Restraining Children

When I worked in ER it was a "joint" decision. The parents did have some say in what we would do, but we also had to discuss the possibility of "convincing" them of the way it WAS GOING to happen. :uhoh21:

As for assault, if the parents are in agreement I don't know if that's even an issue here in the states. You're doing it for the child's betterment and most times they cannot comprehend that.

As for waiting... if you're doing sutures you can't wait until the next day. For the most part 6 hours was our limit. If it had been longer than that they wouldn't do it. You wait until the next day they don't get sutures.

We did use a blanket and papoose them. Sometimes we even wrapped them and taped them. We also had a board that we could use. I certainly don't think it's "crue" or even "harsh". They need the treatment (these wren't used for "iffy" cases) and somehow it has to be done.

As for the parent holding them, most of the times that's a big no no. In nursing school we were taught that if you let a parent hold the child they can look the parent like "why would YOU do this to me". We even talked about having parents wait outside for really invasive procedures so that teh child wasn't thinking "why would YOU let them do this to me". After the procedure the parent comes in and is the hero becuase everything stops.

The only times I have really had to work with children was in my ER preceptorship. I had a few...and different ways of getting treatment to them based on individual basis, age (cognitive and physical), and the treatment itself.

One child was near 4 and ate some of grandma's heart medications. It was a very serious matter in getting that out! He drank the mucomist just fine with help from mom...but I know mom wouldn't be able to handle hold them while a nasogastric tube was inserted...which she admitted was way to much for even her. The authorization to put him on a papoose board (a board that has soft restraints to hold a child in), and we did the procedure. Because of the nature of the medication he took, we could not trust sedatives at this time...he did quite well even though yes..he was scared and crying...which I held his hand and told him I was there for him (I was with him 6 hours anyway...best I be the one to hold his hand.). Sucess and pt got to go home that evening.

Second case...young boy about 10 had a HUGE laceration on his thigh from jumping a fence at home. He was actually put under conscious sedation and that worked out great...no need for restraints. Parents were there to hold his hand and it was very nice.

Third was a young girl who suffered a large bite from a dog in her face. She screamed and clawed RN's and MD's trying to clean the wounds which were found to be too extensive and bone damaged to not treat and would require surgery. However, she would have to be transported to another hospital for a surgeon that could do it. We had to clean those wound and patch her up to a point so she wouldn't suffer bleeding, infection, pain, and further damage. Again, parents were consulted and the use of a papoose board was used and she was mended well enough to travel via ambulance to the surgeon.

Typically what I find is it depends on the patient and the urgency of the treatment. And we all try our best only to use those restraints during the immediate treatment then get them the heck out of them! But we do not put kids in restraints unless it is necessary, and we try to get the parents agreement first, if we absolutely can not get a hold of the parents or relatives we are basically by law allowed to make choices for minor children in their best intrests...and we are very cautious about that...that is a lawsuit about to happen (even if everything is 100% right with a good outcome...crazy folks out there).

Ive just come back from a Peadiatric Study Day for Accident and Emergency.

- The Tutor on the Course said when she worked in the USA 5 years ago... it was common practice in ERS to put children in Restraining jackets before doing anything invasive such as Suturing heads etc

In UK we get the child wrapped up in a blanket by its parant - or give the child a mild sedative OR get the child to come back the next day when they are in a better mood.

Does the above mentioned practice still go on in USA?

Is it only happening in some States and not others?

How do you stand legally? - As it would be considered an Assault if you did this here.

Im not critisizing here ... its just we in the class were all genuinly shocked when we heard this. I just wanted it clarified

OK, well to begin with I am not terribly in favor of restraints but...

Wrapping a child in a blanket is a full body restraint. Additionally, having a parent physically restrain a child is shown by research to violate the child psychologically as it perceives the parents to be a) physically restraining him/her and b) willingly exposing him/her to a painful experience and thus a complete breech of the parent/child trust bond.

I really don't perceive your practice to be any different, after all you are physically restraining the patient except you are having the parents do it which still carries all the trauma of not being able to move. Clearly there are circumstances where "coming back the next day" is not an option. If the injury is in fact an emergency, in fact, it does not qualify for coming back the next day.