Four ways parents can increase their protective role and pain-reducing effect at medical procedures

Many people believe that medical procedures have to hurt, particularly if they involve needles or other sharp instruments. They can hurt, of course, but you may be surprised to know that pain is not a given.  Fear and pain are natural protective mechanisms that parents can help switch off — and the earlier you start, the easier it is.

Checkout this video from Professor Denise Harrison and the Be Sweet to Babies team (Baby vaccination; the secret to a calm and peaceful immunization). 
 

Do your homework and go prepared.  It’s not hit and miss whether a child learns to cope – it’s a combination of their previous experiences, how well prepared they are, and what the adults say and do.  Instead of relying solely on the healthcare professionals, find out in advance how you can be a positive influence, reduce the perception of threat and help your child feel safe and comfortable.  You may be surprised how much research has already been done.

Get all the important tips from a tiny tot in It doesn’t have to hurt from the Centre for Paediatric Pain Research in Canada.

Children sense and watch what’s going on around them and adults need to stay calm; it is the key to a child’s sense of security.  As a parent, I also know it can be hard and may require faith, combined with an Oscar-winning performance, to present the medical world as a safe and friendly environment. “You have to be brave for your child” is how one experienced mum put it.

It’s not helpful when parents identify with their child’s potential or actual suffering and show their own emotions.   If you are releasing a cascade of anxiety-producing hormones, then your young child will too, amplifying any fear and pain.

Remembering to breathe and watching the natural rhythm of your breath can make a big difference.

There is a long, history of parents being excluded from the care of their children in the medical setting.  Fortunately times have changed, and parents no longer have to hand over their children and their power to the healthcare providers.  You can speak up, maintain your authority and become a vital member of the team.  Calm, informed parents provide the ideal protection from fear, pain and trauma for children.

It’s not about being demanding.  It is what works for my son.  We are positive and confident when we go for procedures and we have never had a problem.  It has changed our perspective on the hospital.”   Parent and health rights lawyer Liz Bishop, who has more to say in the video Listen to a parent’s experience.

When parents and health professionals all work together as one harmonious team, each bringing their complementary areas of knowledge and expertise, medical procedures can become a source of resilience and mastery for children.

REPLACE THE OLD MALADAPTIVE CYCLE

Procedures→Threat→Fear→Distress→Pain→Aversion→Avoidance

WITH

Procedures → Normal→Sense of safety→Coping→Happy to go back again→Mastery


Angela Mackenzie
Paediatrician/author
29 June 2015

Keeping Kids’ Needs in the Picture


When it comes to medical imaging why won’t kids just smile for the camera? Children have trouble staying still at the best of times and when feeling unwell, unfamiliar experiences can become especially daunting. Their parents are often anxious too, about their child’s health and radiation risks. As children can have increased risks from radiation exposure so it’s important that scans are completed with a minimum number of takes.  So how do we get kids to comply?
Paediatric hospitals have the benefit of staff who are trained and experienced with kids. Many employ Child Life Therapists specifically to prepare children for procedures like scans and help them to develop coping strategies. University trained Child Life Therapists have extensive knowledge of both child development and medical procedures. This places them in a unique position to bring the two together as harmoniously as possible.
But what about the non-paediatric facilities where staff are trained for, and treat, mostly adults? In 2012 The Royal Australian and New Zealand College of Radiologists approved a new policy on Paediatric Imaging to guide those clinicians in how to limit radiation, trauma and possible pain to children in their care. It is also recommended reading for parents wanting to understand the options for children but please note the ages mentioned are a guide only. Younger children have achieved successful scans without sedation and appropriate preparation.  For further research read here: Minimising the use of anaesthesia / sedation in paediatric imaging and radiotherapy : The role of play therapy and patient education or if you want quick information, see our tips below …
When your child needs a scan:  How you can navigate these potential pitfalls.

1) RADIATION:   

  • Check with the doctor: is the scan necessary? Is it need immediately?  Are there any alternatives with less radiation?   

  • If booking with a private radiology practice for a non-urgent scan, ask if Radiography staff have experience with children.  How, specifically, do they help kids with scans? If you don’t feel assured of a child friendly approach, then shop around (if possible).

 

2) INJECTIONS:

  •  Check in advance whether the scan requires an injection of contrast. This will allow you to prepare your child for every aspect of their treatment.
  • If yes, then request a numbing cream such as Emla or LMX4 be used.
  • Is your child needle phobic? Discreetly let the staff know. If child life therapists are not available, try distracting your child with a book, game, or reassuring words.

 

3) SEDATION:
There are instances where it’s necessary to sedate children, either to avoid pain or because zero movement can occur.

  • Check the necessity for sedation, which type, and the risks associated.
  • Prepare your child for having that type of sedation
  • If general anaesthetic will be used, prepare your child for an overnight hospital stay.

4) BREATH HOLDS:

  • Is your child required to perform breath holds for their scan? These are generally needed for abdominal and chest scans. Learning this skill in advance of scanning helps the radiographer get the pictures they need. This means less retakes and less radiation.
  • Take the time to coach your child in breath holding in advance. Try to make it fun by doing it in the bath or pool, using counting games and blowing bubbles.

5) WAITING LISTS:

  • Non-urgent scans at paediatric hospitals may involve waiting lists. If you’d like the scan sooner ask your referring doctor if it can be done by another hospital or clinic. Consider your options in consultation with them.
For further assistance with preparing children for scans and injections, or appropriate distraction techniques during those procedures, contact Child Life Therapy at your child’s hospital. If attending a private clinic you can consult a Child Life Therapist in private practice.
Blog written by: Renee Campbell
Renee Campbell is a university trained, registered Child Life Therapist with the Australian Child Life Therapy Association (ACLTA) and a member of the ACLTA Certification Committee.
Renee has over 7 years’ experience as a Child Life Therapist (formerly Play Therapist) at the Sydney Children’s Hospital Randwick (SCH) where she helped establish their MRI Play Therapy program. In that time she conducted research into children’s coping in medical imaging and helped children as young as 4yrs old to have their scans without anaesthetic.
Currently, Renee remains employed at SCH part-time in the Medical Day Unit assisting children and adolescents to cope with invasive procedures. She also has a private practicehelping children with healthcare needs and parents of newborns with sleep guidance.

Therapeutic activities for children and teens coping with health issues

Therapeutic activities for children and teens coping with health issues
By Robyn Hart and Judy Rollins.
John Wiley & Sons, Hoboken, New Jersey, 2011, 379 p. ISBN 9780470555002.
Bibliography, pp  339-364. Includes CD-ROM.

“Therapeutic activities for children and teens coping with health issues” is a book richly filled with activities to assist health professionals, child life therapists, counsellors and social workers in their work with families. Activities and related information promote adaptation and coping for children, adolescents and their families in hospital or living with health issues. It is great to see so many ideas presented in an easily readable format, with over 200 practical activities to choose from.

Chapters focus on promoting understanding and coping for adolescents and children through different aspects of their healthcare experiences. Topics of the 16 chapters include separation and anxiety, self expression, socialization and help with many aspects of coping with illness. Set out in a clear way, each topic covers an overview, special considerations and coping interventions. The theoretical framework behind each topic is outlined. Activities are set out using an easy-to-read table which includes: therapeutic goals, age group, adult/child ratio, required time, restrictions and precautions and materials. You will also find an extensive bibliography (pp  339-364) as well as black and white illustrations and photographs. The accompanying CD has activity sheets and templates that can be customised.

With a great mix of theory and hands on, this book is sure to be a helpful reference tool and provide both information and inspiration. In fact I think I’ll gather up my supplies and try my hand at making a volcano.

About the authors
Robyn Hart, director of Child Life at Rush University Medical Center in Chicago. Judy Rollins, coordinator of the Studio G Artist in Residence Program at Georgetown University Hospital and Adjunct Professor at Georgetown University School of Medicine. This is the second  book they have worked together on, the previous award winning book is entitled, Therapeutic play activities for hospitalized children.

Keywords: Activities; Adaptation, psychology; Adolescent psychology; Bereavement; Body image; Child life; Child, hospitalised; Child psychology; Culture; Death; Families; Group work; Hospitalization; Medical art; Medical equipment; Mental health; Pain; Patients; Play therapy; Self-esteem; Self-expression; Therapeutic activities; Therapy

Awards
Winner of the American Journal of Nursing Book of the Year 2011
(Category: Maternal And Child Health)

Other titles also by Judy Rollins available for loan from the AWCH collection:
Meeting children’s psychosocial needs: across the health-care continuum / Judy A. Rollins, Rosemary Bolig and Carmel C. Mahan. Austin, Texas: Pro-ed, 2005. xv, 551 p.: Includes bibliographical references and index. Call number: 618.92 ROL 1
Core curriculum for the nursing care of children and their families / Marion E. Broome, Judy A. Rollins, Editors. Pitman, New Jersey: Jannetti Publications Inc., 1999. Call number: 610.7362 BRO 2

Review By:
Jillian Rattray
AWCH Librarian
March, 2013