1. Pediatric Variations in the Hospitalized Patient
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2. Variations in Nursing Techniques with Children
Pediatric medication administration is well covered on the videos on reserve in the library. These are mandatory to be viewed
Go to Reggienet for websites where you can practice med calculations and improve your competence in this area – medication forms for clinical are also at this site
Use past textbooks and information – med calculation book has chapter on Pediatrics; Health Assessment (Jarvis) has great info and pictures on Pediatric assessment & variations
Use open hours at Lab to review clinical skills using the information from your textbook to apply these to the Pediatric patient.
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3. Preparation for Procedures
Psychological preparation
Age-specific guidelines for preparation
Drawings, puppets, dolls, etc
Based on developmental characteristics
Establish trust
Parental support
Explanation to the child
Always think “atraumatic care”
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4. Performing Procedures
Special treatment room for procedures
Expect success
Distract the child; use play if appropriate
Conscious sedation may be used
Allow expression of feelings – during and after procedure
Praise the child afterward and provide positive reinforcement
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5. Therapeutic Hugging for Extremity Vein Puncture

6. Positioning for Procedures
Analgesia, sedation
Topical anesthetics (EMLA, numby)
Use appropriate restraints; excellent pictures & descriptions on the Pediatric Unit and in book
Therapeutic hugging
Jacket restraints
Mummy or swaddle restraint
Limb restraints
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7. Mummy Restraint

8. Elbow Restraints

9. Nurse Maintains Hand Contact

10. Position for Lumbar Puncture

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SPECIMEN COLLECTION
Urine—sterile catheterization may be indicated or use of a U-bag
Stool—if very loose diarrhea-like stools, may put U-bag over anal opening to collect stool
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12. Application of a Urine Collection Bag

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Specimen Collection
Blood—use EMLA prn, may be capillary or venous… Not for circumcision and may interact with acetaminophen
Sputum—often needed for children with Cystic Fibrosis
Gastric washings—in cases of poisonings
Nasal washings—especially for RSV/bronchiolitis
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14. Alternative Feeding Techniques
Gavage feedings NG OG
Gastrostomy feedings
Jejunostomy feedings
May be continuous drip or intermittent (bolus) feedings
G-button care
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15. Gavage Feeding (Always wear gloves)

16. Healthy Granulation Tissue Around Stoma

17. Skin-Level Gastrostomy Device

18. Improving Absorption of Feeds
Use pacifier during alternative feeds
Non-nutritive sucking improves digestion
Quiet, calm environment
Consistent feeding techniques by caregivers/family members
Hold and nurture during feedings
Positioning is essential to foster gastric emptying especially for children with GERD
HOB  30 degrees ( infant seat helps with this, but flat crib raised 30 degrees is better)
Right side promotes gastric emptying
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19. Eating/Feeding is Social
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20. Devices for Delivering Medication to Children

21. Administering Oral Medication

22. Holding Child for IM Injection (Always wear gloves)

23. Instilling Nose Drops (Always wear gloves)

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There you have it!
You have a bird’s eye view of some of the unique approaches in working with children—what we do, why we do it, and how to do it atraumatically!!
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