As a child life specialist, I’m often asked by parents in my community and social circles how they can appropriately support their children through medical procedures. In the hospital setting, I’m frequently asked to partner with and educate physicians, mid-level practitioners, and nurses on evidence-based ways to care for children in the acute emergency environment. This post is intended to be a WIDE overview of the information I’ve learned, practiced, and mastered during my (nearly 6) years in Child Life. Full diclosure, although I have trained and worked in many areas, I have worked in pediatric emergency medicine for 4 full years now, and most of my tips and tricks tend to be tailored to that population. I have more detailed posts coming on many of these topics and can’t wait to share them with you!
Involve the parents in their child’s care. This comforts the parent by giving them an active role in helping their child feel better, and it comforts the child to have their parent closely involved during invasive procedures. Most procedures can be performed while a child is being held and comforted by their parents: this includes routine examinations, testing including swabs, lab draws, and IV placement; and more invasive procedures like abscess drainage and laceration repairs. There aren’t any procedures or instances I have at the top of my head that would indicate a necessity for the child to be placed flat on the bed without being held or comforted by a parent. Some procedures do require a reclined or recumbent position, but the parent can still lie next to the patient, or rest the patient’s head in their lap. If procedural sedation is needed, consider allowing the patient to remain in a position of comfort during the induction phase of sedation and transfer them to a supine position immediately after. In research studies, children who are held upright rather than supine have less distress during the pre-procedural period, during the actual procedure, AND they return to baseline more quickly following the procedure. “ many, many children scream in panic and struggle fiercely as soon as they are placed in a supine position” (ie, before any medical procedure has even started). Similarly, “children who are calm react with less intensity to negative stimulation than do children who are already upset for other reasons (Korner & Thoman 1972). Consequently, procedures require less time and fewer staff. The positions of comfort also lessen the chance that the procedure will fail”.
There are VERY few situations where I would discourage parental presence at the bedside altogether. It is commonly misconceived that parents should not be allowed in the room during critical procedures such as rapid responses or code blue/resuscitation, but the research shows us parental inclusion is important during these times of crisis as well. “Studies show that the presence of parents does not have a negative impact on the performance of medical staff and that being with their child also results in less anxiety in the parents (Bauchner et al. 1991; Bauchner et al. 1996). “
GET DOWN ON THEIR LEVEL! I cannot stress enough how important it is with a pediatric population, to squat or sit down to meet kids at their level. Imagine laying scared in a hospital bed with many large adults looming over you, looking down at you with unfamiliar equipment in their hands. Talk about scary!
Children should always be offered choices, but only when the choices are realistic. Instead of asking a patient “can I put this on your finger?” try saying “I need to put this on your finger. Which one would you like me to use?”. Similarly, if taking medicine is not a choice, avoid asking questions like “are you ready to take your medicine” or “do you want to take some medicine"? Consider what your options would be when the child simply replies “no”. My favorite question instead? “ It is important for you to take this medicine to help you feel better. Do you want juice or a Popsicle when you’re done drinking it?”
Children are far more comfortable with medical equipment if they’re given a chance to familiarize themselves with it first. Child Life Specialists are often available to provide in depth exploration and play with medical supplies including tools and equipment needed for use during IV starts, sutures, surgery, and more! (post coming on this soon!) Even without a child life specialist and the detailed resources and prep kits we have available, clinicians can provide their own basic preparation and familiarization. Simply showing a child a stethoscope and allowing them to touch it can ease their anxiety. Similarly, allowing a child to see and touch an IV catheter can clear up many misconceptions and fears of needles. Demonstrating procedures, even as simple as a physical exam, on a stuffed animal or even the child’s parent can encourage compliance in the toughest of patients.
Language use: much of the language we use in the hospital is not accessible to our adult patients and caregivers, and is especially confusing to children. Avoid use of terms that may have double meanings or alternate definitions in the mind of a child. This includes “cat scan”, “stool sample” “IV”, and “dye”.
Pain control: a topic I’m incredibly passionate about. Simply put, “They’re going to cry anyway” or “they’re too young to remember this” is NEVER a good excuse to deny a patient appropriate pain control. This topic will most definitely have it’s own detailed post coming soon so stay tuned for that!) In the meantime, a few fun facts: did you know that…..
“A child’s experience during painful medical procedures likely plays a significant role in shaping that individual’s pain response to future events” (Young, MD, 2005)”?
Infants, even as young as neonates, “who undergo procedures with inadequate analgesia have long-standing alterations in their response to and perceptions of painful experiences”? (Zempsky et al. 2004
“Our youngest patients are at the highest risk of receiving inadequate analgesia” (Zempsky et al. 2004)
That’s all for today folks! Stay tuned for more information on communicating with pediatric patients, managing acute pediatric pain in the emergency department, positioning patients for procedures, and more! Hope this information is helpful and that you can use it in your practice, or even in your home!
Oh and one more thing - Happy Child Life month to all those heroic ladies and gents around the country fighting the good fight every single day. You are appreciated. You are valued. YOU ARE IMPORTANT!