How do you deal with a crying child?

[bambam1288]

i am a nursing student and don't have children of my own so i have no clue on how to clam a child down so i can inspect wounds. i have a child who crying and moving her arms and legs. she won't let me come near her, let alone clean her wounds. what are some good methods that allow me to comfort her enough to inspect and clean her wounds? my attempts have failed please help!

[J9G2008]

I don't think much you do is going to convince a child to allow you to clean/pack wounds. When my son was in the hospital, his nurse would always bring someone else with her to hold down his arms/legs/whatever was flailing. I used to help hold him down, but after a while I stopped doing that...he needed to know his mom was on his side and wouldn't help hurt him.

[RNnik07]

As a pediatric nurse I know exactly what you mean! Unfortunately to be able to do your job you do sometimes need to bring in another set of hands to help hold the child. Sometimes when the parents get involved it makes it a bit easier because it's mom/dad helping to hold them still, not a stranger. I also have used stickers, they do work to put a smile on their face. At the hospital I work at they have packages filled with a stuffed animal, coloring book, crayons, etc. so when a child is really upset about something (putting in an IV, cleaning a wound, etc.) we give that to the child when it is all over to help them calm down and to not be so upset. I hope some of those tips help. I think also explaining yourself (not in too much detail) before doing anything makes it easier!!

Good luck!

[cookienay]

No child is going to "let" you do anything. As the above poster said...bring some muscle with you, have them help hold. THen assess and inspect away. Remember two things: First, you are the nurse, they are a child- you know this is for their own good. Second: no child ever died from crying.

btw...these two rules can be applied to parenthood as well. :)

Good luck!!

[tewdles, RN]

Remember that your interactions with children need to be age appropriate, so...when you say "child" do you mean infant, or toddler, or school aged? The tools and strategies you would use with an infant would be distinctly different from the approach which would most likely work with a school aged patient. Review the stages of development and then apply them to your patients. Pick the brains of your more "experienced" peers. One of the tidbits of wisdom I learned from my PICU preceptor back in the day...."tell them what you are going to do, DO NOT EVER ASK THE CHILD FOR PERMISSION TO COMPLETE AN UNCOMFORTABLE TASK". (they will always say...uh, no...where's my mom? with or without using words)

[bambam1288]

she is a 3year old

[tewdles, RN]

For this age keep in mind that fear may begin to play a part in their ability to relate to you and an unfamiliar world. If you can get to a happy place with the child you may be able to pique her growing sense of curiosity about bodies in general and hers in particular.

Do not mislead her about comfort...if what you are going to do will be unpleasant, do not forecast this in advance, but do be honest at time of ouchie.

Be aware that the cries of a child will generally be exacerbated by any frustration or irritation which you convey....try to maintain a calm and pleasant tone of voice throughout. I often sang simple children's songs during blood draw and dressing change procedures, etc. That helped others in the room to keep their "game face" and "inside voice" ever present.

Bottom line...wound assessment on this age group generally requires the efforts of more than one determined adult...or versed. (joking)

good luck!

[leslie :-D]

Do not mislead her about comfort...if what you are going to do will be unpleasant, do not forecast this in advance, but do be honest at time of ouchie.

i am BIG on being truthful with everyone, but esp with children.

i did pedi hospice for awhile, and boy, was i challenged with questions by my kids.

but ultimately, kids sense integrity, w/o even knowing what it is.

they just know.

and yes, i will bribe if able, i.e., i will get you ________ when this is all over.

that was often a consolation.

you just need to do whatever it takes, without losing the child's trust.

leslie

[Purple_Scrubs, BSN, RN]

Not that this is helpful in your situation with a 3 year old, but maybe for other scenerios. If it is an older child and a minor wound (I'm a school nurse and thankfully most of the wounds I see are minor), let the child do as much as possible him/herself. I let them apply the wound cleanser themselves because as much as I tell them it won't burn, they don't believe it because the parents may have cleansed wounds with alcohol before. Once they dab at it a little, then I take a new gauze/cleanser and tell them "let me help get the germs out". Never fails.

As far as inspection/assessment, act like you are impressed with the wound and they will want to show it off to you.

Me: Hi Sammy, I hear you have a reallly big bo-bo on your leg.

Sammy: *nods*

Me: Wow, I wonder if it is the biggest I have ever seen? I want to see your bo-bo! (Notice I did not ask "can I see your bo-bo", the response will always be no, LOL!)

Sammy: points to dressing on leg

Me: That sure looks like a big one. I'm going to take off this bandage so I can see how big it really is...

You might still need more muscle in there, but for me it is worth a shot at doing it in the least traumatic way possible.

Also, praise, praise, praise. Even if the kid is raising ten kinds of heck and trying to bite you or pull out your hair, PRAISE the heck out of them.

[Flare, ASN, BSN]

I work as a school nurse -for my kindergarteners who come in hysterical it's important to calm them to get to the root of the problem. I always tell them that i can't start helping them until they clam down and tell me what is wrong. Then I lead them in a couple of deep breaths and tell them exactly what i'm going to do. works like a charm every time - though a younger child may need to be restrained.

[Virgo_RN, BSN, RN]

A three year old is going to need to be sedated or restrained.

[VICEDRN, BSN, RN]

As a mother of a young child (and one big kid), I just wanted to add my two cents. Please know that under ordinary circumstances you may be able to calm this child down. She may soothe easily. She may distract easily.

However, the child is on to the "game." She knows what you are there to do and she knows that it hurts. Do both of you a favor: do it quickly, with empathy but not apologetically and offer a comfort or reward after. (I am not saying not to pre-medicate for pain, etc. I just mean try to help her forget after). DO NOT hesitate. 3 year olds will see that telegraphed in your face. Like everybody, anticipation is worse than reality. The good news is that they move on quickly.

Try to remind the child of the small reward you have brought (even kicking and screaming). "We are half finished and then you can look at this book I brought from the playroom!"

Good luck out there. You didn't fail at anything! You just learned that 3 year olds are super smart! :loveya: