Hugs, Not Drugs
Written by Editor   
Wednesday, October 26, 2016 12:00 AM

Non-pharmacologic strategies and tactics to ease a child’s pain may help expedite treatment and improve care in this challenging population.  With both increased pressure to decrease waiting times in the ED and minimize the use of pharmacologic therapies due to the opioid abuse crisis, providers have been forced to get creative.  This may mean turning to certain behavioral and physical/sensorial forms of pain control for children -- everything from how a child is seated to offering electronic games and toys for distraction.

Clinicians were advised to perform a comprehensive assessment, including a physical exam and history as well as the child's developmental stage in order to better target these interventions. The provider should also take note of the family dynamics and identify available resources in the hospital that might be able to help the child.

Strategies to help reduce a child's pain may include:

  • Physical/sensorial interventions and stimulation

  • Distraction and conversation

  • Guided imagery and relaxation techniques

Pain and anxiety are twins.  We can't have aromatherapy and we're probably not going to do hypnosis in the emergency department, but we should treat pain like any other abnormal vital sign.

Examples of physical interventions include offering a pacifier with sucrose to an infant in pain, a warm blanket or gel pak to a child in a drafty ED, or cutaneous stimulation with ice for injuries.

Another important component of physical intervention is positioning. A child should be allowed to sit on a parent's lap or placed in a "bear hug" position, rather than be forced to lie down or be strapped down during procedures, unless necessary.

Distraction can involve simply talking to a child to focus attention on something other than the pain. Research indicates conversation and distraction can help reduce pain by up to 25%.  The family will often provide tips and clues about how to engage the child. In fact, family members can be a valuable asset in distracting a child from pain, providing games on their phone for a child to play. Age-appropriate siblings can potentially provide minor assistance with the procedures. Passive distractions, such as a story, a toy or a movie on a phone, often work best with younger patients, while older patients seem to enjoy active distractions -- such as interacting with an electronic device.

Guided imagery may include having a child picture a relaxing place, while deep breathing can also be encouraged by having the child place his or her hands on the stomach and watch their hands rise and fall from each breath.

Communication is also a key component of helping a child to feel less anxious. Listening to the child and acknowledging their pain, as well as pacing the process may end up saving time in the long run.

Most importantly, said Hernandez, how a child is treated when he or she is in pain may help form lifelong attitudes towards that child's relationship with clinicians.  This is how you help children not be that 70-year-old man who won’t come to the doctor because he was pinned to the bed when he had to get shots or stitches as a child.