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When using nonpharmacological pain management techniques with children, consider the age of the child and his or her temperament, advises Lori Schweighardt, CCLS, a child life specialist at Phoenix Children’s Hospital. "The techniques need to be individualized; so it’s important to work with the patient and family to find out what is going to work best in a particular situation," she explains.
Talk to the parents to find out if the child has had any painful experiences, or has even been sick in the past and what worked then. He or she may be the type of child who wants to be left alone with the lights off when in pain. On the other hand, the child may want to listen to music and have a foot massage from Mom, which is more of a distraction technique. "If the child is old enough, you can ask him or her questions about pain management," says Schweighardt.
It is important to determine what type of personality a child has when determining the best way to help him or her cope with pain, agrees Chris Brown, MS, CCLS, director of child life and education at The Children’s Hospital of Philadelphia. "We can start to assess children as young as toddlers to determine what type of personality a child has, whether really curious or fairly distractible," she says. If a child is curious, they are better off during a procedure if allowed to look at what is happening and play with the stethoscope or a cotton swab.
Whenever possible, it is good to rehearse the nonpharmacological pain management or coping technique ahead of time. It’s also important to involve children in the planning stages so that they buy into the technique and actually do it during a painful procedure or if in pain, says Schweighardt.
Talk about what will happen during the procedure so the child has an appropriate understanding, then talk about ways to make the procedure a little easier. "I ask children what they would like to do while we are doing the IV, and some will know and some won’t. If not, I offer some suggestions, such as reading a book or blowing bubbles, to generate some ideas."
Schweighardt encourages the children to choose several options vs. one technique. For example, they might want to squeeze Mom’s hand or bring along a favorite stuffed animal. "We find that kids in hospitals feel like they don’t have control, so we give them choices whenever we can so they get some of their control back," she says.
No matter which pain control technique children want to use, it must be age-appropriate. For example, if deep breathing is used to help a child relax and ease pain, it would be tailored to the age of the child. A 1-year-old would not understand a verbal instruction to take a deep breath, but would copy a parent or child life specialist. "They can do a lot of modeling for that child about blowing out so he or she can imitate them," says Schweighardt. Blowing bubbles is a nice way to get children to take nice deep breaths. (For examples of age appropriate nonpharmacological pain techniques, see "From infancy to teens, pain control is possible," in this issue.)
Even with practice, the techniques may not always work during the stress of the actual procedure, so it’s important to be prepared to try something else. For example, if deep breathing is not working, tell a story, says Schweighardt. It’s also important to make sure that the parents are involved in the training so that they can help with the child. "Parents can be a calming effect, plus we want them to be part of a child’s care," she says. In addition, they will be able to use the techniques in future medical situations, such as when their child is being immunized.
However, a child cannot always be prepared for a painful incident. In an emergency situation, it often helps to just give a child information on what is happening in a calm voice. "There is always a place for nonpharmacological pain techniques. It can be in the form of a calming voice telling the child what is happening. Lack of information is a big part of fear which can really add to the pain," says Schweighardt.
For more information about nonpharmacological pain-control methods for children, contact: