Distraction and Coping Techniques Your name, institution, date, etc.

Introduction State the purpose of the in-service - to teach techniques for helping children cope with procedures Briefly explain the role of Child Life in your setting

Things to remember when meeting patients Get on the child's level. Introduce yourself and your role. Unknown people are threatening. Only give choices where choices exist. Be careful about comparing children. Being in the hospital can be pretty tough. Regression is normal for some kids.

Things to remember when meeting patients Don't make promises you can't keep, e.g., "This is the last time you have a 'poke' today." Appearances can be deceiving. Be careful what you assume about a patient's developmental level or coping ability.

Language issues You DON'T have to say it hurts. Hurt is a relative word. It's better to say or use descriptive words, saying "Some patients say it feels like... and others say it feels like...." (This prevents YOU the care giver from being seen as a liar.) Be careful of medical terms we take for granted, e.g., "I'm going to TAKE your blood." "I'm going to DRAW your blood.")

Language issues Don't use the phrases "Be a big girl/boy" or "Big girls/boys don't cry." –Remember appearances can be deceiving. Big doesn't equal old. This can add extra pressure to the patient. This isn't something they always have full control of. –Give them an achievable goal: "Your job is to hold still. It's okay to say 'ouch' or even cry, but your job is to hold still."

Language issues Talk to the patient and explain what you're doing. Even infants benefit from soothing voices. Beware the touch-hurt-leave with no verbal interactions. Don't lie to patients (e.g., "This won't hurt.")

Procedural Support Distraction/comfort –How/why it works…. facilitates coping increases trust pain management studies show that use of distraction decreases use of pharmacological methods

Procedural Support Distraction/coping –techniques developmentally appropriate comfort items –parent or designated comfort person (hold hand, stroke hair, soothing talk) –Blanket, stuffed animal, pacifier, etc. –allow choices (which hand for IV, whether or not to watch procedure) –prize to signify end of procedure

Procedural Support Distraction/coping –Techniques (cont.) Coping techniques –Not looking –Controlled breathing –Squeezing mom's hand –Watching something else (i.e., distraction) »Bubbles »Books »Singing »Windmills

Procedural Support Distraction/coping –parental presence parent serves as comfort-giver –coping role for both parent and child (each has a "job" during procedure) –Parents can provide support during lab work, but should not be responsible for primary holding. –Parents need to be a part of safe environment.

Procedural Support Distraction/coping –Position the patient for comfort. NOT holding child down (loss of control) Sitting on lap Remember prone is a very vulnerable position. (Think how you feel lying on the doctor's table.) Many patients actually do better sitting up. (Demonstrate possible positions using doll. Show poster.) Very small infants should be swaddled.

Procedural Preparation Help develop a safe environment for patient. –Whenever possible use the treatment room for procedures. –Remember some areas are "safe," e.g., playroom. *The bed is an infant's world. Try not to do procedures in the bed. It can lead to fear and sleep disturbances.

Your Reactions to a Child in Pain: Your job is tough; trying to rebuild trust afterwards can be hard. Stickers or cool Band-Aids sometimes help. Remind patient it's not because he/she did something wrong that they had a procedure. Don't take it personally if patient doesn't warm to you afterward. If you're concerned about patient's ability to cope or rebound, let a child life specialist know.