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.
Why? What is the difference between a painful outpatient procedure and a painful inpatient procedure? He had 10/10 pain with the last set and screamed for 15 minutes straight. No need to subject him to that. One time dose prior to procedure.
The dangers of the medication outweigh the benefits. For example, a benzo sedates a child for at least a couple hours, and does not blunt the feeling of pain. An EMLA patch might be more appropriate, or having a syrup covered pacifier to help him calm quickly.
Why? What is the difference between a painful outpatient procedure and a painful inpatient procedure? He had 10/10 pain with the last set and screamed for 15 minutes straight. No need to subject him to that. One time dose prior to procedure.
OK, a paragraph with a 6-month old ... the numerical pain scale ... and benzo administration before vaccines ...
this is a completely ridiculous hijacking of the OP's thread.
News flash ... it was MOM who couldn't handle it, not the kiddo.
i only worked with adults and teens as rn, but have a lifetime of experience as a patient. i am the only surviving triplet, born at 29 weeks gestation. i weighed 3#. at 13 months, the first of four aneurysms ruptured. i had many procedures regularly that i hated, but by the time i was three, i held still. i was fine because we reheorificed every single procedure that would be done on me on my
panda bear over and over until i was comfortable with the idea. i also knew that if i held still and was
good, i'd get a surprise when it was over. if i didn't, no punishment, but no reward either.
my mom told me i could yell or scream all i wanted or needed to but i must hold still. she was always there by my side for any test or exam where i was awake, and that made all the difference for me. staff sometimes objected to her being there, but that was not negotiable. she would be there and i could squeeze her hand if i panicked or if it hurt.
before mris, ct scans, etc. the neuro exams were obnoxious from the patient's pov and there was this stupid theory that babies and little kids didn't perceive pain as acutely as adults, so no anesthesia much of the time. my comment as a former child? against tos to type it here!
this thread is about restraint of babies, toddlers, and smaller children, but if an older child says she will not let ___ draw blood or start an iv, but will let anyone else do it, please please please listen to her! i remember one lab tech who could have done as well with the side of a rusty tin can as she did with a needle.
i do not disagree with holding some kids, just with automatic restraint of all children.
ok... i'm wrapped in my bubble wrap with my suit of armour on top!
I agree that children that have been in the hospital a lot tend to be better at going through these procedures. Sad but true. No 3 year old (or any age) should know to ask to help flush her port or help take her temp and BP. But most kids are acutely sick and haven't had these procedures. I never sneak up on a kid and I explain everything before I do it. I also tell them they can scream all they want but that I need them to hold still. Parents make a big difference. If the parent's are an obvious detriment due to their own anxiety I ask them to leave the room (which majority of them gladly do).
Again, we do as much as we can to make the situation quick and as pain-free/stress-free as possible. And there is always the toy closet visit afterwards.
Oh and for parents....Don't ever tell the kid that "the mean nurse is going to stick you with a big needle if you don't behave (or insert whatever the parent wants the kid to do....go to bed, eat their food, etc)" (I scold the parents in front of the kid for that one) or (as we get ready for a procedure) that it will be "only one little poke and then you'll never have to get poked again." I can't promise that so you aren't allowed to either.
Sharpiemom, I hate that everyone used to believe that infants (and young kids) didn't "feel" or remember pain. I remember being horrified when I was a student and saw a PICC line started on an infant in NICU with no topical pain control. It was also as a student that I saw some presentations on pain that helped support my feelings that pain control should be offered to everyone regardless of age. There are some recent and wonderful studies that follow children that did and did not get pain control in the NICU. They showed that the ones that did not receive pain control had a lower tolerance for pain the rest of their lives. That attitude is changing and pain control is big for us. I don't work NICU but I am hoping that this is changing in their practice as well.
Specializes in Certified Med/Surg tele, and other stuff.
My special needs child fights like Hell is on her heels for any procedure. It takes a few of us to hold her down (safely). She fights so hard the second the shot, etc.. is over she immediately goes the other way and has a syncopal episode.
I work in a peds ER and for IV starts and injections, it's pretty routine to have one person along to help hold. After a certain age, you can explain that the needle is so that we can help them, that we need them to hold still in order to get it in, that the needle comes out quickly and that only a "little straw" is left. On kids of borderline age I ask if they want someone in to "help them stay still" or just say "this is Nurse X/Medic Y, she/he is going to help you stay still".
In most cases, one other person is enough to get the needle in and get the IV secured (we call our boards "pillows" in front of the patients and explain that they are to help keep their IV safe). IME, multiple people are usually needed for sutures, and even if we do give oral benzos sometimes in those cases (we use them sparingly and they wouldn't be on the table for a set of booster shots), sutures take a long time and for everyone's safety (including the patient's- where does that suture needle lodge when they flail out while getting a facial lac stitched?) it is still important to have multiple people in there.
We have a child life department that is not always available but when they are they are a great help, talking the child through whatever procedure and doing distraction therapy with books and games. We also tell the parents that if they want to step outside during the procedure and come in when it's done and be the savior, that is fine.
We use needles sparingly- we don't do routine IVs- there has to be a reason the child has to have one and "just in case" isn't reason enough unless the patient is very sick.
AmyS123: your child can sense your fear and misgivings. Rather than drug your baby so YOU can't see the pain, soothe and comfort him, offer him his pacifier if he takes one, speak gently, pat his back. Do some research on non-pharmacological pain management techniques in infants. Benzos are for anxiety, and at his age he's not reacting to fear of the needle but the actual pain, so consider your motivations in requesting unnecessary and ineffective drugs from your doctor.
there are some recent and wonderful studies that follow children that did and did not get pain control in the nicu. they showed that the ones that did not receive pain control had a lower tolerance for pain the rest of their lives.
and, hence, the reason i go to our neighbor and friend, a pediatric dentist...
it really helps me a lot if i can sit up while some procedures are done. for example, when i get cortisone shots in my knee, i sit, whereas most of his other patients lie down. if i said it hurts
AmyS123: your child can sense your fear and misgivings. Rather than drug your baby so YOU can't see the pain, soothe and comfort him, offer him his pacifier if he takes one, speak gently, pat his back. Do some research on non-pharmacological pain management techniques in infants. Benzos are for anxiety, and at his age he's not reacting to fear of the needle but the actual pain, so consider your motivations in requesting unnecessary and ineffective drugs from your doctor.
Why? What is the difference between a painful outpatient procedure and a painful inpatient procedure? He had 10/10 pain with the last set and screamed for 15 minutes straight. No need to subject him to that. One time dose prior to procedure.
What about the sedation of the baby? The chance of aspirating for hours after a 10 second (if someone is SLOW) shot? The great thing about babies is they don't remember this stuff.... aspirating and ending up with anoxic encephalopathy will also help with not remembering .... if your pediatrician goes for this, he/she is nuts.
The great thing about babies is they don't remember this stuff.... aspirating and ending up with anoxic encephalopathy will also help with not remembering .... if your pediatrician goes for this, he/she is nuts. 
canoehead, BSN, RN
6,909 Posts
The dangers of the medication outweigh the benefits. For example, a benzo sedates a child for at least a couple hours, and does not blunt the feeling of pain. An EMLA patch might be more appropriate, or having a syrup covered pacifier to help him calm quickly.