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.
Studies also show that when kids are held by their parents they experience less fear and distress and are more compliant, among many other benefits!
So why are we still laying kids down and restraining them for procedures?
Before you jump in, make sure you've read my post on Benefits of Comfort Positioning for Medical Procedures: How you can help your child at the doctor to find out why comfort positioning should be used and to discover the full list of benefits of comfort positioning. You can find that post by clicking here.
In this post, I'm going to be talking about how to use comfort positioning at your doctor visits and during procedures, but I won't be going over the benefits so be sure to read that post first!
HOW TO CHOOSE A COMFORT POSITION
It's important to be intentional when selecting a comfort position.
There's certainly not one universal comfort position that would work for every child and procedure so it's best if you take some time to think about what position would be ideal for whatever medical experience you and your child have to tackle.
You are the one who knows your child best!
You probably know how your child typically responds to medical interventions, what your child will need extra help with, or what she can handle on her own.
That's why your child needs YOU to help her.
You have the brain needed to advocate for your child and work with medical staff to figure out what position will work best for the procedure!
3 THINGS YOU'LL WANT TO KEEP IN MIND WHEN CHOOSING A COMFORT POSITION:
1. The procedure (or what part of the body needs to be accessed by staff)
Certain positions would not work well if staff needs access to different parts of the body. Think about where the medical professional would need access & if your position would give her that access. Don't be afraid to ask the medical professional if the position would work for the procedure.
2. Your child's developmental age and size
Older kids who are incredibly fearful and express that through their bodies would need you to have the ability to help secure their limbs! Does your comfort position allow you to do that?
3. Your child's temperament & typical response to all things medical
Using your knowledge about how your child typically responds to medical procedures, pick the comfort position that would work best to help your child hold still while giving him/her as much (wanted) touch as possible.
All of these things should lead to you picking the safest, most comforting position for your child!
HOW TO USE A COMFORT POSITION
1. Make a Plan
The most important thing you'll need to do is to talk to the medical staff before the procedure (and the earlier the better to make a good plan) about your desire to use a comfort position.
The reason for this is so that you can be on the same page to make a good plan, but also because many medical professionals will say, "no," and for that reason you'll need to...
I can't emphasize this enough!
Many times medical professionals are hesitant or say no to comfort positions because they simply have not used one before.
You will need communicate confidently that this is what you expect to happen.
It may take much persuasion and for that reason I've got a PDF (coming soon) to help you educate your medical professional about the research & benefits of comfort positioning.
It's best to plan on staff being reluctant, so be ready to educate them!
I have yet to meet any medical assistant I haven't had to educate and all of them have said "no" initially causing me to have to demand it.
You are the parent. You can do this!
3. Maintain a Safe Position
Ok so you finally convinced everyone to use a comfort position?
Now you will need to do your part to maintain a safe comfort position because if this doesn't go well staff won't want to use one again! No pressure hah!
Be sure you have a secure hold on your child, especially for those fearful feisty kids!
If the staff member doesn't feel comfortable with your position because your child's legs or arms are flailing, then they won't proceed (and shouldn't!).
You may need to practice with your child (or a stuffed animal or doll) the night before so you feel 100% comfortable and ready.
Here's the ideal method for using comfort positions according to The Mary Barkey & Barbara Stephens Comfort Measures Model: 1. Parents and children need to be prepared before the procedure. 2. Caregivers should be invited to be present. 3. Whenever possible, stressful procedures should be done in a treatment room (rather than hospital bedroom). 4. Use a comfort position. 5. Maintain a calm and positive atmosphere.
Ok let's dive right into what these positions look like and when you would want to use them! I've broken them down by age group but this certainly doesn't mean there isn't crossover between them so check out the ages surrounding your child's age as well.
NEWBORNS, INFANTS, & BABIES
Swaddle (4 months & under)
Babies feel comforted when they are swaddled. Swaddling helps babies feel less anxiety more secure like when they were in the womb.
Swaddling for shots and procedures works well with infants who aren't sitting up yet. You can add a pillow to support your arm if needed.
Leave baby's arm(s) or leg(s) out depending on what extremity medical staff needs access to for the procedure.
If you're able to hold your swaddled baby, that's even better! Because we know kids feel less pain during shots when they are sitting up!
I have a whole post on Why You Should Breastfeed Your Baby During Vaccinations so be sure to check that out for a full list of benefits and research!
So many research studies have shown that when babies breastfeed during procedures they actually feel less pain!
Breastfeeding has been shown to have an analgesic effect, which means it acts like a painkiller!
It's also been found to be more effective in decreasing pain than just using a pacifier, so do your best to time it right so you can breastfeed your baby during her procedure.
If the timing doesn't work out, don't stress! Pacifiers are effective, too!
Arms at Midline
Attention NICU moms! This is a great position for you!
If you're unable to pick up your baby during care and/or procedures, simply hold her hands into her chest at her midline. This is a comforting position for baby.
If you can, wrap your arms around baby's feet while holding his hands (creating a V or heart shape). This gives baby a surface (your forearms), which she can push against with her feet helping her brace during the procedure, another form of comfort.
Pacifier with Sucrose (12 months & under)
Non-nutritive sucking helps babies feel less pain during procedures!
Bring your pacifier and even better, ask your provider beforehand if they have sucrose (sugar water).
Sucrose also has an analgesic effect on babies, which means it acts similar to a painkiller. Breastfeeding has been shown to be more effective than sucrose with a pacifier, but the pacifier and sucrose option has still been shown to be significantly effective in having an analgesic effect.
Ask your medical provider how to use the correct dosage for your child, especially if your baby is in the NICU! Dosage is based on weight and NICU babies have a different dosage chart than other infants.
The most important part of dosing your child is that the first dose needs to be given TWO MINUTES PRIOR to the procedure in order for the sucrose to be effective. Then you can give the next dose right before the procedure starts and then place baby's pacifier in her mouth. If the procedure lasts a while, you can continue to give more doses as recommended by your physician.
Some studies suggest that sucrose can be beneficial up to 18 months, but most suggest up to 12 months. It looks like not much has been studied past 12 months.
If your doctor's office or hospital doesn't have sucrose readily available, some pediatricians provide lollipops instead (or you can bring your own).
If you don't have sucrose, and don't want to use a sucker, you can breastfeed or use a pacifier!
Chest to Back - Sitting (4 months & up)
This position works well for babies who are sitting up or learning to sit up.
If your baby doesn't like to be swaddled, this is also a great option for you!
Place your baby in your lap with your chest to her back (baby facing out).
Hold your baby's hands at her midline to keep her safe from touching things (helping the medical professional) and providing her another form of comfort.
Don't forget to bring some items for distraction! Sing or talk to your baby, too!
TODDLERS & PRESCHOOLERS
Chest to Chest - Straddle
This is my favorite position for shots with my own toddlers and preschoolers!
It works really well for immunizations & flu shots because it gives access to the child's legs.
Most kids at this age are terrified of needles, so I love that I can completely shield their focus from seeing what's happening and keep their attention on my items for distraction.
In this position, your child will sit on your lap facing you and you should be chest to chest.
Since most kids at this age become more fearful when watching procedures, you can secure her head and keep it looking away from the procedure by holding it in a hug.
Wrap your arms around hers keeping them from moving also.
If your child isn’t as fearful and tends to hold still on her own, these wouldn’t be necessary and you could use one of your arms to hold a distraction item like a look and find book.
If you are sitting on the exam bed and your child starts to push off of the bed and up out of your arms leaving you unable to keep him still and safe, this position would not work for you in the sitting position.
Try this position with you standing (next position).
This position is great for ear checks, shots, or anything that requires access to one side of your child’s face or just one side of his body.
PRESCHOOL & SCHOOL-AGE
Chest to Chest Standing Straddle
Similar to the last position I posted, this comfort position has you chest to chest with your child.
In this position though, your child is sitting on the exam bed with you standing in front of her.
Pictured is a position that would work for a child who is able to hold still on her own.
If your child needs more help holding still, secure her head (and keep it looking away from the procedure if she chose to look away or if she’s too young to make that choice) by giving her a hug and wrapping your arms around hers, keeping them from moving also.
This position is great for vaccines, IVs, & flu shots because it gives access to an arm & leg.
This comfort position gives great to access to your child's face, arm or leg.
With your child in your lap, position her looking to one side of your body with her legs also on that side.
Secure her head in your hand on your shoulder and if you need to you can also wrap your legs around her legs and arms around her arms like a hug.
Remember to bring your child's favorite comfort item from home! Use it during the procedure to help comfort her.
This position is great for ENT visits, ophthalmology appts, check-ups, vaccinations, flu shots, & more!
Chest to Back - Sitting
The most natural position to get into and often the position I jump into when the doctor is ready to do their “exam” part of the check-up (as shown in the picture) because it gives great access to the face and chest.
This position gives an opportunity for the child to watch the procedure, so it's good for kids who are a little more information-seeking (want to see what’s going on), do well with watching the procedure (doesn’t increase their anxiety), and are able to control their body a little better (calmer and less fearful at baseline).
If your child is more anxious and/or has chosen not to watch the procedure, I Spy or look and find books are fabulous procedure blockers and one of my favorite tools for distraction! Place a book in front of their face to block your child's view of the procedure.
This position can be done sitting or even laying down if needed (see next position). It’s great for babies up to school-age kids.
Remember to use your legs if needed to help keep your child's legs safe for the procedure!
This position works well shots in the arm or leg, IVs, blood draws, finger pricks, vitals, eye exams, ENT visits, etc.
Chest to Back - Laying
This position WOULDN’T be my first choice since the child is laying and research tells us kids do better when they are sitting up; HOWEVER, if your child is super anxious and/or is difficult for you to hold because of his strength & size or age, this position WOULD be my first choice!
In this position, you and your child are sitting with your legs also up (meaning you’re sitting in a hospital bed or all the way up on the exam bed).
Place your child in between your legs with his back to your chest.
Wrap your legs around his and your arms around his and lay down.
This position is the most helpful at keeping all extremities secure! If your child is more anxious and/or has chosen not to watch the procedure, look and find books are fabulous procedure blockers! Place a book in front to block your child’s view of the procedure. This is one of my favorite tools for distraction!
This position is great for procedures that need access to a child's tummy, bottom, mouth, eyes, and face. Also great for nose and mouth swabs, catheterization, VCUG exams, NG tube placements, facial stitches, and dental visits! It can be tricky to hold both a child's hands and face secure so if it's the face the medical professional needs access to, you may need some help keeping the child's face still.
Side to Side - Sitting
This comfort position is great for kids who are used to medical procedures or aren't very fearful of them!
This position also works well for kids who older and are able to control their body a little better.
Keep in mind this is another position that allows for the child to watch what's going on so it really wouldn’t be great for those kids who are anxious!
Sitting next to your child, you can place your arm around him or hold his hands in front of his body.
If needed, you can also wrap your legs on top of his to keep his feet from kicking forward.
This comfort position works well for spinal taps, accessing ports & central lines, EEG placements, shots, blood draws, IVs, and pretty much anything that allows your child to be in the sitting position.
Side to Side - Laying
This position works well for any age!
It isn’t my first choice because the child is laying and we know kids do better when they are sitting.
It also isn’t my first choice for little kids specifically because they often benefit from more physical touch during procedures and it would be more preferable to hold them. Laying next to your child (on your back or side), with your body completely on the exam bed, stretcher, or hospital bed, you can hold your child's hand and place your legs over your child's legs. This position often allows the child to watch the procedure so if you are wanting to block his view of the procedure, have someone else hold an I Spy book, iPad, or something similar that’s large in size and serves the purpose of distraction in between the child and the medical professional.
This position works great for IVs and blood draws and for kids too sick or hurt to sit up!
Sitting in a Chair
This position works well with kids who are very fearful and don't even want to get near an exam bed, because it allows them to stay in the chair.
Hold your child on your lap.
You can have your legs on top of your child's legs to keep them still if needed.
You can also hold your child's hands or wrap your arms around her arms in a hugging position.
If needed, this position can be done with a table in front for an arm to lay on for the procedure (i.e. IV placement).
ENT visits, annual check-ups, shots, IVs, eye drops, eye exams, blood draws, stitches, and so much more!
This position would be my very LAST choice because the child is laying & research shows children do better when they are sitting up!
Also, contact between parent and child is extremely minimal, which means it’s less comforting to the child but also that you are unable to help your child maintain a safe and secure position during the procedure.
With your child laying on the bed (sometimes in butterfly position with her feet together and legs open), you can stand behind the bed and hold your child's hands or stand to the side of the bed to hold your child's hand.
This position is especially great for many radiology exams, catheterizations, VCUGs, and any procedure where the medical professional would need access to the child's bottom. It also works when the child is too big for you to hold in any other position.
SCHOOL-AGE & TEENAGERS
This is probably the most frequently used comfort position for this age group.
Luckily we already know that holding a hand can help decrease stress for a procedure.
It's not rocket science, but sometimes we just forget to offer it.
Our teens' brave faces may be too brave to share that they need a hand, but they can benefit from one.
Let's say your teen is just such a teen and is way too cool to be touched, get serious!
Even allowing your teenager to sit up for a procedure (vs. laying down) promotes a more comfortable position in which the teen will feel more control and ownership over the experience.
Just remember to always be at the ready in case your teen surprises you and does a last minute freak out. It does happen!
COMFORT POSITIONING TAKES TIME AND PRACTICE BUT DON'T GIVE UP!
Please try using a comfort position at your next doctor's appointment and please let me know how it goes!
Remember that change takes time and practice.
The more you (and your medical professional) practice comfort positioning, the better you'll get at it.
Don't give up after your first attempt!
If one position doesn't work, try another one next time.
It takes trial and error to see what will work for your child and with children getting older and procedures varying it can make for various comfort positions to be explored when you approach each new situation!
Each experience will build your child's trust in you and decrease her fear for future situations!
I hope you quickly see the incredible difference that comfort positioning can make for a child undergoing a procedure!
Please check out the additional resources I have linked at the bottom of this post!
Many of them, especially the videos, are fantastic and can help you understand how to better implement comfort positioning.
Good luck all!
- Kara Kimball, CCLS
*DISCLAIMER: My posts are for educational purposes only and do not constitute professional medical advice.*
Additional Resources / Links to Other Websites
Intermountain Healthcare on Helping Children Cope with Procedures
Children's Mercy Kansas video!
Analgesic effect of 30% glucose, milk and non-nutritive sucking in neonates
Child Life Services: American Academy of Pediatrics Policy Statement
Evaluating Comfort Measures for Commonly Performed Painful Procedures in Pediatric Patients
Exploring Perspectives on Restraint During Medical Procedures in Paediatric Care: a qualitative interview study with nurses and physicians
Far From “Just a Poke”: Common Painful Needle Procedures and the Development of Needle Fear
Parental Holding and Positioning to Decrease IV Distress in Young Children: A Randomized Controlled Trial
Parents’ Positioning and Distracting Children During Venipuncture: Effects on Children’s Pain, Fear, and Distress
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
Using feeding to reduce pain during vaccination of formula-fed infants: a randomised controlled trial