6 creative ways to comfort children during procedures
An 8-year-old boy with a fractured arm was grimacing in pain when he arrived at the ED at Children’s Healthcare of Atlanta. Nurses quickly learned about his love for dinosaurs, cars, and superheroes and talked to him about his interests.
"It was amazing to see what a difference it made to get his mind off of his broken arm," recalls Kristen Stocks, the ED’s child life specialist. "He went from screaming and crying to laughing and joking."
During the upcoming fracture reduction, the boy remained calm. "He asked appropriate questions, and even asked to watch," Stocks says. "With a little bit of distraction and simple preparation, we were able to perform a Bier Block with minimal medication and absolutely no tears."
Nonpharmacological approaches can have a dramatic impact on children in pain, but these methods often are overlooked in the ED, says Kitty O’Brien, a child life specialist for emergency services at Cincinnati Children’s Hospital Medical Center. Some ED staff used to caring for adult patients may underestimate children, she says. "They just assume that the child won’t understand and won’t be able to hold still, so immediately the child is placed in a papoose without any explanation," she says. "These same folks then complain that the child fought and screamed the whole time."
If you don’t use developmentally appropriate pain management techniques, this can lead to anxiety, irritability, and exhaustion in children, Stocks warns.
By using nonpharmacological approaches, use of sedation for procedures such as sutures,lumbar punctures, and computerized tomography scans has decreased significantly, reports O’Brien. "As a result, there are physically fewer risks to the patient, and patients don’t have to wait as long to go home; thus, we are able to get them in and out of the ED faster," she says.
Techniques such as distraction can be used to help children hold still for procedures that aren’t painful, or used along with appropriate analgesics or procedural sedation for ones that are, says Nancy Eckle, RN, MSN, CNS, clinical nurse specialist for emergency services at Columbus (OH) Children’s Hospital. "Before and after the medication is given, we have the child listen to soft soothing music or give the parent a book to read to the child in a soothing voice," she says.
To improve pediatric pain management during procedures, do the following:
• Encourage parents to comfort children.
While parents or primary caregivers should never be forced to stay in a room during a procedure, they should always be given this option, says O’Brien. She recommends asking parents to hold the child’s hand or speak softly, so that an infant or toddler recognizes a familiar voice.
• Position child for comfort.
"Have parents help with positioning the child whenever possible," says Eckle.
Allow the child to sit in their parent’s lap, face-to-face, with their hands free for intravenous line insertion behind the parent’s back, says Stocks. "Children feel much safer in their parent’s arms," she says.
• Place ice packs on painful areas.
Prior to giving an injection, place a cold pack or ice pack on the site for a few minutes if it does not distress the child, Eckle recommends.
• Distract children.
Making bubbles or blowing on pinwheels can help a child focus on breathing instead of the pain, and children can be distracted by singing, watching television, reading, games, or counting aloud, says Eckle. "Older children can be coached in the use of imagery," she says. "Ask the children to picture themselves going to a favorite place or doing something they like to do: swimming in the ocean or pool, or playing with a pet. Have a staff member or parent talk softly to the child to help create the image."
Give children a job before a procedure, such as squeezing a parent’s hand, counting out loud, or taking deep breaths, suggests O’Brien.
• Give compliments.
Instead of giving generic praise like "Good boy," comment on specific behaviors such as "You did such a good job holding still!" or "I like the way you let us know how you felt!" suggests Stocks.
• Dip pacifiers in a sucrose solution.
"We have had great success with this for infants," reports Stocks. "When they suck on the pacifier, the high sugar content leads to a feeling of euphoria and they are less distressed during painful procedures." Parents are encouraged to re-dip the pacifier during the procedure, she adds.
• Prepare children before procedures.
Describe in simple, concrete terms what will happen, says O’Brien. "For example, show them the tourniquet and plastic straw’ that will be put in their blue lines’ and point to one of your veins, and explain that after the straw is in, there won’t be a need for any more pokes or pinches," she says.
For more information on nonpharmacological approaches to pediatric pain management, contact:
- Nancy Eckle, RN, MSN, Clinical Nurse Specialist, Emergency Services, Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205. Telephone: (614) 722-4353. Fax: (614) 722-4380. E-mail: [email protected].
- Kitty O’Brien, Child Life Department, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229. Telephone: (513) 636-8973. E-mail: Kitty.O’[email protected].
- Kristen Stocks, CCLS, Children’s Healthcare of Atlanta, 1001 Johnson Ferry Road, Atlanta, GA 30342. Telephone: (404) 785-4975. E-mail: [email protected].
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