Elbow Restraints for In Home Use

[AliceKay]

Hi there:

I am extremely upset right now! I am 12 weeks away from graduating from my PN program and have just completed 3 months of Peds clinical rounds. A very good friend of mine has a 5 year old child with CP. He was a 24.5 week preemie, is (of course) wheelchair bound, requires a trach, is completely deaf (without his cochlear implant), and is nearly blind. He has severe developmental delay and is non verbal.

Recently, this child has begun playing the game of "Pull out the trach", because he knows it will ALWAYS get somebody to come running. He thinks it's HILARIOUS, at first. A couple of days ago his mother had a very difficult time getting his trach back in and she and Patton were both traumatized by the experience, as you can well imagine. This, of course, did not correct his behavior. She posted something about it on facebook, and I suggested that she ask her doctor about elbow restraints. Note the fact that I said "ask your doctor" and not "go out and buy them". The thing that has me so ticked off is that another friend of hers, with zero experience with special needs children, and zero medical training thinks that the internet has all of the answers and is telling my friend that the internet says that elbow restraints are a no no. My response to that was that pulling a trach out is a BIGGER no no and that if used, intermittently (under a doctors supervision), it could prove to make life much safer for Patton and much saner for his parents. Not a cure all forever.. but, just until he gets past this phase that he's going through, and just for part of the day.

Is there anybody here with an actual license who disagrees with me? If I am wrong I would really like to know, and understand the rationale behind it. Thanks so much, and sorry for being so long winded. I love this child and, simply, want to help him and his family. :heartbeat

[traumaRUs, MSN, APRN]

I think this is treading into too much information.

I sincerely hope that Patton is not the real name of the child.

All we can advise is that you tell the pts mother to see her provider.

[AliceKay]

I think this is treading into too much information.

I sincerely hope that Patton is not the real name of the child.

All we can advise is that you tell the pts mother to see her provider.

This family are friends of 20+ years and have never.... ever.. been in a professional relationship with me. This child is not a patient of mine.. but, very nearly a member of my own family. I would never divulge that kind of information about a patient.

[NRSKarenRN, BSN, RN]

instead of restraints, alternative could be padded mittens ---allows child to use fingers inside but blocks ability to pull -- used at bedtime with peds "trach pullers".. daytime, keep hands occupied with ringed toys in their hand, cloth books, etc.

if child has ot involved in care, would ask them for recomendations.

great website for parents advice carying for child with trach is: aaron's tracheostomy page

[sams76]

Here is a site for your friend to check out for modified appliances for children and adults who need to keep their hands away from their trachs or ET tubes. http://www.customsolutions.us/adaptatray/Arm%20Cuff%20Instructions.htm; Good luck with your studies and God bless your friends for trying to maintain the care of their child in a home enviroment. My father was on a vent for six months prior to his death and he had to be restrained at times. We also used rolled up wash clothes in his hands as he would grasp them. as long as he didn't work them out it bought us enough time to maybe eat or shower. While it is easy for a nurse to take care of of a patient like this with back up on the floor so we can eat and use the bathroom; it is very difficult for a family, even trained to relax. This is one of the main reasons that couples end up divorced, due to stress. This family needs suggestions, and she does not need the HIPPA law reminder! What happens to "Patton" if his mother is unable to get the trach inserted back in? She is not talking vent tube but trach. Ever try to insert one if you don't know what your doing and scared at the same time? Not fun.

[Flare, ASN, BSN]

I don't necessarily disagree with the use of elbow restraints (snuggle wraps as one company so delicately puts it!). If mom needs to shower or needs 20 minutes to cook dinner - i'd be afraid that a child with such limited senses would react poorly to having motion restricted.

Like the op said, hopefully this is just a phase and he will grow out of it - but in the mean time, and for short term usage when the child can't be monitored (i.e. mom's shower) it may be appropriate. It is certainly not the first time someone's looked to deter unwanted behavior by limiting range of motion of a DD child.

[sams76]

thanks for the additional tip, will pass it on to another friend who is dealing with a smaller child. I am concerned that some are not reading this childs disabilities before they berate her for asking. this is a five yr old child who just now discovered his trach? I am not sure if this behavior can be corrected with his disability per the decription. I unfortunately live in an area where there are swimming pools in every other yard. It is nice for the public when they say the child was revived after being under for a certain amount of time, but what they get back is nothing near their child. We have a facility that is nothing but kids who parents are unable to tend to them, most "drowning" victims. Is a hard place to work both physically and emotionally. Before someone rips into a person for asking for help, they need to place themselves in their shoes for one day. Is not as easy as it seems.