Focus on Pediatrics: Make nonpharma pain care age-appropriate
Focus on Pediatrics: Make nonpharma pain care age-appropriate
Adult methods can be altered
Nonpharmacological pain management interventions can be used effectively with children of any age. There are a wide variety of techniques that can be adapted based on a child’s age, temperament, likes, and dislikes, says Chris Brown, MS, CCLS, director of child life and education at The Children’s Hospital of Philadelphia.
Many of the techniques that adults adopt can be used with children if altered to fit the child’s age range, agrees Maura Fitzgerald, MS, RN, CNS, a clinical nurse specialist in Integrative Medicine and Cultural Care at Children’s Hospitals and Clinics in St. Paul, MN.
"Relaxation and breathing techniques are very effectively used with children old enough to understand instructions and the sensations associated with slow, deep breathing or choo-choo breathing,’" says Brown.
Preschool-age children can be coached in abdominal breathing or belly breathing. They can be trained in this technique with pinwheels and blowing bubbles, says Fitzgerald. "If you tell a 4-year-old child to breathe out longer, it doesn’t make sense; but if you have them make a bubble, it takes their focus onto something else as well as slowing their breathing," she explains.
When children are older, they can learn abdominal breathing by placing their hand or a beanbag on their stomach so they can see it rise and fall, which indicates that they are deep breathing. While children need to be coached in the beginning, they can learn to do it on their own, says Fitzgerald.
Children are much more easily engaged in alternative focus interventions, including distraction and imagination activities. Adults tend to be more guarded or less willing to stray from established habits. Children have fewer established coping mechanisms and often will embrace a new and helpful technique, says Brown. Imagination or "imagery" games and mutual storytelling effectively can alter a child’s focus away from the pain or procedure to a more pleasant place, says Brown.
Guided imagery can be used with any child old enough to listen to a story. Simple imagination techniques such as visualizing and thinking or talking about a favorite place such as a room in one’s house or a trip to Disney World can be very effectively used by child-life specialists, parents, and others with age-appropriate communication techniques, says Brown.
For guided imagery, have children choose images they find comforting or distracting. While adults often choose images such as lying on a warm beach when using this relaxation technique, children usually like more active images such as riding a roller coaster. It’s just the difference between the child’s mind and the adult mind, says Fitzgerald. Children can relax and be active. Often if they have to sit still, they are not relaxed, she says.
Aromatherapy is another effective nonpharmacological pain management technique that works with children. The essential oils have properties that help with relaxation and can be incorporated into breathing and mental imagery exercises.
Nonpharmacological pain management techniques can be used for either acute or chronic pain. With acute pain, the techniques might be used to help children through the period of time it takes for medications to get into their system. These techniques also can help children calm down during a medical event, which helps ease the pain.
The use of biofeedback helps children learn how to effectively use relaxation techniques. Children learn whether muscle tension is being reduced with the use of a device that measures relaxation by muscle tension, finger temperature, breathing, or heart rate. By receiving this feedback from a computer, they learn what relaxation feels like, says Fitzgerald.
"When working with children, you are conducting shorter sessions and often using hooks that are more like a game to get them more engaged. You also let them define what is working or not," says Fitzgerald.
Interventions work best if taught before the child is in pain or in significant distress. Children learn best by doing, rather than by hearing or seeing. Having a chance to rehearse techniques ahead of time and over time will enhance success," says Brown.
For the most part, nonpharmacological techniques that are guided and facilitated by a trusted and responsive coach are most effective with children of all ages. School-age children and teens can successfully incorporate techniques such as muscle relaxation, music assisted relaxation, or relaxation breathing into their own repertoire of coping skills," says Brown.
Sources
For more information on using nonpharmacological pain management techniques with children, contact:
• Chris Brown, MS, CCLS, Director Child Life and Education, The Children’s Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA 19104. Telephone: (215) 590-2001. E-mail: [email protected].
• Maura A. Fitzgerald, MS, RN, CNS, Clinical Nurse Specialist, Integrative Medicine and Cultural Care, Children’s Hospitals and Clinics, Mail Stop 70403, 345 N. Smith Ave., St. Paul, MN 55406. Telephone: (651) 220-6538. E-mail: [email protected].
Nonpharmacological pain management interventions can be used effectively with children of any age. There are a wide variety of techniques that can be adapted based on a childs age, temperament, likes, and dislikes, says Chris Brown, MS, CCLS, director of child life and education at The Childrens Hospital of Philadelphia.
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