Psychological impact and intervention strategies for unaccompanied patients in pediatric intensive care units: a narrative review.

BACKGROUND AND OBJECTIVE: The pediatric intensive care unit (PICU) is a high-stress medical environment. Family-Centered Care (FCC), which ensures parental presence and participation, is recognized as the standard of practice to mitigate psychological distress and trauma in critically ill children. However, infection control mandates [most notably during the coronavirus disease 2019 (COVID-19) pandemic] and resource limitations often necessitate restrictive visitation policies, leaving children in an "unaccompanied" state. This separation from parents constitutes a significant deviation from the standard care model and poses a unique psychological risk. A systematic synthesis of the specific psychological impacts of this parental absence and adaptive strategies to effectively intervene within this context remains underdeveloped. This narrative review aims to analyze the primary psychological consequences of parental absence for children in the PICU and to explore the intervention strategies adapted to mitigate these effects.

METHODS: We reviewed journal articles from the past 15 years (2010-2024) that analyze and discuss the psychological impact and intervention strategies of unaccompanied patients in pediatric intensive care units.

KEY CONTENT AND FINDINGS: Our analysis indicates that an unaccompanied state is a significant, independent risk factor for psychological morbidity in PICU patients, markedly exacerbating separation anxiety, fear, loneliness, and depressive symptoms, which may also impede physiological recovery. Effective interventions must focus on mitigating the trauma of separation. The core strategy identified is "Virtual Family-Centered Care" (e.g., re-establishing family connection and participation in rounds via video technology). Other critical interventions include alternative socio-emotional support from the healthcare team (especially Child Life Specialists), professional psychological therapies, and environmental optimization to reduce threat perception.

CONCLUSIONS: We conclude that while parental presence is irreplaceable, PICUs must adopt innovative interventions, particularly technology-assisted virtual connections, to protect the psychological well-being of unaccompanied children whenever visitation is necessarily restricted.