Dealing with pediatric patients

RNsarahj · Apr 12, 2015

You're right in saying that no method of soothing/comfort is going to work 100% of the time and that's okay.

I usually start by asking the parents what does best to soothe them- parents know best! I usually don't lie to them either but I will give a non-descript answer. Like if someone asks me if a medicine tastes bad I'll tell them "Why don't you try it and let me know what you think?" If it's a teenager or an older kid that clearly knows I'm BSing them, I'll say basically what you said above- "it doesn't taste the best but I have juice right here."

Explaining procedures: depends on the age of the child- school age I might depending on their developmental status but I typically wait till right before and explain it simply- same for toddlers. Older kids, I'll explain it in more detail. If your new place has access to Child Life Specialists, these can be excellent resources to help prep kids for procedural type things (they often have stuffed animals that they can practice change a dressing on etc.)

As far as soothing kids you just do your best. If possible, I'll let the parent hold them, or at the very least be right in front of their face soothing them (stroking their hair, talking to them etc.). Distraction can be your best friend with school age and older kids (ask about their pets their favorite color... just get them talking!) Older kids I'll do breathing techniques or even some guided imagery and depending on the kid it will work great. But like I said, sometimes there is just no way to calm them down and it's not your fault- a lot is parent dependent too. Parents can be your greatest asset or your worst enemy and there's no way around it. I had a 12 year old almost sprint out of the room yesterday before we put an IV in her- there was nothing to calm her down and eventually we just had to hold her down and do it- just remember that you're not being mean, you're helping them feel better and get the heck out of the hospital.

I hope this helps. Don't be nervous! You'll learn a lot as you go along- pay attention to what different parents and nurses do and you'll eventually develop your own "tool kit" of methods. Good luck!

JimmyDurham9 · Apr 12, 2015

Thank you for your advice and words of encouragement! I've found I do best with school age kids because I find it easy to be silly and banter with them. I tended to take more of an authoritative role with adolescents, particularly when I would have to literally chase some of them around the exam room to administered a vaccine or get a strep swab. I've also had adults behave like that, but at least then I have the option to say " You know what? We're not doing this. You obviously don't want this treatment, and you have every right to refuse."

Kids are different because whether they like it or not, if the parent says go, then we have to do it. I don't have a problem with powering through with a screaming kid because I know what we're doing is in their best interest, but I'd like to mitigate the experience for them.

KelRN215, BSN, RN · Apr 12, 2015

It's trial and error for some kids. When you find something that works, go with it.

Last year I had a 7 year old with cancer who was incredibly behavioral and would flip out with everything. A lab draw from his PICC line was just as bad as a dressing change. Then he had a port placed. It was the easiest port I've ever accessed in my life and he never had anyone miss or anything like that. He was so uncooperative that after several failed attempts at reasoning with him, we just started holding him down to do it.

THEN, one day I saw him at his Dad's house. He was a different child. He took his shirt off, sat still and kept playing video games while I accessed him. After he cooperated like this twice there, I made him shake my hand and say that he would do the same the next time we did it at his Mom's house. The next time I went to Mom's house, he was playing with his iPad when I got there. Mom tried to tell him he needed to put it away and come in the other room, which caused him to escalate. Then she started threatening to take it away from him for the rest of the day. (He knew that was an empty threat, so that didn't help.) When I reminded him that we had made a deal- which his aunt and grandmother had witnessed- that he would cooperate at his mother's house and told him that he could keep playing while I accessed him, he was fine.

Some parents are incredibly helpful, others not so much. I deal with parents all the time who have no idea how to deal with children at all, their own or otherwise.

enuf_already · Apr 12, 2015

Agree with everything RNsarahj had to say, especially about utilizing child life if you have them available.

I also believe in being honest with kids. If something, like a shot, is going to hurt, I tell them they will feel an owie/sting (developmentally appropriate term) for a second, but I'll make it really quick and we'll be done.

Some facilities have procedures done in a procedure room so the child's room stays a 'safe place' where no medical procedures are performed. Things like vitals are okay, but blood draws, IV insertions, LPs, etc. are done in a procedure room.

Use kid friendly terminology.

B/P=giving a child's arm a hug. Parents with chronically ill children can tell you what works with their kids so don't try to reinvent the wheel. Just ask because they are always happy when someone recognizes them as part of their child's team.

It sounds like you are already on the right track. Good luck in your new job!

Pediatric Critical Care Columnist · Apr 12, 2015

There's not a lot I can add to what you've already been told. Honesty is the best policy, of course. The first time you downplay something that really hurts you've lost that kid's trust forever. I will tell kids from about 4 years old and up, "I promise you I will never do anything that will hurt without warning you first. So if I touch you and I haven't said it's going to hurt, you don't have to worry."

I also offer them choices, which lets them feel like they have some control. "Your central line dressing needs to be changed. Should we do it now or after breakfast? BP on your right arm or your left arm? Meds with water or juice? Do you want me to do it or do you want Mom?" Be really careful how you word things. Any time you imply a choice, be prepared for them to choose. I hear so many people say things like, "I'm going to give you your enoxaparin now, okay?" Well, what if the kid says it's not okay? And you do it anyway? Two strikes.

Of course time management is important, but you'll find working on a peds ward quite different from the primary care clinic. It's not like the provider still has 15 patients to see before the end of the day so don't spare any extra seconds for anything. You'll have a list of things you need to get done, but there's some flexibility in when and how they all get done. If it takes a little longer to get a kid to cooperate with something, you might be able to make the time up elsewhere. As the others have said, if you make the parent(s) you ally, you can enlist their help when you need to. Because they are the best resource you have.

Best advice? Have fun!

ceebeejay · Apr 13, 2015

Choices! Yes, choices! And, everything else said. Good luck to you. I am sure you will do well, because you are already invested and care.

~PedsRN~, BSN, RN · Apr 14, 2015

There will be times you have to be the bad guy, and it's best that you accept this going in. You will, at some point in the very near future, have to solicit help from two or three teammates to hold the screaming three year old down to put in an NG tube. Or a foley. Or an IV. Some things will not be open to choices or negotiations. I always tell my little people the truth, how to make things work better, if something will hurt, etc. But I also tell them that sometimes the ouchy stuff I have to do is just to help them get better. It's a hard truth. Not everything will be rainbows and kittens.

You will stick a kid one night four times trying to get in an IV and you will fail. You will fail, another nurse will fail, IV team will fail... The parents will hate you, the kid will think you are the devil, and you will have to stick this kid as many times as you have to because he needs something stat. You will end up begging a NICU nurse to throw you a bone and they will come in and slap an IV in a kids scalp on try six. Believe me, by try 6 there is an army of people holding down a screaming kid.

You'll find your groove sooner than later. :) Kids are awesome and resilient and FORGIVING. My little guy that I held down to deep suction last night (his O2 was 85 and he was full of the crud at 3am) who HATED MY FACE at that moment... gave me a huge and a high five on my way out the door this morning.

LoveMyBugs, BSN, CNA, RN · Apr 24, 2015

If you have child life, find them follow them around for a shift! They are amazing. I have started IVs on 3 year olds who didn't have to be held down because child life does an amazing job at distraction.

Bubbles, magical bubbles I keep some on me and when I 1st enter the room I start by blowing bubbles while I ask parents questions.

Then slowly move closer to the child let the kiddo blow bubbles while I assess them.

Distract, distract, distract, then reward. Stickers, books, juice, bubbles, some kids you won't win over and that's okay. Always be honest using terms they understand.

Use the parents to soothe.

A lot of times I tell parents, we are going to do this ..... When we we are done you rescue him from us. With a lot of hugs and cuddles