CHAPTER II BASIC CONSEPT

A. Growing and Development 1. Definition a. Growing Growing is increasing of physical size ( anatomy ) and body structur in the sense part or all of body beause of multiplication ( many increase ) body cells and because of cell enlarge ( Nursalam, 2005:32 ). Growing is a natural process that happen on individu there is step by step child will be more heaviness and tall (Supartini, 2002 : 49). b. Characterstic of Growth According to Hidayat (2008), characteristic of child growth are: 1) During growth will be cahnge in physical, suhc as body

weight, tall, head circle, arm circle, chest circle, and another. 2) Dueing growth will be change proportion that can seen on

physical or human organ that occur Stara from conception until adult. 3) In growing and development past of characteristic that appear

during growth, likes thymus glan, the loss of milk teeth or the loss of certain reflexes 4) In growth there is a new feature is slowly following the

maturation process as the hair on the axilla area, pubic, or chest.

c. Detection of Growth and normal standard Detection and normal Standard of growth according to Nursalam (2005:47), are: 1) Antropometry Size Meassuring of antropometry to know physical size a children with use certain of size equipment like scales and measuring tape. Anthropometry measurement can be grouped into two depending on age and not dependent age. And anthropometric measurements were used to measure, weight, height, head scale, upper arm scale, and skin fold. 2) All of physical With physical examination, can get that child where being sick or health. Related with growth, things that can be observe from physical examination is all of body, muscle tissue, hair, and tooth. 3) Laboratory and Radiology Examination Laboratory and radiology examination can be done in clinic if any sign or symptoms of disease, for example anemia or abnormality of physical growth. Laboratory examination which often is the examination of blood for Hb, serum proteins (albumin and globulin), and growth hormone. Radiological examinations performed primarily to assess the biological age, is the bone age. 4) Detection of development Detection of development to give toddler nursing care.

d. The growth of the baby (10 month year old) According Hidayat (2005:23), at the age of 10 months of growth in body weight can occur twice body weight at born and average 500-600 gram per month if get well nutrition. Where as tall no increasing on growth and occur stabilization based on age add. Development According to Hidayat (2005:15-16), events on the child's development can occur on a change of form and function of organ maturation begins from social, emotional, and intellectual aspect. Development of physical can happen in size change large and small of the organ function start from cell stage until organ change of body. Development of intellectual can seen from ability symbols or abstract such as speak, play, account, read, and another, whereas emotional development of children can seen from social behavior in children around. Development is a process that happen stimulant with growing that produce individual quality to function matured and learning process from environment (Supartini, 2002: 49). Development is ability and structure or body function which more complex in stable pattern, can be predicted for result from cell differentiation process, body tissue, organs, and organized system (Pusponegoro, 2004: 369).

2. Growth and Development Phase Growth and Development Phase according to Soetjiningsih (2002) is: Growth and development phase (2002) are: a. Prenatal period ( born concept ), divided into: 1) Fetus embryo : conception period until 8 weeks 2) Fetus period : 9 weeks until birth b. Postnatal period, divided into: 1) Neonatal period 0 28 days a) Early neonatal ( prenatal ) : 0 7 days b) Advance neonatal : 8 28 days 2) Baby period a) Early baby period : 1 12 months b) Last baby period : 1 2 years c. Preschool period (3 6 years) d. School age period ( 6 12 years ) e. Teenager period ( 13 18 years ) 3. Theory of Growth and Development a. According to Freud

Frued said if child psychosocial development consists of oral phase, falik phase, and genital phase.

1)

Oral Phase (0 11 months)

During enjoyment baby limited in oral activity look likes suck, bit, chew and say. Detention or unsatisfied in oral need compliance will effect to the next phase of development. 2) Anal phase (1 3 years)

Life child with centrally in child enjoyment, there is during sphincter muscle development. Child happy to hold up the feces, eventually playing their feces as they want, so toilet training is the best time to do in this period. 3) Falik phase (3 6 years)

During this phase, genital has been interesting area and sensitive body area. Child start learns different sex stuff. In psychosocial this phase start growing super ego, there is child with decreasing of their ego. 4) Pelitescent phase (6 12 years)

During this phase child use physical energy and psychological that include media for explore knowledge and experience by physical activity or their social. 5) Phase genital (12 18 years)

The last development phase according to freud is phase when child entry pubertal phase, there is whit any mature process of sex organs and sex hormone production.

b.

Psychosocial development according to Erickson

Erikson's approach in discussing the process of child development is by using the five stages of psychosocial development, there is: 1) Relieve and unbelieve (0 1 years) Investment confidence is The most basic thing in this phase. Establishment of trust got from relationships with other people and the man who first connected are parents, especially his mother. Therefore mothers need support especially from her husband to foster a close relationship with the child. 2) Autonomy vs. shame and doubt The development of autonomy based on the ability of children for control the body and its environment. Children want to do the things he wanted to do by their self with use ability that they have like walking, tiptoe, climb, and choice toys or stuff that they wanted. In this phase, children will imitate the behavior of others around them and this is a learning process. 3) Initiative vs. guilt (3 6 years) Initiative developing got by assets the environment by own sense ability. Child developing they wanted with explore what around them. Guilty will be occur to child if child cannot achiever so they unsatisfied with them development that has not achieved.

4) Industry vs Inferiority (6 12 years) Child can learn walking for cooperate and compete with another child by activity that was done well in academic or association by game that was done together. Autonomy start developing in this phase, especially in early 6 years old with the closest family support. Child ability to interact more with friend around can facilitate success feels development (sense of industry). 5) Identity vs wrong role (12 19 years) Adult will try to dapted as they role as child that were trantition phase from child to adult. They show them role with dressy as adult wich very close with them group, interact with adopted group value and environment to take own decicion. Clarity identity was goten if any decicion wich get from parent or environment they place wich help them by searching self identity process as adult, where as unability to solved conflict will occur wrong role that must be done (Supartini, 2004: 59 63)

B. Brhoncopneumoniae 1. Definition Pneumoniae is lower acute respiratory infection, wich hit lungs parenkim (Mansjoer, 2000 : 465) Pneumoniae is infalamation that hit distal lungs parenkim from adalah peradangan yang mengenai parenkim paru distal dari terminalist

broncheolous wich includes respiratory broncheolous and alveoli and occur disturbance of gas exchange arround (Dahlan, 2007 : 964). Pneumoniae is lungs inflamation that caused of many etiology such as bacterial, virus, ang foreign body (Hassan, 2005 : 1228) Brhoncopneumoniae also can called an inflamation on lungs parenkim that caused of bacterial, virus, fungus or foreign body wich signed fever, anxiety, dispnoe, tachipsnoe, fast and shallow breath, vomiting, diarrhea, dry and productive cough (Hidayat, 2006 : 80). Brhoncopneumoniae is obstruction on the las brhoncheolous that obstruct by exudate, mukoprulent, to built consolidation plaques in lobus (Wong, 2004 : 460) From above definition can be concluded brhoncopneumoniae is infalamtion on lungs parenkim that caused of bacterial, virus, fungus, or foreign body agent that can be disturb gas exchange on the last brhonceolous because of exudate so built consolidation plaques in lobus. 2. Etiology According to Hidayat (2006 : 80) etiology from brhoncpneumoniae are: a. Bacterial Strepcoccocus pneumoni, staphylococcus aureus. b. Virus The most often virus is parainfluenzae, influenzae, adenovirus and RSV. c. Foreign Body

d. Fungus Hystoplasm, capsulatum, cryptoccus neoformans. e. Aspiration Aspiration can be happen because drink a lot of kerosone or gasoline, food. And foreign body. According to Ngastiyah (2005 : 577), another factor that can influence pneumoniae is decreasing of body imune, for example because malnutrition of protein energy ( MEP ), chronic disease, traumatic lungs, anesthesia, aspiration, and unperfect antibiotic medication . 3. Pathophysiology If patogen germ reach terminalist broncheoly edema fluid entry to alveoli inclusion leoucosite in large quantity, then macrofag will cleans debris cell and bacterial. This process ussually spread more far enlargement or just in the same lobus, or maybe to another part of lungs by brnchials fluid that has been infected through lungs limph lines, bacterial can reach blood flow because lungs tissue has been consolidation occur shunt from right to left with perfution ventilation so can occur mismacth, on hypoxiae. Heart work maybe increasing because of oxygen saturation has been decrease and hyperchapneoa in severe condition, can be happen respiratory failure (Nursalam, 2005: 114- 115) According to Hasan (2005:1229-1230), Pneumococcus entry to lungs through droplet. Infalamtion process can be divided in four stage:

a.

Hyperemia stadium : refer to inflamation early response that

was happening in lung which was infected. This is as sign as increasing of blood flow and permeabillity capiler in infected area. This Hyperemia because of mediators release from mast cell after imune cell activation and traumatic tissue. Mediator icludes hystamine and prostaglandine . Degranulation mast cell also activated complemen lungs line. Complemen work with hystamine and prostaglandine to relax smooth lungs muscle and increasing capiler permeabillity. This is can cause plasmae exudate movement into interstitial so occur oedem and edema between capiler and alveoli increasing distance that must be reach by oxygen and carbondioxide to disfution, so decreasing of gas difution has been happen. Because less of oxygen disolved better than carbondioxide, so gas movement into blood most influence, that most cause decreasing of oxygen haemoglobine saturation. b. Red hepatization Stadium: lobes and lobules that have been hit

become tight and without air, clour become red and like hepar palpation. In alveoli got fibrin, leoucosite neoutrofile, exudate and more erytocite and microbe. This stadium last very short. c. Gray Stadium hepatization: lobes still tight and red colors

become pale gray. Superficies pleura look pale because be around of. Alveolus contains of fibrin and leukocyte, place of phagocytes pneumococcus. Caviler not congestive any more.

d.

Resolution Stadium: exudates are decrease into alveoli,

macrophage and leucosticte been necrosis and lipid degeneration, Fibrin have been resorting and disappear.

Pathway Bacteria, viruses, fungi / foreign body Entry in airway Inflammatory process Germs growing in the bronchus
Risk of infection Increasing of body temperature

Fever

Pathogen Reach the bronchi

Body's immune compensation issue (Ig E) Mast cell degranulation Increased mucus production Cough, nausea, vomiting Anorexia Increased blood flow in the bronchi and pulmonary vascular muscles Nutrition less than body requirements

Bronchospasm Airway constriction Difficulty breathing

Histamine

Prostaglandin

Ineffective breathing pattern

Increased capillary permeability Transfer the plasma into the space exudates interstitial

Swelling between capillary and alveolus

Swelling between capillary and alveolus Increasing of leukocyte Accumulation of fluid in the alveoli

Macrophage cells Decreasing of gas diffusion clean up debris and bacterial Experienced consolidation of Decreasing of oxygen saturation lung tissue Vital capacity and decreasingIncreasing of work heart lung complains
Disturbance of perfusion tissue Fatigue Intolerant activity

Disturbance of gas exchanges

Lack of information

Lack of knowledge

(Modification: Nelson, 2000: 885; Nursalam, 2005: 114-115; Hasan, 2005: 1229-1230)

4.

Clinical Manifestation According to Corwin (2000:413), shymthomps of pneoumoniae like

Cemas pada ortu dan anak

to all kind of pneoumoniae. This shymthomps includes: a. Fever and shake because of inflamation process b. Productive and purulent cough c. Red Sputum (for streptococcus pneumoniae) pink (for stapilococcus aureus) or greeny with khas smell (for pseudomonas aeruginosa) d. Krekel (additional lung sounds) e. Pleura pain because of inflamation and oedema f. Maybe occur cyanosis shymptomps 5. Supporting Examination According to Marry (2005 : 230), supporting examination on brhoncopeoumonia are : a. Radiologyst Examination This examination as description brhoncogram fluid (airspace disease) b. Chest X-Ray Chest X-Ray will show plaques infiltrate c. Blood culture, gram colouration, culture sputum can get caused organism. d. Pulmonary Fungciont Examination Volume maybe will be decrease (congestive, and alveoli colaps), airway pressure can increase and decrease. Maybe will be seeped.

e. Laboratory Description of pheriperal blood showed leoucocyte can reach 15.000 40.000 / mm3 f. Spirometric statistic Used to assest air volume that have been inspirated. 6. Treatment a. Medical According to Ngastiyah (2000:58-59) medical threatment that must done are: 1) Penicillin 50.000 u/kg bodyweight perdays,

added with cloronifenikol /50-70 mg bodyweight perday or give antibiotic that have large spectrum such as amphycillin. This medication give continuesly until no fevevr in 4-5 days . 2) Oxygenation and intravenous therapy fluid,

usually needs 5 % glucose and NaCl 0,9 % combination for comparison 3 : 1 added KCL 10 mg/500ml/bottle. 3) Because majority patient suffer acidose into

metabolic acidose because lack of nutrition and hypolena, so can give correct whereas with the result of artery blood gas analysis. 4) to hozpitalisation. Patient with light brhoncopneumoniae not need

b. Nursing According to Ngastiyah (2000:58-59) nursing threatment that must be done are: 1) Keep breathing continuity

Patient pneoumoniae where in dyspnoe and cyanosis condition because of any pulmonary inflamation and amount of mucus in bronchous or lungs. So patient can take a breath continuesly, that mucus must be through out for reach oxygenation needed help with oxygen therapy 2 literperminutes. 2) Resting Needed

Pneoumoniae patient is weak patient, high body temperature, often hyperexia so patient need more resting, all of patient needed must been helped on the bed. Taking assesment contain or injection donot give when patient still take a rest, try to make patient happy and comfort so patient can take a rest well. 3) Observation Body Temperature

Pneoumoniae patient sometimes can got hyperexiae. For this, so body temperature must be observe every hours beside try to decrease body temperature with cold compress. 4) Lack of parent knowledge about the disease

Education especially shown to prevent pneoumoniae is with give about definition. If chil suffer common cold with fever on 2 days not getting better to bring to medical health service. 5) Prevent complication or disturbance of save

and comfortable feeling that canot been through out so atelektasis and brhonchietaksis happen. 7. Nursing Diagnosis a. Ineffective breathing pattern related to inflamation on lungs or lungs parenkim. b. Ineffective airways related to mecanical obstruction, inflamation, increasing of secretion, pain c. High risk of infection related to ineffective organism d. Intoleran activity related to inflamation process, Intoleran aktivitas berhubungan dengan proses inflamasi, imbalance beetwen suplay and oxygen needed e. Disturbance of gas exchange related to secret acumulation f. Lack of nutrition from body needed related to anorexia g. Hypertermia related to increasing of heat production h. Lack of knowledge related to less of information 8. Focus Intervention a. Ineffective breathing pattern related to airways constriction. Purpose : reaten normaly breathing function.

Intervention :

1) degrees. 2) 3) 4) 5)

Give semi fowler position or head elevation more than 30

Avoid tigh wearing Give support pillow so airway still open. Give oxygenation as child needed. Give lotion to contuinity breathing airway

b. Clear ineffectife airway related to mecanical obstruction, inflamation, increasing of secretion. Inflammation : airways still clear and child can take a breath easly,

respiratory in normaly limits Intervension 1) : Prepare child in right body equal so can be lungs expantion well (facedown,

and repair gas exchange, and prevent secretion aspiration slape) 2) 3) Suck the secretion airways as needed

Give supine position with head on snuff, neck more extend

and nois through to upper 4) 5) 6) Help child to through out the secretion Give backslap Give expectorant as rule

c. High risk infection related to ineffective organism Purpose : Infection shymptomp decrease and infection not to spread

Intervention :

1)

Keep aseptic enviroinment with use steril suction catheter and

well hand washing thecnique 2) spread. 3) 4) Give antibiotic as indication to prevent or solved the infection Give nutrition diit as child favorite and desire to consumption Isolating child as indication to prevent nasocomial infection

nutrition to support natural body 5) Give chest therapy.

d. Intolerant activity related to inflamation process, imbalance beetwen supply and oxygen needed Purpose : child can rest well and optimally

Intervention : 1) 2) 3) 4) 5) Assest child physical. give distraction activity as old age, condition, and interest. Rest period and sleep as old age and condition Help chilg in daily activity wich more tolerate Balancing rest and sleep if patient ambulation (Wong, 2002 : 353) e. Change nutrition lack of body needed related to anorexia (Carpenito, 2001 : 450). Purpose : patient got optimally nutrition

Intervention : 1) Give food and drink that child wanted.

2) 3)

Give little but often food Antisipation sadness reaction to child losing perfectlly.

Because this is ussually happen in adapted process 4) 5) 6) Avoid oversupport to consumption for eat and drink Avoid food with strengh smell because can make nausea. Give fun enviroinment to eat (Wong, 2002 : 368) f. Disturbance of gas exchange related to accumulation of secret. Purpose : Increasing adequate gas exchange.

Intervention : 1) Asset respiratory status every 2 hours, regular respiratory

sound or irregular and vital sign . 2) 3) 4) Elevating head more high than sleeping bed. Change position every 2 hours as well as condition. If child can tolerate give free to choice comfortable position. (Suriadi, 2001 : 276) g. Hypertermia related to increasing of heat production. Purpose : Keep patient temperature in normally limite.

Intervenstion : 1) 2) Give cold compress during 20 30 minutes. Give cold towel, wet, or washlap, chnge as needed, continues

approximately 30 minutes.

3)

Dont ever use isopropil alcohol swap when take a bath to

compress because can occur neurotocsic effect. 4) Observe body temperature to prevent over body colder. (Wong, 2002 : 377) h. Lack of knowledge related to lack of information. Purpose : Patient and family can make life change and participate in medication programe. Intervention : 1) Discuss inability aspec from the disease, healing time, and whises to geting better. 2) Give information by notes and verbal. 3) Choise method, vocabulary , and content as education level patient family to optimally learning process . 4) Choese condusive enviroinment to studyed. (Wong, 2002 : 534)

B. Hospitalization 1. Definition According to Supartini (2004: 133), hospitalizes is process that cause reason which planned or emergency, require process to hospitalize, going to therapy and caring until get back home. Many feeling that often occur there is: anxiety, madness, sad, afraid, and guilty. That feels can occur because of face a new something and never

experience yet. If child stress during hospitalization, parent will stress too, and parental stress can increasing child stress. 2. Stressor on child when hospitalize a. Anxiety because of separation More stress happen in todller until preschool child, especially child in 6 years old until 30 months old are anxiety because of separation. Todller canot comunicate with language well yet and have limited knowledge about reality. Relationship child with mother is close, so separate with mother can occur loss feeling on child. Child response attitude with effec separation divided into three phase, there: 1) Phase of protest (phase of protest)

This phase sign with strong crying, yelling, and calling mother or use aggressive behavior such as kick, bit, hit, pitch, and rejecting parental attention. 2) Phase of despair (phase of despair)

In this phase child looks strained, reducing them cry, passive, not interest to playing, anorexia, withdrawal, silence, sad, aphasia, and aggression ( for example bedwetting, sucking tumb ). In this phase condition of child is worrying because of child reject to eat, drink, or moved . 3) Phase of denial (phase of denial)

In subtly child accepting the separation, start interesting with something around, and built a little relation with other people. Child starts happy. This phase usually happen after a long time with parent. b. Lost Control Child under 5 years old try more to defens them autonomy. This is looks clearly in their attitude on motoric ability, play, making interpersonal, activity daily living, and comonication. Cause of sick and hospitalize child can lost they freedom and egocentries description on their autonomy development. This is can occur regression.

c. Wound of body and pain (pain) Consept about body image, especially definition about body protection ( body bondaries ), very little ca developing on child under 5 years old. Accoerding to monitoring result, if doing ear, mouth, or anal temperature examination can make child worriy. Child response related to hurt examination, looklike reactiont when theiy get hurts . 3. Family reaction to child who was sick and hospitalized According to Nursalam (2005 :18 21), family reaction to child who was sick and hospitalized are : a. Parental reaction Parent reaction to them child influence of several factor, among: 1) 2) Serious stage of child disease Past experience to disease and hospitalization

3) 4) 5) 6) 7) 8) 9)

Medication procedure Available of support system Intensity of individual ego Ability on coping possession Family support Culture and trust Communications on family

b. Reaction of sibling Lonely, fear, worried, angry, jealousy, hate, and guilty

c. Decreasing of family member role Effect from separation to family role is loss of parental role, brother, son and grandson. Attention of parent just special to son who was being sick, so their brother felt if thats thing is not fair .

C. Stimulation and Role Play 1. Definition Stimulation is something that activated on organ or part of bodies (Hincliff, 2000: 417). Activity of play is a happy activity for children although that is cannot result of specific commodity, for example benefit of money. Childs free expressing fear, worry, happy, or another feeling. So with giving freedom to playing, parent can understand child feeling.

Playing is kind of infantile from adult ability to face model of particular situation and try to capable through experiment and program . 2. Function of children play a. Development of motoric sensor Activity of motoric sensor is parth that most developing on babies. Developing of motoric sensor supported by visual stimulation, auditory, palpation, and kinetic. Stimulating of sensoric that was given by child enviroinmen will be response with attention to motorics activity.

b.

Developing of cognitive Child learn with recognize the colour, form/meassure, texture

from many kinds of object, nimber, and object. Child start to string up word, and thingking real and related to room like uo, down, under and open. c. Socialization From early child, baby have showed interesting and happiness to another, especially to the mother. With playing, recognize moral grade and ethic, learn about what was wrong and right child will developing and enlarge socialization, learn to solve the problem that has been occur. d. Creativities

Children can make experimen and try to another idiea. Once child feel satisfy to try samething new and different, they will moving their creativities to another situation. e. Self-awareness With playing, children can awarenes that they are different with other people and understan them self. f. Grade of moral Child learing a right and wrong attitude from enviroinmen, house, or school. Interaction with group that have given meaning on their moral practice.

g.

Grade of therapeutic Play can decreasing pressure or stress by enviroinmen. With

playing children can express emotion and unsatisfy of social situation and their fear feeling that canot express in real. 3. Principe of playing activity Several thing that need attention so playing can be effective stimulation, following: a. Need more energy b. Need enough time c. Toys must be adjust with old age and phase of child developmen d. Place to play e. Knowledge how to play

f. Playmate 4. Educative game equipment Educative game equipment is equipment that can optimize child development as age and developing stage and useful to physical development, language, cognitive, and child social. Parent can give educative equipment to children, requirement are: a. Safety

Toys for children under 2 years is better not to small, not toxic coloration, because in this age often entering something to the mouth. b. Size and weight

The principe of game not dangerous and conform with children age.

c.

Design

Equipment game is better having simple design in size, structure, and colors, and clear of purpose. d. e. Clear Function Varies of game equipment

Equipment is better can be play variety (can be tide loading) but not too difficult so children not frustrated. f. Universal

Equipment game is better easily accepted and famous by all of culture and nation.

g.

Not easily to broken, easily obtained, and affordable to large

community. 5. Type of Game According to the content of playing can be different of game related to another people (social effective play), game that related to fun (sense pleasure play), game that just saw (unoccupied behavior) and skill play. Game type according to social characteristic there are attention friends playing (onlooker play), game that was playing by self (solitary play), game with friend without interaction (parallel play), game that playing without group purpose (associative play), and game that playing with together organized (cooperative play). a. Babyhood (0 1 years) Equipment sample that suggest is safe equipment to enter the mouth, human/ animal soft doll, voice toy, handbell, ball, and other. Characteristic of game on baby according to the content is possible to interact child with social environment that can give fun to children. b. Toddler (2 3 years) Game equipment that suggest on this age are candle that can be design, painting equipment, simple puzzle, chaplet, home equipment. In this time children egocentrics very dominant and think that all toy is own self. According to game content, game in this time include in skill play and parallel play.

c.

Preschoolhood (3 - 6 years) Following with growing and developmen, preschoolhood have hard

and soft motoric that more mature better than todlerhood. Children are nore creative and imaginative. Kind of apprpiate gameare asosiative play, dramatic play, and skill play. Children playing together with their playmate, and comunicate as them language ability. Child also have playing particular persons such as father, mother, or them teacher. Game that use motoric ability more choice on prescholhood. Kind of the right game are: bycicle, toy car, sport equipment, swiming, and big box toy. d. Schoolhood (6 - 12 years) In schoolhood social ability is decrease, their more can cooperate with them playmate. So game on schoolhood not onli advantage to their physical skill and intellectual, but also can developing their sense to involve into the group and cooperate with another . Characteristic of schoolhood game different according to the gender. Boy is right to playing kind of mecanic, that can stimulate their creatifity on creation as a boy for exampel car toy. Girl is right to playing game that can stimulate a feeling, thing, and attitude into role as a girl, for exampel: cook toy and doll. e. Adult (13 - 18 years)

Game charaterictic to adult are doing constructive activity, for exampel with sport, hearing or playing a music. And doing positive organitation

activity of teenagers, such as bascetgroup, soccer, young group, and another. Principe, play activity on adult not only look for fun and increasing of emotion development. But also more to distribute interest, talent, and aspiration also help teenagers to find self identity. For that the right equipment can be divide to sport equipment, musical equipment, and painting. 6. Playing in hospital The purpose of playing in hospital principally is to continue developing phase optimally, developing of children creativity, and can adapted more effective with stress. Often happen when child on hospitalize, growth development aspect has been ignored. Officer just focuses to how they will recover. After go home parent complain if they child be regression, although before sick child can more independent and normally growth likes another. In order to children can more effectively playing in hospital, intense with this Principe is: a.Children with not much use of energy, shorter play time, to avoid fatigue and tools more simple game, for example: built a box, making Kraft (hand basket), and watching TV. b. been avoid from nasocomial infection. c.Appropriate with same group age. Safe and

d. contra indication with therapy. e.Need anticipation from parent and family.

Not

Implementation of play activities in the hospital, need involvement from medical officer, include nurse that on duty in pediatric. For that need effort are: a.Prepare of equipment game b. of equipment game c.In implementation, game activity in Hospital is health officer responsibility help by parent. d. In the Prepare

first year children just inspecting around object. Beetwen 2 until 3 years old age, generally children with role play s mother, baby, docter, child with customer. In school hood children more often join with in the same age group and have a favorite friend. (Nursalam 2005: 74 84)