How to "calm" down autistic pediatric patient?

CharleeFoxtrot, BSN, RN · Nov 6, 2019

This organization has a lot of good EBP information, it's a place to start learning more about this disease.

https://www.autismspeaks.org/

allnurses Guide · Nov 6, 2019

Autism is both sensory seeking and sensory avoiding. You will need to spend time with her without the iPad to get to know her. Then you will begin to find the things she enjoys doing, those which settle her, those which trigger her etc. I am alarmed at the idea of her spending your entire shift wrapped up in an iPad. She has a lot to offer the world and deserves someone who will invest in helping her. Please don't use a perpetual battery as a "solution". Get to know her and her condition. It won't be easy but it will be rewarding.

JadedCPN, BSN, RN · Nov 6, 2019

2 hours ago, Nurse SMS said:
.. I am alarmed at the idea of her spending your entire shift wrapped up in an iPad. She has a lot to offer the world and deserves someone who will invest in helping her...

THIS. I am glad I wasn't the only one who had this thought. There were several other concerning statements in the OPs post, including "I feel like the only time I have to myself to "relax" is when she takes a nap or is extremely busy in her iPad" and "refuse to stay in bed." Perhaps you didn't word them properly, but it comes across that you are just expecting an easy payday and that expectation is going to have a negative impact on the quality of care that girl receives.

You are there to do a job, not to "relax." I'm also concerned that you think she should stay in bed. Just because she is autistic does not mean that she should be forced to sit still in bed glued to her iPad. That is a lazy fix.

Autistic children are amazing and challenging to work with but it is extremely rewording. The previous poster put it perfectly when they said you need to actually spend time getting to know her to find out what she likes and what her triggers are. Then you will be able to figure out how to help calm her down.

carti, BSN, RN · Nov 6, 2019

5 hours ago, JadedCPN said:
THIS. I am glad I wasn't the only one who had this thought. There were several other concerning statements in the OPs post, including "I feel like the only time I have to myself to "relax" is when she takes a nap or is extremely busy in her iPad" and "refuse to stay in bed." Perhaps you didn't word them properly, but it comes across that you are just expecting an easy payday and that expectation is going to have a negative impact on the quality of care that girl receives.
You are there to do a job, not to "relax." I'm also concerned that you think she should stay in bed. Just because she is autistic does not mean that she should be forced to sit still in bed glued to her iPad. That is a lazy fix.
Autistic children are amazing and challenging to work with but it is extremely rewording. The previous poster put it perfectly when they said you need to actually spend time getting to know her to find out what she likes and what her triggers are. Then you will be able to figure out how to help calm her down.

I agree working with her is sometimes regarding such as when I help her count to 10 and she starts to smile so wide. But when I say that I like to "keep her in her bed", I say that for her safety.

I like her in her bed because

-she doesn't run/walk around and disconnect herself from her g-tube during feedings

-doesn't pull the curtains (she's broken 2 already since I've started working)

-doesn't grab expensive objects from the living room and throw them; or stuff in her room such as equipment.

-Grabs pens and draws uncontrollably on walls/tables

Nothing I'm doing is affecting her quality of care. I feed her on time, give her medications and I change her diaper frequently. But if she isn't on her iPad, she causes a huge mess and breaks things around the house. I just want something to keep her distracted. I can't act like a clown the entire shift and entertain her, she will eventually get bored. Even then, how do I "get" to know her? She has the mind of a 2 year old and she can't even talk. I am with her on the weekend only so there is no teachers, PT, OT or SLP's that day so I'm with her every second. I'm just confused about keeping her mind stimulated so she doesn't break stuff around the house and harm herself.

JadedCPN, BSN, RN · Nov 6, 2019

39 minutes ago, carti said:
I agree working with her is sometimes regarding such as when I help her count to 10 and she starts to smile so wide. But when I say that I like to "keep her in her bed", I say that for her safety.
I like her in her bed because
-she doesn't run/walk around and disconnect herself from her g-tube during feedings
-doesn't pull the curtains (she's broken 2 already since I've started working)
-doesn't grab expensive objects from the living room and throw them; or stuff in her room such as equipment.
-Grabs pens and draws uncontrollably on walls/tables
Nothing I'm doing is affecting her quality of care. I feed her on time, give her medications and I change her diaper frequently. But if she isn't on her iPad, she causes a huge mess and breaks things around the house. I just want something to keep her distracted. I can't act like a clown the entire shift and entertain her, she will eventually get bored. Even then, how do I "get" to know her? She has the mind of a 2 year old and she can't even talk. I am with her on the weekend only so there is no teachers, PT, OT or SLP's that day so I'm with her every second. I'm just confused about keeping her mind stimulated so she doesn't break stuff around the house and harm herself.

YOU are supposed to be what keeps her distracted. She shouldn't have to stay in bed just so she doesn't make a mess, just like a "regular" 2 year old isn't kept in bed the entire day simply so they don't mess things up.

Her parents should (in theory) be a good resource in regards to what keeps her stimulated appropriately. Otherwise you need to be inventive and creative, do research on the internet, find out from her other therapists what works for them.

Editorial Team / Moderator · Nov 7, 2019

My two-year-old knows her alphabet, can count from 1 to 20 and backwards from 10 to 1, and she talks in complete sentences. I realize your patient can't talk, but that certainly does not mean she cannot understand you, and it doesn't mean she can't communicate. You just have to take the time to figure out her language. Have you asked other staff or her parents how they handle her?

FolksBtrippin, BSN, RN · Nov 7, 2019

Risperidal is approved for autism agitation and works well for kids who get overwhelmed and self injure (headbanging) or have destructive meltdowns. It sounds like this might not be the case for your patient, but keep it in mind.

You will need to experiment a bit with sensory input. Try to find out what is alluring about pulling down the curtains. Does she wrap herself in the curtains? Put them on her face? Get her similar fabric that she can play with, and bring it to her when she goes near the curtains to redirect.

Keep pens and large pads of paper for her to draw on, or put white boards up on the walls.

Take note of triggers. Check your notes for clues. Are the troubling behaviors happening when she's wet? Hungry? Look for sensory triggers.

Self care is important too. Don't feel bad for needing to relax sometimes. When you get to know her really well you will be able to relax when she is relaxed, and you will be able to anticipate those times better.

allnurses Guide · Nov 8, 2019

I second all of the above. Talk to the parents about putting away the expensive breakable things or providing some other safe space to hang out with her. If she is like a two year old then the house needs to be childproofed for a two year old.

You get to know her by spending time with her and experimenting with different types of activities. Does water calm her down? It does frequently for those with sensory disorders. My oldest son was autistic. When he would melt down, a warm damp washcloth stroked gently over his face took the wind out of his sails and helped him get himself back.

I will be honest. This is going to be a very tough job at first and it is going to be exhausting until you begin to build a relationship with her. She isn't an animal and you must NOT let yourself think of her as a series of tasks you have to accomplish. Yes, you will definitely need downtime, but you won't do right by her if you seek to maximize your downtime. Definitely do some soul searching as to whether you feel you are up for this job. There would be no shame in admitting this isn't your cup of tea.

JKL33 · Nov 8, 2019

On 11/6/2019 at 3:28 PM, carti said:
I like her in her bed because [....]

You can't keep her in her bed nor on her iPad as much as humanly possible. Those things are inappropriate (understanding that they may not have been introduced by you). She should have a therapeutic care plan developed by her team.

3 hours ago, Nurse SMS said:
There would be no shame in admitting this isn't your cup of tea.

Glad you wrote this and surprised it didn't come up earlier.

This child is being done no favors by having caregivers who are not prepared, and this is beyond basic nursing preparation. Additionally it seems negligent to not have a detailed interdisciplinary care plan at baseline (if that is indeed the case).

I think this thread was a little rough on the OP.

Daisy Joyce · Nov 8, 2019

Twelve hours is a long stretch to go without a break, especially when you have responsibilities and no authority.

That being said, you have an opportunity to be a positive force in this child’s life, look at it as a chance to learn from each other. Like people upthread said, find out everything you can about relating to persons with autism, and experiment until you find a routine that works well for you and kiddo.

carti, BSN, RN · Nov 8, 2019

8 hours ago, JKL33 said:
You can't keep her in her bed nor on her iPad as much as humanly possible. Those things are inappropriate (understanding that they may not have been introduced by you). She should have a therapeutic care plan developed by her team.
Glad you wrote this and surprised it didn't come up earlier.
This child is being done no favors by having caregivers who are not prepared, and this is beyond basic nursing preparation. Additionally it seems negligent to not have a detailed interdisciplinary care plan at baseline (if that is indeed the case).
I think this thread was a little rough on the OP.

The only "plan" I was given when I took the job was to give her meds and do your best not to get burnt out by the little girl lol. I only had 1 shadow shift and the nurse I was paired up with told me as long as her Ipad is charged, the shift should go pretty well; it is when it dies that it gets hard. That day, it wasn't that bad because there was 2 nurses in the room however (I obviously got to do all the dirty work lol).

It isn't my cup of tea but I really need this job so I'm going to stick it out. Besides, I was even offered more shifts because another day shift nurse already quit the case. The family is ran by a single mother (who is at work 24/7) and a bunch of the patients young siblings and little cousins so I can't really quit on the child.

I rarely see the mother as it is because I'm only there for a little bit each week but when I do see her, I will ask how she keeps her controlled that was a very good idea. Or her siblings. This weekend shall be fun..