em a. Par a con t r ib u ir con est a d iscu sión , el t ex t o t r at a d e las n ecesid ad es d el n iñ o d u r an t e la r ealización de la punción venosa en un am bient e de hospit al y la par t icipación de la m adr e en el pr ocedim ient o, t om ando com o base aut or es del psicoanálisis y el v ínculo m adr e y hij o.
DESCRI PTORES: n iñ o h ospit alizado; en fer m er ía pediát r ica; r elacion es m adr e- h ij o; apego a obj et os
VÍ NCULO MATERNO- I NFANTI L E PARTI CI PAÇÃO DA MÃE DURANTE A REALI ZAÇÃO
DA PUN ÇÃO VEN OSA: A ÓTI CA DA PSI CAN ÁLI SE
A par t icipação da m ãe acom panhant e j unt o à cr iança dur ant e a r ealização de pr ocedim ent os dolor osos é discut ida pelos pr ofissionais com o um a possibilidade de cuidado ao binôm io, por ém , não há consenso quant o a esse t em a. Par a cont r ibuir com essa discussão, o t ext o abor da as necessidades da cr iança dur ant e a r ealização da punção venosa no am bient e hospit alar e a par t icipação da m ãe no pr ocedim ent o, t endo com o base aut or es da psicanálise e o v ínculo na r elação m ãe e filho.
DESCRI TORES: cr ian ça h ospit alizada; en fer m agem pediát r ica; r elações m ãe- filh o; apego ao obj et o
1 Doct oral St udent , São Paulo Federal Univer sit y Medical School, Facult y, Anhem bi- Mor um bi Univer sit y and São Cam ilo Univer sit y Cent er; 2 PhD in Nur sing,
Adj unct Pr ofessor, São Paulo Federal Univer sit y
I NTRODUCTI ON
S
ince 1 9 6 0 , sev er al st udies hav e descr ibed t he m ot her ’s par t icipat ion in t he hospit alizat ion of achild as a fundam ent al suppor t fact or t o t he child( 1). This is obser v ed in hospit alizat ion unit s t hr ough t he
m o t h er ’ s p er m an en t p r esen ce b y t h e ch i l d ’ s si d e, esp eci al l y r eg ar d i n g car e i n t er m s o f f eed i n g an d c l e a n i n g , b u t u n u s u a l d u r i n g p r o c e d u r e s l i k e
v e n i p u n c t u r e . H o w e v e r, s e v e r a l a u t h o r s d e f e n d p a r e n t s ’ p a r t i c i p a t i o n d u r i n g p a i n f u l p r o c e d u r e s
because t hey believ e t hat t he pr esence of som ebody significant t o t he child can offer suppor t and secur it y
on t hese occasions as w ell( 2- 5).
S o m e h o s p i t a l s o r p e d i a t r i c u n i t s h a v e s t a n d a r d s t h a t a p r i o r i e s t a b l i s h t h e m o t h e r ’ s
p ar t icip at ion d u r in g v en ip u n ct u r e, in d ep en d en t ly of
t he child’s need or t he m ot her ’s desir e. Som e m ot her s, i n t u r n , ch o o se n o t t o p a r t i ci p a t e o r o b ser v e t h e v en ipu n ct u r e, ev en if t h e in st it u t ion or pr of ession al
agr ees w it h her pr esence( 6).
Resear ch sh ow s t h at p ain f u l p r oced u r es in
h o sp i t al i zed ch i l d ar e o n e o f t h e m ai n so u r ces o f suffer ing for accom pany ing m ot her s( 4- 7). I n addit ion,
e v e n m o t h e r s w h o r e c o g n i z e t h e b e n e f i t o f v en ip u n ct u r e f or t h e ch ild ’s t r eat m en t su f f er w h en w at ching t he child’s suffer ing and t hink about quit t ing
h ospit alizat ion( 6 ).
Th is sit u at ion r ev eals t hat t h e car e focu s is
not cent ered on hospit alized children and t heir fam ily and also t hat t here is a need for new discussions about
t h is con t ex t in or d er t o im p r ov e at t en d an ce t o t h e c h i l d a n d m o t h e r ’ s g l o b a l n e e d s w h e n t h e y a r e
confr ont ed w it h painful pr ocedur es.
Hence, analyzing issues involving t he m ot her
an d ch ild r elat ion sh ip in t h e h ospit alizat ion pr ocess h as b een con sid er ed f u n d am en t al in p ed iat r ic an d n e o n a t a l n u r si n g ca r e , b e ca u se t h e y a f f e ct ca r e
qualit y( 8).
To su ppor t t h e discu ssion , w e u sed n u r sin g
a n d p s y c h o l o g y a u t h o r s , e s p e c i a l l y f r o m psychoanalysis. This discussion is focused on children
bet w een zer o and 24 m ont hs old and t heir m ot her s. Th e pr esen ce of older ch ildr en ’s m ot h er s is u su ally
a ssu r ed b y t h e ch i l d r en t h em sel v es, w h o a l r ea d y p ossess a set of r esou r ces, su ch as v er b alizat ion , cr y in g an d m ov em en t s t o r eq u ir e t h is. Th is op t ion
does not int end t o devalue t he suppor t of a significant person t o older children since, j ust like t heir m ot hers,
t h e y a l so n e e d su p p o r t t o p a ss t h r o u g h d i f f i cu l t ex p er i en ces.
Th e r e f l e c t i o n s a r e a l s o b a s e d o n t h e con v ict ion t h at m ot h er s w h o ar e w ell at t en d ed ar e
capable of helping t he child in difficult sit uat ions and t hat t heir par t icipat ion in t he venipunct ur e pr ocess is
fundam ent al for t heir childr en’s psy chic healt h.
THE MOTHER- I NFANT RELATI ONSHI P AND
BONDI NG
An in d iv id u al’s p er son alit y is in f lu en ced b y
i n t r i n si c an d ex t r i n si c f act o r s. Th e f o r m er i n cl u d e genet ic and her edit ar y fact or s, w hile t he lat t er r efer t o fact or s r elat ed t o t he social and fam ily environm ent ,
w h ich can in f lu en ce t h e con st it u t ion of a p er son ’s
p e r so n a l i t y. Re g a r d i n g t o e x t r i n si c f a ct o r s, i t i s obser ved t hat som e childhood event s can deeply affect a per son’s dev elopm ent . Psy chological t est s m ak e it
possible t o iden t if y t h e m ar k s lef t by t h ese ev en t s, even if t he per son does not r em em ber t he im pr essions
t hat caused t hem( 9).
Peop le in g en er al d o n ot r em em b er ev en t s
f r om t h eir ear ly ch ild h ood , t h at is, u p t o six y ear s old. This fact is due t o a psy chological phenom enon t hat can be ex plained t hr ough t he under st anding of
t he unconscious, called childhood am nesia( 9). Alt hough, in childhood, w e experience em ot ions and can receive
and r epr oduce im pr essions, w e ar e capable of r et aining in our m em ory only int elligible and fr agm ent ed fact s.
Th e r e f o r e , t h e e x p e r i e n c e s c h i l d r e n g o t h r ou g h d u r in g h osp it alizat ion , ev en if t h ey can n ot
r em em b er t h em , ca n m a r k t h ei r p er so n a l i t y. An y dam ages r esu lt in g f r om t h is ex per ien ce w ill depen d
on how w ell it is addr essed by people involved in t he p r o cess.
I t i s k n o w n t h a t , d u r i n g t h e f o r m a t i o n o f
children’s personalit y, an adult , usually t heir m ot hers, r e p r e se n t s t h e i r co n n e ct i o n w i t h t h e w o r l d . Th e
m ot h er s’ im p or t an ce in p er son alit y con st r u ct ion is b ecau se t h ey ar e t h e ch ild r en ’s r ef er en ce p oin t , in
r e l a t i o n t o t h e w o r l d a n d t o t h e m s e l v e s( 1 0 - 1 1 ). Br e a st f e e d i n g i n f a n t s a r e se e n b y D o l t o a s p r e
-subj ect s, w hose sur vival depends on t he m ot her w it h w h o m t h e r e e x i s t s a f u n c t i o n a l a n d d e p e n d e n t r elat ion sh ip .
hum an beings or w it h ev ent s of life( 1 2 ). Thus, if t he child does not obt ain t he necessar y suppor t t o bond
w i t h t h e m o t h e r si n ce t h e f i r st d a y s o f l i f e , t h i s sit u at ion w ill af f ect t h e ch ild ’s cap acit y t o d ev elop
sat isf act or y r elat ion sh ip s. Th e af f ect iv e con n ect ion bet w een m ot h er an d ch ild is est ablish ed du r in g t h e
child’s fir st 24 m ont hs of life of t he child and r esult s f r om t h e con st an t in t er act ion s b et w een t h ese t w o sin ce bir t h . Th e m ot h er is t h e per son w h o an sw er s
or st im u lat es h er ch ild ’s m an if est at ion s su ch as a sm ilin g , cr y in g , b ab b lin g , f eelin g cold , h u n g r y an d
pain( 10).
I n nursing, one of t he m or e diffused t heor ies
i s t h e At t a ch m en t Th eo r y, w h i ch a l so a f f i r m s t h e im por t ance of bonding bet w een t he dev eloping child a n d t h e r e s p o n s i b l e . A t t a c h m e n t b e h a v i o r i s
char act er ized by per m anent physical cont act bet w een
m ot her and child w hen t he child is hungr y, cold, afraid or anguished( 12).
Th e d a i l y r e p e t i t i o n o f t h e se i n t e r a ct i o n s
allow s t he child t o elaborat e a schem e of her m ot her or anot her car egiver. Thus, ar ound t he four t h or fift h
m o n t h o f l i f e, t h e ch i l d al r ead y d i f f er en t i at es t h e m ot her fr om ot her people and does not allow ot her s
t o r ock or feed her( 10,12).
Accor ding t o At t achm ent Theor y, bet w een t he ages of six an d t w en t y - f ou r m on t h s, t h e ch ild goes
t h r ou g h t h e at t ach m en t d ef in it ion p h ase, st ar t s t o d em on st r at e f ear of st r an g er s an d cr ies if can n ot
h av e access t o t h e m ot h er ; f r om t h e t en t h t o t h e eight eent h m ont h, t his feeling is int ensified, in a crit ical
per iod k now n as separ at ion anx iet y( 12).
Th u s, w h en t h e ch i l d i s ex p o sed t o t en se
sit u at ion s, lik e in t h e case of h ospit alizat ion w h ich , b e si d e s t h e i l l n e ss, a l so co n t a i n s e n v i r o n m e n t a l
c h a n g e s , p r e s e n c e o f s t r a n g e r s a n d p a i n f u l p r o ce d u r e s, t h e p r e se n ce o f a f a m i l i a r p e r so n i s f u n d am en t al t o t h e ch ild , esp ecially in t h e f ir st 2 4
m o n t h s. Th i s p r esen ce b eco m es essen t i al , m ai n l y w hile t he child does not dist inguish bet w een her body
and t he ex ist ence of her body on t he one hand and her m ot her ’s ex ist ence on t he ot her. The child under
st r ess seek s a w ay t o r each t he m ot her ’s pr esence, r elat ed t o safet y and com for t( 11).
Af t er t h ese 2 4 m on t h s, t h e ch ild p er ceiv es t h e m ot h er as an in d ep en d en t an d , t h en , b ecom es ca p a b l e o f t o l er a t i n g sep a r a t i o n f r o m t h e m o t h er
w it h ou t su f f er in g, if in a f am iliar place or r eceiv in g guar ant ees of her r et ur n( 12).
TH E M OTH ER’S PARTI CI PATI ON D URI N G
V EN I PUN CTURE OF TH E H OSPI TALI ZED
CHI LD
I n t he v enipunt ur e pr ocess, if t he m ot her is a b s e n t , i t i s o b s e r v e d t h a t t h e c h i l d , u n t i l appr ox im at ely t w o y ear s old, cr ies cont inually, since
t he m om ent t he m ot her leav es and ev en befor e t he needle is int roduced. The suffering t he child show s is not caused j ust by t he punct ur e it self, but also by t he
separ at ion fr om t he m ot her.
This is due t he fact t hat t he m ot her, as t he pr im ar y obj ect of childr en’s affect iv e connect ion, has
t he condit ion t o calm and pr ot ect t hem fr om fear w hen t hey go t hr ough an unknow n sit uat ion( 10). The m ot her s’ capacit y t o alleviat e t heir children’s anxiet y or fear is
f u n dam en t al f or gr ow in g at t ach m en t an d n ecessar y for t hem t o lear n how t o separ at e fr om t heir m ot her w i t h o u t em o t i o n a l d a m a g e, a s t h ei r d ev el o p m en t
im pr ov es( 1 0 , 1 2 ).
Th e e x p e r i e n c e s o f o u r r e a l i t y m a k e a n im pr ession and ar e also influenced by t he or ganism ’s
int egr it y, by it s t ransit or y or per m anent inj ur ies and b y p h y siolog ical an d v iscer al sen sat ion s( 1 1 ). I n t h is sense, v enipunct ur e, w hich fr equent ly occur s dur ing
infant hospit alizat ion, can be considered as a t ransit ory inj ur y t o t he or ganism .
Pa i n r e se a r ch e r s r e p o r t t h a t ch i l d r e n a r e
c a p a b l e o f f e e l i n g p a i n f r o m b i r t h . Th e i r e a r l y m an if est at ion s ar e cr y in g an d body m ov em en t s. As n u r sin g in f an t s can n ot ex p r ess t h em selv es v er b ally
about t heir feelings, adult s t end t o devaluat e or even ign or e t h em . Th at does n ot m ean t h at t h ey do n ot ex pr ess t hem selv es in uncom for t able sit uat ions( 13- 14).
Cr ying, in r esponse t o discom for t or a st r ange ev en t , is an abilit y ch ildr en possess sin ce t h e ear ly m om ent s of life. The m ot her s’ pr oxim it y w hen children
cr y helps t hem t o r elax and t o nest in t he m ot her ’s ar m s( 1 0 - 1 1 ). Wh en ch ildr en ’s r equ est f or at t en t ion is v a l u e d , e v e n i f t h e i r m o t h e r ca n n o t p r o v i d e t h e
r equest ed pleasur e, t his gr ant s a highly com pensat or y hum an v alue and m ak es t he childr en feel lov ed and ack n ow ledge in t h eir desir e, st r en gt h en in g m ot h er
-infant bonding( 11).
Dur ing t he v enipunct ur e, ev en if t he m ot her can n ot av oid t h e p r oced u r e, h er p r esen ce assu r es
com p r eh en sion an d lov e t o t h e ch ild . Wh en f eelin g assist ed b y t h e m ot h er, ch ild r en w h o g o t h r ou g h a d if f icu lt ex p er ien ce w ill b e b et t er p r ep ar ed t o cop e
t h e y a r e t h e i r m o t h e r ’ s p r e f e r r e d o b j e c t ,
m an if est at ion s of d iscom f or t p r ev ail, lik e cr y in g in r esponse t o an aggr ession, because t hey feel safe t o ex p r ess t h eir f eelin g s( 1 1 ). Alt h ou g h lim it at ion s an d
co r r e ct i o n s m o t h e r s m a y i m p o se o n ch i l d r e n a r e necessar y t o for m t heir per sonalit y, so is r espect for t h eir f eelin gs. Th u s, t h e ch ildr en ’s f eelin gs m u st be
v alued t o av oid dam age t o t heir m ent al healt h. Not at t en din g t o ch ildr en ’s m an if est ed n eeds r epr esen t s a lim it at ion im posed by t h e m ot h er. How ev er, t h ese
lim it at ion s, w h ich t h e in d iv id u al g oes t h r ou g h f r om ch ild h ood t o ad olescen ce, ar e h u m an izin g b ecau se t hey favor t he form at ion of adult s r esponsible for t heir
act ions and capable of assum ing t heir life( 11). On t h e ot h er h an d, if t h e m ot h er im pedes, ig n or es or d isd ain s t h e p ain or f ear m an if est ed b y
t he child in r elat ion t o t he v enipunct ur e, besides not feeling lov ed, t he child can also under st and t hat t he m ot her w ant s her t o go t hr ough t hat and, t hen, agr ees
w it h t he pr ocedur e t o sat isfy t he m ot her ’s desir e. A s i t u a t i o n t h a t l e a d s t o t h e d e s i r e o f r e a c h i n g sa t i sf a ct i o n t h r o u g h su f f er i n g , i n st ea d o f t h r o u g h
pleasur e, is consider ed a per v er sion. Per v er sions ar e d ef i n ed as p at h o g en i c d e- co m p en sat i o n s t h at can or iginat e m asochist , hy pochondr iac, aut o- dest r uct iv e
behav ior s, am ong ot her s( 1 1 ).
M e l a n i e K l e i n a f f i r m s t h a t t h e p o s i t i v e relat ionship w it h t he m ot her, t hat is, w hen she sat isfies
t he child’s need, allow s t he child t o overcom e anguish a n d f r u st r a t i o n ca u se d b y t h e a g g r e ssi o n a n d t o in cr easin gly believ e in t h e possibilit ies of sat isf y in g
t hese needs( 15).
Lik e w it h illn ess, h ospit alizat ion an d pain f u l event s can lead t o a failure in nar cissism . Narcissism
is descr ibed as “ t he sam eness of being”, w hich giv es r ise t o t h e h u m an bein gs “ n ot ion of ex ist en ce” an d desir e t o liv e( 1 1 ). Ch ildr en leav e t heir r out ine dur ing
hospit alizat ion , w h en an gu ish in g fact or s ar e pr esent an d con st an t ly fr u st r at e t h e ch ild’s n eeds. Th e pain p r ov ok ed b y t h e v en ip u n ct u r e an d t h e f act of n ot
f in d in g an y an sw er t o t h eir n eed s in t h eir m ot h er causes anguish in childr en.
A n x i e t y i s a n u n p l e a s a n t f e e l i n g t h a t
r epr esent s sy m pt om s lik e cont r act ion and r espir at or y sy m pt om s. I n nor m al life, cont r act ion and r elax at ion alt er n at e. An en v ir on m en t t h at k eeps t h e ch ild in a
sit u at ion of con t r act ion can lead t o t h e loss of t h e abilit y t o r elax( 15). I n healt hy indiv iduals, cont r act ion and r elaxat ion ar e balanced w hen t hey ar e fr ee fr om
int ernal t ensions, hunger and ot her needs. For children
up t o t w o y ear s old, t he m ot her ’s const ant pr esence
is fundam ent al t o m aint ain t his balance.
When infor m ed about v enipunct ur e, in t ur n, m ot h er s can t u r n t h is ex p er ien ce m or e f am iliar t o
t heir childr en. I n view of t he childr en’s unknow n and sur pr ising per cept ions, m ot her s usually int er m ediat e t h e i r ch i l d r e n ’ s r e l a t i o n w i t h t h e w o r l d a n d o f f e r
answ er s t o t he unknow n fact . The m ot her s hum anize ev er y t h i n g su r r o u n d i n g t h e ch i l d r en t h r o u g h t h ei r w o r d s , m a n i p u l a t i o n a n d p r e s e n c e , g r a n t i n g a
per cept ion of safet y t o t he childr en( 11).
D u r i n g t h e p e r i o d w h e n c h i l d r e n d o n o t d i sso ci at e t h ei r b o d y f r o m t h ei r m o t h er s’, f o r t h e
c h i l d r e n , t h e i r m o t h e r s ’ a b s e n c e d u r i n g t h e v enipunct ur e can m ean t hat t he m ot her cannot bear t he sit uat ion, leading t o t he conclusion t hat t hey cannot
eit her. Talk ing t o t he m ot her and ex plaining t hat her p r esen ce can con t r ib u t e t o m in im ize t h e ch ild r en ’s suffer ing benefit s t he childr en not only at t hat m om ent
but dur ing t heir ex ist ence.
S o m e m o t h e r s h a v e n e g a t i v e p r e v i o u s ex p er ien ces, p er son ally or in v olv in g t h eir ch ild r en ,
r egar ding hospit alizat ion and v enipunct ur e. This can m a k e t h e i r p a r t i c i p a t i o n i n t h e p r o c e d u r e m o r e difficu lt( 6 ). Giv en t h e ex ist in g m ot h er - in fan t bon d, if
t he m ot her has an incr eased per cept ion of t he pain caused by venipunct ur e, t his feeling is sensed by t he child. Alt hough pain int ensit y cannot be m easur ed, it
can be influenced by t he pain per cept ion dem onst r at ed by people t he child t r ust s.
The nur se, by m eans of com m unicat ion and/
or pr oj ect iv e t echniques, can ex plor e t he issue w it h t he m ot her in or der t o st r engt hen her, so t hat she can decide about her par t icipat ion in fav or of t he child.
Prelim inary sessions w it h parent s, w it hout t he ch i l d ’ s p r e se n ce , ca n b y t h e m se l v e s i m p r o v e t h e child’s st at e. Par ent s, m oved by per sonal anguish and
not expr essing t hem , pr ovoke t he childr en’s r eact ion. By t alking, t he m ot her elabor at es her hist or y and can find new w ays t o act t ow ar ds her child( 11).
Not being able t o decide about t he best w ay t o act is one of t he m ost fr equent causes of anguish( 15). Th e ch ild su b m it t ed t o con secu t iv e v en ip u n ct u r es,
w hich m ay happen dur ing hospit alizat ion, and w it hout adequat e suppor t , can get int o a per m anent st at e of an g u ish .
Of f er in g con dit ion s t o t h e ch ild an d m ot h er t o d eal w it h t h e an g u ish en ab les t h em t o d ev elop m echanism s t o cope w it h t he sit uat ion if t hey perceive
t hat t his is t he best w ay t o cont inue t r eat m ent , despit e
t h e su ffer in g.
The clar it y t he m ot her acquir es about sever al aspect s involved in a sit uat ion, can help her t o decide
w het her t o par t icipat e in t he punct ur e or not w it hout feeling guilt y. Am biguous behav ior s, such as ly ing t o t he child t hat t he pr ocedur e is not going t o hur t and
looking scar ed, by keeping her eyes w ide open dur ing t h e p u n ct u r e m o m e n t , ca n a l so b e a v o i d e d . Th e m ot h er ’s am b iv alen ce occu r s ev en w h en , alt h ou g h
sh e w an t s an d is ad v ised ab ou t t h e im p or t an ce of being close t o her child, ack now ledges t hat she does n ot h av e t h e r esou r ces t o h elp t h e ch ild du r in g t h e
venipunct ure. That is, she is not able t o bear her ow n pain and t hat of her child. I n t his case, t he m ot her ’s absence can be indicat ed, because she is at t he r isk
o f b e i n g a m b i g u o u s a n d s e n d i n g c o n t r a d i c t o r y m essages t o her child( 10).
I f t he m ot her is absent dur ing t he venipunt ur e
w it hout infor m ing t he child about her leave and about w h at is g oin g t o h ap p en , t h is can m ak e t h e ch ild f a n t a s i z e i n o r d e r t o e x p l a i n t h i s a b s e n c e ,
u n d er st an d in g t h is ab sen ce as n ot b ein g lov ed( 1 0 ). Therefore, it is essent ial t o inform t he child, no m at t er at w hat age, and if possible by t he m ot her.
I n h o sp i t a l i za t i o n s, i t i s a l so co m m o n f o r ch ildr en t o h av e on e of t h eir lim bs im m obilized f or v ar ious day s, due t o t he pr esence of an int r av enous
d ev ice. Th e lan g u ag e est ab lish ed b et w een m ot h er and child can pr ev ent alt er at ions in t he child’s body im age pr ovoked by or ganic inj ur ies. I n t his case, t he
m o t i v e o f t h i s r e s t r i c t i o n , t h e n o r m a l p a s t a n d possibilit ies of recovery m ust be explained t o t he child, no m at t er at w hat age( 1 1 ). The child feels r espect ed
as a per son w hen t he m ot her expr esses her suffer ing, b ecau se w or d s con t in u e in t h e ch ild ’s u n con sciou s m em or y for ev er( 1 0 - 1 1 ).
When in cont act w it h t he child w ho has care dem ands differ ent fr om t hose pr esent ed in t he hom e env ir onm ent , t he m ot her m ay not be able t o at t end
t o t h e c h i l d ’ s n e e d s i n n e w c i r c u m s t a n c e s . Th e m odificat ion of t he child’s body schem e, due t o part ial im m obilizat ion of a lim b, can cr eat e doubt s about how
t o h old , f eed or clean t h e ch ild . Th is w ill p r ob ab ly dem and a change in body schem e fr om t he m ot her, so she can em br ace and be r ecognized by her child
as a per son capable of iden t if y in g an d at t en din g t o h is/ h er n eeds.
Th e m o t h e r ’ s v e r b a l i za t i o n a b o u t w h a t i s
h appen in g also av oids am bigu it y. By t alk in g open ly
w it h t h eir ch ildr en abou t t h e sit u at ion , t h e m ot h er s
can im pede t heir childr en fr om fant asizing about t he ev en t . Wh en t h e ch ild r en ar e n ot clear ly in f or m ed about w hat is happening or w ill happen, t hey per ceives
sig n s t h at som et h in g d if f er en t is h ap p en in g , w h ich gener at es expect at ions t hat som et hing bad is com ing. Com m unicat ing w it h t he child allow s for em ot ions and
affect s shar ed w it h t he envir onm ent t o be under st ood by t he child( 11).
I n addit ion , t h e dif f icu lt ies ch ildr en dev elop
by t he child do not originat e from funct ional or physical inj ur ies, but fr om w hat w as not ex plained in t im e t o t h em , ev en i f sh e ca n n o t ex a ct l y u n d er st a n d t h e
w or ds( 11).
Th e m ot h er ’s ey es ar e an ot h er f act or t h at facilit at es any experience lived by t he child. The adult ’s
ey es au t h or ize access t o p er son al ex p er ien ces an d explor at ion of t he w or ld( 10- 11). The child can feel m ore secu r e in d ealin g w it h t h e p u n ct u r e m at er ial if t h e
m ot her is pr esent and, t hus, get accust om ed t o t he p r o ced u r e.
A friendly relat ionship bet ween t he m ot her and
t he nursing t eam is anot her fact or t hat helps children t o accept t he pr ocedur es per for m ed by pr ofessionals, because it is easier for t hem t o accept ing t he care of a
person who keeps a good relat ionship wit h t heir m ot her. I n t he m ot her’s absence, obj ect s fam iliar t o t he child, such as t oys nam ed by t he m ot her and persons w it h
w hom t he m ot her com m unicat es v er bally ar ouse t he m ot h er ’s m em or ized pr esen ce in t h e ch ild, t oget h er wit h t he feeling of securit y and com fort associat ed t o
t he m ot her figure( 11).
FI NAL CONSI DERATI ONS
Th e r e f e r r e d a u t h o r s m a d e i t p o ssi b l e t o
d eep en a t h em e t h at h as in cit ed d iscu ssion s ab ou t n u r sin g car e t o ch ild r en an d t h eir m ot h er s d u r in g v en ipu n ct u r e. Th is r ef lect ion allow ed u s t o con sider
t h e m o t h er ’s p ar t i ci p at i o n as f u n d am en t al t o g i v e m ean in g t o t h e ex per ien ces liv ed by t h e ch ild. Her par t icipat ion in t he pr ocedur e is essent ial, since it is
t h r ou gh t h e m ot h er ’s pr esen ce t h at t h e ch ild lear n s t o r ecognize t he ot her and acquires t r ust t o est ablish ot h er r elat ion sh ips.
I n sum m ar y, t he nur sing t eam m ust consider t he m ot her ’s part icipat ion in painful pr ocedures dur ing hospit alizat ion. This par t icipat ion is pr esent ed in t he
of t he punct ur e, t he m ot her can help t he child, based
o n t h ei r af f ect i v e b o n d , m ak i n g d i f f i cu l t m o m en t s f am iliar an d bear able.
Th e n u r se’s r ole is t o m ediat e bet w een t h e
child, t he m ot her and t he pr ocedur e. I t is her t ask t o pr ov ide t he necessar y ex planat ions, adapt ed t o t heir needs. This w ay, t he nur se w ill be play ing her r ole,
facilit at ing t he m ot her ’s and child’s adapt at ion t o t he
sit uat ion so t hat , despit e t he suffer ing, t hey can liv e
t he exper ience and st r engt hen t heir bond. The nur se’s act ion s in cr ease t h e possibilit y t h at t h e m ot h er an d child w ill be st r engt hened by t he sit uat ion and apt t o
ov er com e n ew ex p er ien ces t h at m ay t h r eat en t h e child’s phy sical and m ent al int egr it y. This ex per ience, w h en w ell con d u ct ed , allow s t h e ch ild t o con t in u e
ex plor ing t he w or ld w it h confidence.
Recebido em : 6.9.2005 Apr ovado em : 29.5.2006
REFERENCES
1. Ribeir o CA. Cr escendo com a pr esença pr ot et or a da m ãe: a c r i a n ç a e n f r e n t a n d o o m i s t é r i o e o t e r r o r d a hospit alização.[ t ese] . São Paulo ( SP) : Escola de Enfer m agem / USP; 1 9 9 9 .
2 . Br en an n A. Car in g f or ch ild r en p r oced u r es: a r ev iew of l i t e r a t u r e . Pe d i a t r N u r s 1 9 9 4 S e p t e m b e r / O c t o b e r ; 2 0 ( 5 ) : 4 5 1 - 8 .
3. Bauchner H, Vinci R, Bak S, Pear son C, Cor w in MJ. Par ent s and pr ocedur es: a r andom ized cont r olled t r ial. Pediat r ics 1996 Nov em b er ; 9 8 ( 5 ) : 8 6 1 - 7 .
4. Richar dson CR. Par ent s and pediat r ic pr ocedur es. J Fam ily Pr act 1 9 9 7 Feb r u ar y ; 4 4 ( 2 ) : 1 3 1 .
5 . Boie ET, Moor e GP, Br u m m et t C, Nelson DR. Do par en t s w ant t o be pr esent dur ing inv asiv e pr oducer es per fom ed on t h eir ch ild r en in t h e Em er g en cy Dep ar t m en t ? A su r v ey of 4 0 0 par en t s. An n Em er g Med 1 9 9 9 Ju ly ; 3 4 ( 1 ) : 7 0 - 4 . 6. Pint o JP, Fer nandes RAQ, Teixeira MB. A m ãe e a punção venosa do filho hospit alizado: um a visão fenom enológica. Rev Pau l En f er m ag em 2 0 0 1 m aio/ ag ost o; 2 0 ( 2 ) : 1 2 - 9 .
7. Collet N. Cr iança hospit alizada: par t icipação das m ães no cu idado. [ t ese] . Ribeir ão Pr et o ( SP) : Escola de En f er m agem d e Rib eir ão Pr et o/ USP; 2 0 0 1 .
8 . Fe r r e i r a EA ; V a r g a s I M A ; Ro c h a S M M . U m e s t u d o b i b l i o g r á f i co so b r e o a p e g o m ã e e f i l h o : b a se s p a r a a assist ência de enfer m agem pediát r ica e neonat al. Rev Lat ino-am En fer m agem 1 9 9 8 ou t u br o; 6 ( 4 ) : 1 1 1 - 6 .
9. Fr eud S. A sex ualidade infant il. I n: Fr eud S. Tr ês ensaios sob r e a t eor ia d a sex u alid ad e. Ed ição St an d ar d Br asileir a das Obr as Com plet as de Sigm und Fr eud. Rio de Janeir o ( RJ) : I m ag o; 2 0 0 2 . p . 1 1 7 - 2 1 2 .
10. Mazet P; St oler u S. I nt er ações pais- lact ent es. I n: Mazet P, St oler u S. Man u al d e p sicop at olog ia d o r ecém - n ascid o. Por t o Alegr e ( RS) : Ar t es Médicas; 1 9 9 0 . p. 9 5 - 1 1 0 . 11. Dolt o F. Esquem a cor poral e im agem do cor po. I n: Dolt o F. A i m a g e m i n c o n s c i e n t e d o c o r p o . S ã o Pa u l o ( S P) : Per sp ect iv a; 2 0 0 1 . p . 1 - 4 8 .
12. Bow lby J. Apego. São Paulo ( SP) : Mar t ins Font es; 1984. 1 3 . Lee LW; Wh it e-Tr au t RC. Th e r ole of t em p er am en t in p ed iat r ic p ain r esp on se. I ssu es Com p r Ped iat r Nu r s 1 9 9 6 Jan u ar y / Mar ch ; 1 9 ( 1 ) : 4 9 - 6 3 .
