Physical restraint on uncooperative children

GHGoonette, BSN, RN · Sep 12, 2010

Even if they could hold the child still, there would still be the problem of her muscles contracting too tightly. The danger exists of the needle snapping off in the muscle.

I find it easier to restrain them if it's into the buttock, but if the child fights too much, it becomes too much of a risk. Fortunately for me, all my patients are post-operative and are still fairly relaxed.

vlomankill · Sep 12, 2010

I've worked in a doctors office, you don't want the parents to hold the child, that is not their role, and yes children will kick in to the fight or flight mode, and become little incredible hulks. you can try to talk, an bribe the child, but even with babies, you may have to restrain them. As someone who has two disabled children, YES it can happen. my oldest required 7 male adults (very build) to have an injection to sedate him enough to start an IV to sedate him even more before they could do any procedures (they needed a et tube, foley, etc). my youngest receives her "special" juice and our therapy dog before any procedures. Age has nothing to do with strength when your scared. I'm just sorry for the little girl and the trauma she had to experience.

lifelearningrn, BSN, RN · Sep 12, 2010

I don't know of a 5 year old that doesn't have a needle phobia. In some ways, I think the child's natural instincts to fight (fight or flight) kick in and they have unbelievable strength and power.

I try to give my boys plenty of warning before shots so they are somewhat aware that they may need one. I personally think that works better than blindsiding them. (though I know that isn't always possible).

chloecatrn · Sep 12, 2010

I am 18 and just started my apprenticeship to become a medical secretary working for a pediatrician.
The other day i was talking to my colleague when she told me about a 5 year old girl who had to get a neccessary injection which she refused because she has needle phobia and 3 people tried to hold her down but they still could not get it done because the girl was raging and was unable to restrain.
Now i am wondering how can it be that 3 adults are unable to overpower a 5 year old girl.
I told my collegue that its hard to belive and that i think if i was with them i would just hold her tight with my arms
wrapped around her body and somebody only has to take her arm and get the shot done.
But she (my collegue) said that she was also surprised by that girl's strength and never experienced something like that before. And shes working there for over 20 years.
But i still find it hard to beleive.
Did anybody ever experienced something like this?

BWAHAHAHAHA. I've worked peds. I've seen it take four and five people to hold down a five year old for an insulin shot with a tiny little insulin syringe. Absolutely, I believe this. Small people are powerful when they are scared.

vamedic4, EMT-P · Sep 12, 2010

Children can be stronger than you ever believed possible, especially when presented with a percieved threat to their safety or anything they think is going to hurt them. We all know that shots are no big deal, but children don't have the experience that tells them that everything is going to be okay and it'll all be over in about 15 seconds...so they cry, scream, kick, bite, spit...anything they can do to get out of the situation.

You'd be amazed how kids can wriggle and squirm their way out of your grasp. It doesn't matter how many people hold them down, some of them still fight to get away. Working critical care peds, my job is to put IVs in little ones and there have been many times it's taken 3 or more to hold them down...and some of them were no more than 3 years old.

Mandychelle79, ASN, RN · Sep 12, 2010

It took 5 of us to hold down my dd when she was about 2 for an iv stick. 2 medics ( they work in our ER), my mom, my husband and me. And the nurse to start the IV. one per limb and one holding head. Youd be amazed by how strong kids can be. She was fine the next time.

Aleccandra · Sep 12, 2010

...there have been many times it's taken 3 or more to hold them down...and some of them were no more than 3 years old.

are you serious? 3 people for a 3 year old?

there is mo way i would let a 3 year old break free when i hold her/him tight.

i am 5.5 128lbs and not the strongest but a 3 year old...

GHGoonette, BSN, RN · Sep 12, 2010

are you serious? 3 people for a 3 year old?
there is mo way i would let a 3 year old break free when i hold her/him tight.
i am 5.5 128lbs and not the strongest but a 3 year old...

I have a particular hold which I apply when restraining a child for an injection in the gluteus maximus. However, that is in PACU, with nary a parent in sight. My experience is that children are more unmanageable when the parents are around. Just my :twocents:

kessadawn, BSN, RN · Sep 12, 2010

are you serious? 3 people for a 3 year old?
there is mo way i would let a 3 year old break free when i hold her/him tight.
i am 5.5 128lbs and not the strongest but a 3 year old...

Yes, a 3 year old. I've worked peds for 6 years, and I have seen MANY kids that require more than one adult to hold them safely. It's not just about pinning them down, it's about positioning them safely for whatever procedure they are about to undergo. I'll be the first to admit that I've been bested by a toddler, and I am not a weak woman. When a kid is terrified, they'll fight to the death. Imagine how hard you'd fight if some stranger was about to pin you down and stab you with a giant needle, and you had very little understanding of why it was being done, not that you would really care. You would fight with everything you have, and so do these little tykes.

kessadawn, BSN, RN · Sep 12, 2010

I have a particular hold which I apply when restraining a child for an injection in the gluteus maximus. However, that is in PACU, with nary a parent in sight. My experience is that children are more unmanageable when the parents are around. Just my

I agree that sometimes having the parents there is more detrimental than comforting for the child, especially if mom and dad can't keep their own fears and emotions in check. Things can spiral down very quickly then...

allnurses Guide · Sep 12, 2010

Some of the things in the story ring true yes, a 5 year could be strong enough that 3 adults would have trouble keeping a child motionless enough to give an injection in the proper place, but normally for a 5 year old an injection isn't given in the arm. An older child will very rarely consent to being stuck with a needle and pretty much 100% are fearful.

We would lay the child down on the exam table which works well to prevent their arms and legs from flying all over the place, or sometimes the parent could hold a small child on their lap. We gave lots of shots in the peds clinic, and never had a bad incident occur. Sometimes the parent would object to having their child restrained and tell us they have discussed the issue and the child is fine with it. Instinct always kicks in though and it's really unsafe to give the shot without knowing for certain ahead of time that they can't kick or pull their arm away.

I had a real close call with a 4 year old girl at a different job - that was when I didn't have co-workers to help - everyone was in a hurry and I let myself go ahead and give the shot with only the parents to help and the girl seeming calm -bad idea- the little thing broke loose with superhuman strength before I pulled the needle out and it almost broke off. That was after I'd been giving shots for years but just goes to reinforce the idea that when in doubt to wait and don't let the parents try to rush you.