Preparation for medical and surgical procedures Archives - Association for the Wellbeing of Children in Healthcare

Children in hospital: a guide for family & carers – review

26 November, 202028 June, 2017 by AWCH

Children in hospital: a guide for family and carers by Richard Lansdown
Oxford University Press (Oxford Medical Press) (1996) ISBN: 0-19-262357-5

“Matching the intervention to the child”…

Children in hospital: a guide for family and carers is an information-packed book combining research and personal experience. Written by Richard Lansdown, formerly consultant Psychologist at Great Ormond St Hospital London, one of the world’s leading children’s hospitals.

Although the book is over 20 years old, families, healthcare professionals, early childhood educators and students will find a useful overview supporting children in hospital and healthcare. Researchers continue to read this book today.

Child rights

Have we come to expect child-friendly services? Lansdown writes about early hospitals and emotional aspects such as separation and the battle of early visitors, this gives a significant background. Development of child rights in hospital, saw the emergence of advocacy organisations and the Charter for children in hospitals, NAWCH 1984.

In Australia, AWCH promoted child rights and better healthcare with Health care policy relating to children and their families published 1974, revised 1999 and Charter on the rights of children and young people in healthcare services, 2010. Understanding child rights in healthcare is essential. An 11 year old girl on a children’s ward in the UK asks “aren’t we kids supposed to have a bill of rights when we are in hospital?”, Children’s hospital charter revisited.

Fear and coping

Children and families going to hospital or healthcare appointments may be fearful, Lansdown approaches the topic from a child’s perspective without being simplistic. You will find practical information about children’s understanding of health, illness and treatment. Play in hospital and play specialists (also known as child life therapists or specialists) guide children towards meeting their emotional needs.

Pain

Parents and carers can be supportive when a child is in pain and often know what techniques are likely to distract their child during medical procedures such as injections. Children turn to their parents or carers to see if it is safe and to know what to do.

The chapter on pain gives an understanding of its impact on children. Information and support are based on the child’s developmental stage and what works for them. Supportive strategies for children facing painful procedures include active distraction. This may involve reading books, toys, songs, stories, video games, mobile apps and new technologies such as video goggles. Other supportive strategies are participation, desensitization and modelling, watching a film that shows other children and mastery coping or coping models (initial anxiety then coping). Being noisy (counting out loud), guided imagery, relaxation and breathing techniques are some more options to consider.

A combination of distraction strategies might be used such as bubble blowing and guided imagery. For example, a child is asked to visualize the colour of the pain and places it on a bubble as though it was an imaginary cloud floating away. As the pain moves off, the bubble changes to the child’s favourite colour, blowing away pain and fear (p 116).

Talking with children

Summaries of pain assessment tools show how children rate their pain. Why ask children about pain? Adults usually explain how important a procedure is but there could be a gap in the child’s thinking. For example, a finger prick/injection to take blood may leave some children wanting information about why it is being done and what will happen next with the blood.

Children in hospital: a guide for family and carers reviews literature and includes bibliographical references providing a quick source of information for healthcare professionals and students. Families will find it is easy to dip into relevant sections. This book gives a valuable overview on the wellbeing of children in healthcare and also shows glimpses of what a good children’s healthcare service should look like.

More information

For more information about supporting children through medical procedures, see Needles and Needle-Related Medical Procedures links.

AWCH also holds a copy of Needles: helping to take away the fear, a booklet for parents based on information provided by Dr Richard Lansdown produced by Action for Sick Children, 1994.

Jillian Rattray

AWCH librarian

Email: Jillian@awch.com.au
AWCH Library

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

17 December, 202029 June, 2015 by AWCH

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.

From Everybody Stay Calm

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

Painful paediatric practice

17 December, 202029 July, 2014 by AWCH

I was out to dinner with my girlfriends last night and at dinner the topic of pain relief in hospital came up. One of my girlfriend’s children had broken his arm and to fix the fracture pins had been placed in his humerus. To have pins removed, my friend took her son to the local paediatric hospital. Before Bob had his pins removed he was offered no pain relief and this is where the story really starts…..

To remove his pins Bob was placed in a chair. His mother was asked to sit next to him. A clown doctor was there to distract the child whilst the pin was being removed. To remove the pin the doctor used pliers, which slipped as the pin did not come out easily. This process caused Bob a great amount of distress…. However, as this was happening, the clown doctor was attempting to put a red nose on the mother – impeding her ability to comfort Bob. In addition, there was still one more pin to be removed. Yet by this time the child was hysterical and distraught.

A comedy of errors, or a sheer lack of planning and consideration for the needs of Bob and his mother?

The reason I wish to share this story is that this type of situation exemplifies why AWCH is still relevant in 2014. In our 40 year history we have made lots of progress in advocating for children and their families as they navigate the health care system. However stories like Bob’s and Betty’s still exist.

Betty is an intelligent and articulate woman. She told me that she placed her trust in the medical staff and that if they said that this procedure did not require any pain relief then Bob would be fine. Once Bob became distressed she felt she had no control over the situation and that all she could do was comfort Bob to the best of her ability at that time.

This happened two weeks ago, and prior to the pin removal Bob was always a happy go lucky child with a ready smile and a cheeky sense of humour. Since the procedure he has been having nightmares, being argumentative at school and is scared to play footy or use him arm too much.

For me this story shows that AWCH is still very relevant today and the work we do is still needed.

Ally Hutton
AWCH President

Thanks to Bob and Betty for sharing their story (real names not used)

Jessica’s X-ray – review

17 December, 202024 July, 2014 by AWCH

By Pat Zonta, artwork by Clive Dobson

Firefly books, 2006. 27 p. ISBN 10: 1552975770

Jessica’s X-Ray is a great book for children and families to read and familiarise themselves with what an x-ray does and when it is used. Readers follow Jessica as she experiences an

x-ray for her broken arm and accompany her on a hospital tour to find out about radiology and other x-ray techniques including CAT-scan, MRI and ultrasound.

“X-rays are invisible waves of energy that travel at the speed of light”

Primary school children will find the best feature of the book is the six real x-rays on printed film. Many children are fascinated by broken bones and the human body and they will like taking a look and finding out facts about different types of x-rays. By the end of the book they will have read about identifying bones, muscles and soft tissue from x-rays.

No-fuss information and warm colour illustrations are a feature. The author combines her experience of working in children’s and teaching hospitals as a Medical Radiation Technologist and author of several children’s books. This short book would be a useful addition to a primary school or public library.

Jessica’s X-Ray is available for loan from the AWCH library:

http://library.awch.org.au/jessica_x-ray

Review by:

Jillian Rattray

AWCH Librarian

http://library.awch.org.au

Help! My Child’s in Hospital!

20 October, 202029 July, 2013 by AWCH

Help! My Child’s in Hospital: A parent’s survival guide. Practical advice for parents on preparing your child and caring for them in hospital.
By Becky Wauchope ~ Illustrations by Kaitlyn Miller

“Help! My Child’s in Hospital” is a great read if you are looking for something positive to prepare your child and family for hospital. Written in a warm, personal and easy-to-read style, Becky Wauchope describes what it is like to be in hospital and how to cope with anything from an emergency visit to a long stay and repeated visits. Her experiences with son Gus in over three years of repeated visits to hospital, have resulted in a practical and creative book. Lots of tips throughout provide starting points for children and parents to encourage coping and reduce fear. There are ideas to help keep life as normal as possible with play and some fun. The easy to follow ideas are particularly good for families with young children, Becky has many years experience as an early childhood worker. There are great tips and creative ideas to assist children and families with hospital preparation, daily life in hospital, tests and procedures, anaesthesia and surgery, medication, support and recovery.

This is a stressful time, so parents who are time poor can dip into the book and read on a topic, such as “Having an operation” and read about how to prepare and cope with fasting. Reading the book cover to cover is also a great way to gain an overview.

The book emphasises communication for parents, who know their child best, to work with health professionals for the best care. Honest conversation with your child providing the right amount of information is also a positive step. Parents can read about how to be child advocates, there are examples of steps for being prepared when talking with health professionals. Parents are encouraged to know their limits and if not able to help reduce a child’s fear or confusion then they are empowered to ask for help. Parents are a reassuring presence.

Some variations of what you may expect to find in different hospitals are covered. Parents will feel more aware and strengthened by both the information and supportive ideas. “Help! My Child’s in Hospital” highlights why preparing yourself and your child for the hospital experience is so important.

Find checklists at the back, with what to pack including Surprise packs that offer distraction. With cute illustrations, helpful layout and available for a reasonable price, this book would be a great addition to a Kindy library, hospital waiting room or public library. Copies are available for loan from the Association for the Wellbeing of Children in Healthcare (AWCH) Library and can be purchased via Becky’s website.

About the author:
The Wauchope family were about to emigrate to Australia from the UK, when Gus, the youngest of four developed severe breathing problems. This was the beginning of a three year journey through hospital readmissions in the UK and then Australia. Gus is now well and Becky has made numerous speaking engagements, run support groups and encourages people to share their stories. Find her website at: www.helpmychildisinhospital.com

Keywords: Anaesthesia; Child; Child, Preschool; Communication; Hospital preparation; Hospitalization; Medication; Parent information; Preparation for anaesthesia; Preparation for medical and surgical procedures; Routines; School children

Jillian Rattray
AWCH Librarian
July, 2013

Children in hospital: a guide for family & carers – review

“Matching the intervention to the child”…

Child rights

Fear and coping

Pain

Talking with children

More information

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

Painful paediatric practice

Jessica’s X-ray – review

Help! My Child’s in Hospital!

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