Wondering how you can help your child at the doctor?
Do you ever feel helpless when your child is getting a shot or another stressful medical procedure and you are standing there.....
just watching?
Typically no one tells us what we can do to help our children and we just follow directions because we don't know what choices we do have.
Often, children end up being restrained by one or two or maybe even three medical staff!
Can you imagine what it would be like to be pinned down?
What if you were the size of a tiny toddler and a giant three times was forcefully pushing you down?
The size difference alone is terrifying!
Then you add the fact that the child is immobilized and watching a needle come toward her not understanding why. Then she feels the pain and she doesn’t know when it will end....
Horrifying!
NEEDLE PAIN CAN LEAD TO PRE-PROCEDURAL ANXIETY
Did you know that the pain associated with medical injections can cause so much distress in children and their caregivers that it can lead to pre-procedural anxiety and a fear of needles if it's not addressed?
Sometimes those children aren't getting their vaccinations on time simply because they are so fearful of the injection!
Did you know that children report needle procedures as something they fear the most?
And it's not just children who are afraid.
IN FACT,
10% of the population won't even receive medical injections because of their needle fear...
Clearly needle fear is an issue for many people.
How can we alleviate that? How can we set our children up for success so they don't refuse treatment when they're older?
Studies have shown that children report feeling more pain during vaccinations while laying down as opposed to sitting up or being held by their parent.
So why are we still laying kids down?
If I had the power to change anything about the practice of pediatric medicine, laying kids down for procedures would be it!
What should you do instead?
This is my greatest Child Life passion!
it's a little thing called..
comfort positioning!
WHAT IS A COMFORT POSITION?
Some kids need help holding still during medical tests and procedures.
When they feel fearful, their bodies show it.
Comfort positions are an easy way you can help your child hold still all while feeling secure.
Comfort positions allow children to sit up whenever possible, while being held by a caregiver in a secure, hugging hold; they help children to feel safe while their caregivers help support keeping their bodies safe during a medical procedure.
Comfort positions are just like they sound- comforting to children.
There are many different ways you can hold your child to comfort her while helping her hold still and remain safe.
Comfort positions look different depending on the child (and how fearful they are), the child's age and developmental level, and the procedure being done.
Before we jump into why comfort positions are the best method for helping kids during procedures, let's discuss....
WHAT COMFORT POSITIONS ARE NOT:
You do NOT hold your child down. If you're asked to do that, say no. Holding your child down for a procedure would weaken your relationship with your child. It's much better for a staff member to do that if they absolutely have to, but remember, it's soooo much better to be in a comfort position instead!
A "papoose." Many emergency rooms have these & they're a pretty old-fashioned way to get kids to hold still. Essentially it's a flat board with velcro restraints. In my opinion, this should only be used after ALL methods are exhausted and typically this means the child has behavioral issues and/or developmental delays and/or is older and it's not physically possible for anyone to safely hold the child in a comfort position. Although, if a medical team thinks a papoose board is needed for a child, I would suggest trying to wrap the child in a bed sheet first instead. That way the child feels swaddled rather than restrained.
These options are avoided at ALL costs. They are last ditch efforts when all else has failed.
WHY YOU SHOULD USE COMFORT POSITIONING FOR MEDICAL PROCEDURES
Why are comfort positions so much better than restraining or "holding kids down" for procedures?
Well these aren't just my thoughts.
There's actually a lot of research that supports using comfort positions!
In fact, the American Academy of Pediatrics, the Word Health Organization, and the Centers For Disease Control all suggest using comfort positions!
Here's why!
Comfort Positions...
Work! Research tells us they are effective. Don't believe the crazy lady on the internet? Check out the number of research articles I have listed at the end of this post that all find them to benefit all involved (children, parents, and medical professionals)!
They are non-threatening and non-aggressive. Children prefer to be in their caregiver's arms over a stranger's, especially while feeling pain! Children feel less like the victim when they are respected in this way, where they can sit up rather than being forced to lay down with limbs forced by restraint.
Increase kids' compliance. Research tells us that kids are more compliant when they are upright rather than laying down.
Are safe! They prevent needles going where they aren't intended because staff is not "fighting" the child to restrain him and because children are more cooperative when comfort positions are used.
Decrease pain and kids display less distress and anxiety. They are a quick and easy way to decrease their stress & pain level!
Give kids control and help them feel safe and secure. Children feel a loss of control when they are laying. Sitting up helps them feel more in control.
Eliminate the need to separate the child from their caregiver. That alone builds distress in most kids, especially babies and toddlers. With comfort positions, children can stay with their support person, helping them feel safer and more secure, and keeping them calmer and more in control before the procedure starts!
Reduce caregiver/parental stress and increase their satisfaction. They give you contact with your child and you get an active role in supporting your child rather than standing there, stressed about how you can't help your child. Parents report higher satisfaction when comfort positions are used.
Promote quicker recovery rates for children following procedures. Studies find that kids who are held in a comfort position are able to calm down quicker after the procedure ends compared to kids who were not in a comfort position.
Decrease children's stress and anxiety for future medical appointments & procedures. A negative procedure can lead to more fear for future medical procedures. When comfort positions are used, kids are not only more compliant for the current procedure but for future ones, too! You've decreased their stress allowing them to be less anxious and more cooperative next time around.
Help medical staff & require less staff. They help staff by isolating and giving access to the body part staff needs for the procedure. They require less staff because children are more cooperative so less staff is helping. Additionally, rather than needing another staff member to help the child hold still, the caregiver assumes that role instead! On that note, it's important to recognize that a lot of staff can be overwhelming to a child leading him to be more fearful as well!
Are beneficial for all ages! Even older kids can benefit from a hand hold or even a hug. Babies can be held or swaddled, too, and I'll show you how!
WHEN TO USE A COMFORT POSITION
ALWAYS!
Unless the child is already under anesthesia, I can't think of a circumstance that a comfort position couldn't be used. Let's say your kid is older and isn't one bit nervous, then you probably don't need one. But be at the ready because kids can surprise you! Your child may get nervous in the moment and you'll need to jump in a position to help!
From birth!
They can be utilized from day one of your child's life! There's loads of research on how babies are in fact affected by needles, so please don't forget infants!
Some procedures off the top of my head that could benefit:
IVs, blood draws, shots, stitches, X-rays, enemas, castings, VCUG, lumbar punctures, ROP exam, ECHOs, port or central line access, spinal taps, anesthesia inductions, EEG placements, NG tube placements, catheter placements, well-check exams. Don't forget things as simple as checking vital signs! Some kids are so anxious and upset even at the start of their visit while their vital signs are being checked or even when the doctor is checking their ears, nose, mouth, and eyes; comfort positions should be utilized!
WHAT DO COMFORT POSITIONS LOOK LIKE?
I've rounded up all the comfort positions and broken them down for you so you can figure out which comfort positions will work best at each age and for each procedure.
Go to my post How to use Comfort Positioning for Medical Procedures: How to hold your child for shots to see my GIANT list of comfort positions for medical procedures here.
And don't forget to read my post on What to Do If You Get Pushback From Your Doctor's Office (coming soon) because I'm telling you right now, you probably will! So be prepared!
*If your child is too out of control & too strong or old enough for you to hold in any of these positions safely, check out my post on What to do When Comfort Position Isn't Working For Your Child (coming soon)!
WHY HAVEN'T I HEARD OF COMFORT POSITIONING BEFORE?
You may be wondering why you haven't heard of Comfort Positioning before.
That's how I felt when I learned about them!
I couldn't stop thinking, "how is this not the practice across the board at every hospital and doctor's office? Doesn't everybody hear about this and think, 'yeah, of course that makes sense!'"
Not so.
In fact, it wasn't until 1980 when child life specialists Mary Barkey and Barbara Stephens invented The Comfort Measures Model.
Mary had observed procedures her first few years as a Certified Child Life Specialist (CCLS) and knew there had to be a better way than kids being held down and screaming in treatment rooms!
She and Barbara developed this genius model and have since presented it at conferences and hospitals nation-wide!
They have conducted research, among many others, and the results have supported their model.
Child Life Specialists are working hard to implement comfort positions at their institutions
but
change takes
time...
and there are a few reasons medical professionals may not want to change their ways.
Read about what those might be on my post How to Get Your Healthcare Provider to Use a Comfort Position and What to do When They Say No (coming soon).
WHY I LOVE COMFORT POSITIONS
I love comfort positions!
I have seen firsthand how they can completely change a child's entire medical experience!
One of my biggest goals in starting Child Life Saver was to educate parents about comfort positioning!
I believe it's the simplest way to minimize the trauma kids can experience during medical procedures.
There's so much we don't have control over in the medical environment, but this is one thing we can control.
And it's a quick and simple intervention that can have drastic benefits.
Comfort positions don't cost anything or use any additional resources!
They actually help the medical staff!
Everyone can use them and everyone should use them!
I feel that it's so important to implement comfort positioning when kids are very young because their early visits set the tone for their ability to cope with all their future medical experiences.
You pin them down, game over.
They are far less likely to be calm walking into the doctor's office the next time and it will only escalate from there.
We can be better!
We can set our kids up for success by simply changing the practice of laying them down to perform medical procedures and especially for routine procedures as simple as vaccinations, shots, IVs, and blood draws!
This will probably sound so silly but I seriously dream of the day all medical staff will use comfort positioning in their every day practice!
I know it will make such a difference in kids' coping with medical experiences and I hope to see this change happening in my lifetime!
Are you ready to help me with this?!
Let's change the practice of restraining kids for procedures!
WE CAN DO THIS!
Help me make comfort positioning the new
standard practice for medical procedures!
We need a new standard of care for our children!
They should be respected just like adults are respected!
Again, find my post on which comfort positions would work for your child here. You'll learn what the positions are, and what ages and procedures would work best for each position.
***If you are a medical professional and you'd like to read the benefits comfort positions have for medical professionals, read that post here (coming soon).
I want to give a huuuuge thank you to my sister, Nicole Hill Gerulat, for taking these gorgeous photos and to Dr. Gregory Wynn from Utah Valley Pediatrics for providing the medical office for these photos and for jumping in and modeling for some pictures!! Dr. Wynn was my pediatrician as a child and he's still helping me even though I'm grown! :)
*DISCLAIMER: My posts are for educational purposes only and do not constitute professional medical advice.*
Research & Resources
Child Life Services: American Academy of Pediatrics Policy Statement
Evaluating Comfort Measures for Commonly Performed Painful Procedures in Pediatric Patients
Far From “Just a Poke”: Common Painful Needle Procedures and the Development of Needle Fear
Procedural and Physical Interventions for Vaccine Injections
Reducing pain at the time of vaccination: World Health Organization position paper
Reducing the Pain of Childhood Vaccination: An Evidence-Based Clinical Practice Guideline
The Impact of Positioning on Fear During Immunizations: Supine Versus Sitting Up
The Role of Child Life in Pediatric Pain Management: A Survey of Child Life Specialists
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