How to calm children when starting an IV

Children between the ages of 6 and 12 have a particularly strong fear of injections, reports Marianne Hatfield, RN, BSN, system director of emergency services at Children's Healthcare of Atlanta. "They think in concrete terms and if they don't see something, they can only imagine what it is," she explains. "To simply describe an intravenous cannula as a small 'straw' brings to mind the type they drink from at McDonald's."

ED nurses at Children's remove the needle from a small gauge intravenous (IV) catheter, attach a short piece of connector tubing to it, and tie it to their nametag or keep it in their pocket, says Hatfield. When explaining the procedure to a child, they show them the actual IV and let them touch it to see that it is soft and pliable and does not have a needle in it.

"Even teenagers and some adults think that an IV is a needle in your arm or hand," says Hatfield. "It really helps to show them what the IV is. We try not to focus on the needle part, but some are astute enough to ask, "How do you get the straw into my hand?"

If patients ask this, show them how the little straw is inserted with a needle that immediately retracts and doesn't stay in the cannula, suggests Hatfield. "That provides an opening to discuss why we have placed a topical numbing cream on the potential sites for IV insertion," she says.

If they ask whether the IV insertion is going to hurt, nurses don't say no. Instead, they explain that they are doing everything they can to keep it from hurting, she says. "We then let them know that after it is over, they can tell us whether it hurt or not," she says. "Most will answer, 'It didn't hurt that much,' or 'I didn't even feel it!'"

Ask what the child knows about why he or she is getting an IV, and if he or she has had an IV in the past and, "Which part worries you the most?" recommends Kristen R. Johnson, CCLS, child life specialist for the pediatric ED at Johns Hopkins Children's Center in Baltimore. "This will provide an opportunity to learn from the patients' previous experiences, offer a chance to clarify any misconceptions, and identify coping strategies to match the patients' potential stressors," she says.

Have the child rehearse their coping strategy, such as taking slow deep breaths or blowing a pinwheel, says Johnson. "Taking time to practice in advance makes it more likely the patient will be able to use the coping strategy at the time of the procedure," she explains.