Reducing Pediatric Restraint During Painful Procedures
Simple techniques to help children overcome fear
‘Brooke, she is not going to let you put that numbing cream on her because she knows what will happen next,’ her mother said with contempt in her voice.
I looked at her mother. I looked at Emily, my 9-year-old patient, and I could see the determination on her face. This child was not going to go through this again.
With curiosity, I asked her what her previous needle pokes had been like and she began to explain to me how she had five adults pin her down while she had her last IV cannula inserted.
‘You must have been very scared,’ I said. ‘I’m so sorry this happened to you. I think sometimes we are afraid that it will be a challenge for us that we go overboard to make sure it isn’t and we forget to ask you how you might like it to happen. I am sorry they forgot.’
Emily began to relax a little. I could see I was building her trust in this short, two-minute conversation.
I’ve assisted with a lot of needle pokes in kids throughout my career and I can tell you, we don’t need to restrain kids if we prepare them and stay calm ourselves.
In Emily’s case, her previous bad experience was having a direct impact on her willingness to participate in any future care she needed.
This means that it is essential that we carefully consider the way in which we approach painful procedures in children as they can have a lasting impact on healthcare engagement.
So, how do we remove the need to restrain a child?
Firstly, we need to stop rushing so much.
If it isn’t an emergency, there is no need to jump in there and get that line in without speaking with the child first.
Child Life Specialists are your friend!
Child Life Specialists (CLS), if you’re lucky enough to work with one, are your greatest resource when it comes to preparing the child, the parent, and the scene.
If you don’t work with a CLS, I suggest you begin by taking a moment to take a few deep breaths and clear your mind. Doing this will help you remove the urgency from your voice and relax your body. Believe me, the child will look for these non-verbal communication cues to determine if you’re telling the truth about it not being a ‘big deal’!
Have the conversation
- Acknowledge
Start by acknowledging that they are unwell and that being in this big hospital can be overwhelming for some kids.
2. Reassure
Reassure them that you are here to help them get better and that to do this, you will need their help.
3. Explain
Tell them how you need to insert a little straw or tube into their vein to help them get better. I will often tell them that this straw is a special straw that lets me put the special superhero medicines into their body to make them strong again.
Sometimes I find having a clean cannula with me (without the needle inserted) to show them how it is flexible helps them to understand that it won’t be rigid and painful once it’s in. I usually leave it with them so that they can explore it further while I prepare.
4. Be honest
Let them know that some children have told you it is ‘uncomfortable’ when you put it in whereas others tell you they don’t even notice.
This is where I introduce the numbing creams and offer to put it on to ensure the experience is as comfortable as possible.
You may also like to research The Magic Glove technique which uses hypnotherapy to reduce perceived pain and works a treat!
I used the magic glove with Emily and at the end of the procedure, I gave her my ‘special glove’ and another to her Mum as a ‘back up’ glove so they’d always have one with them. She could not wipe the smile off her face!
5. Set them up for success
No matter what, the goal is for the child to remain as still as possible for the procedure so in setting them up for success, I remind them that I can do it faster when they hold still even if it is uncomfortable.
I finish by asking them who they would like to hold them and cuddle them to help them stay calm.
Once they have nominated their preferred adult, grandparent or friend to hold them, I practice two different comfort holds with them. I ask them to choose which one they want for the procedure to give them some feeling of control over the whole experience — this is key!
6. Let them choose their distraction
Before I leave to set up, I ask them to find something they would like to watch, to listen, or to read while we do the procedure.
This gives them something else to think about and reduces the risk of them becoming so anxious that they cannot cooperate by the time I get back.
It also provides the distraction tool for when I get back.
To summarize, we need to be vigilant when it comes to protecting a child’s needle experience. We can do this by slowing down, by being honest and supportive and finding ways of giving back some control where possible.
If you enjoy reading stories/articles like these and want to support me as a writer, consider signing up to become a Medium member. It’s $5 a month, giving you unlimited access to stories on Medium. If you sign up using my link, I’ll earn a small commission.
