Tips for working with children

meanmaryjean, DNP, RN · Nov 12, 2016

Do not EVER lie to a child. Sometimes, the things we must do as nurses for the patient's own good, are painful. No getting around that. Don't lie and say it will not hurt as you will destroy not only trust of you but of every nurse following you.

CryssyD · Nov 13, 2016

Smile a lot, and touch a lot. Tell your little patients that there's going to be an owwie, and we are going to see who can yell louder, you or me. Recruit parents into doing the dirty work--"Mommy is going to hold your arm so the straw can get into your vein." Make a bargain--"If you let me take your temperature, I'll turn on the video."

Julius Seizure · Nov 13, 2016

Never offer them a choice when there really isn't one. For example, don't say "is it okay if I take your blood pressure now?" But DO try to offer choices that ARE possible. For example, "What should we do first, take your temperature or your blood pressure?"

When possible, consider allowing them to sit in the parents lap for procedures. For example, look up ways that a child can safely be held still in mom's lap rather than pinned down to the bed when starting an IV. It may seem less convenient or more difficult, and the child may cry just as much, but it provides them security. And given the choice, would you want to be held sitting upright or pinned down flat? It's a little scarier the second way.

Child life!!! They are not just the keepers of the toys. They are a great resource for helping to prepare children for procedures, big and small. Make sure to enlist their help well in advance of needing to place that IV - give them time to come and talk to the kid beforehand, rather than just showing up to try to distract them at the last minute. They are also a great resource for sibling support.

When possible, tell them and show them what is happening before hand. I've unpackaged an extra IV catheter just to pull the needle out and let the kid touch the "straw" that will be inside their arm. The unknown is scary.

Be aware of safety - it is extra important to keep crib railings up when you aren't at the bedside, and to make sure not to leave items like syringe caps in the bed. Choking hazard!

Those IV sites can go bad fast. They are very often left in too long - an IV really shouldn't hurt when you flush it slowly with normal saline, so if it wakes the baby up, that's a sign. (This may not be something that you do as a student, but it is still good to know.)

Involve parents whenever possible. Parents often feel so helpless when their child is hospitalized. Let them participate - they can take an axillary temperature while you assess lung sounds. Sometimes they are afraid to change their babies diaper; do what you can to give them back some control when they feel helpless.

When mom says something isn't right with her child, listen. Even if their physical exam is normal and everything seems okay to you.

If you can, take time to let the child get used to your presence before approaching them. Especially with toddlers. Talk to the parent first, and let the toddler see that the parent identifies you as "safe". Wait a bit before making eye contact, then make a few friendly glances while the child decides what they think. Then approach as un-threateningly as possible!

With older school-age children and teenagers, it often helps develop a rapport to talk to them directly, instead of just talking to the parents.

Swaddling a baby is a comfort measure, as well as helpful. If you are starting an IV on the hand, swaddle leaving just that hand out.

Good luck!

meanmaryjean, DNP, RN · Nov 13, 2016

Child Life is great UNLESS you work nights. Because, apparently, kids don't need that service after 4pm. Worked 5 years in PICU and never once saw a Child Life person.

Julius Seizure · Nov 13, 2016

Child Life is great UNLESS you work nights. Because, apparently, kids don't need that service after 4pm. Worked 5 years in PICU and never once saw a Child Life person.

True. Or on weekends. Sure, maybe there as an "on call" person for child life on weekends, but they've never been able to help me when I needed something.