23 min
Episode 32 Part 1: Pain in the Pediatric ED – an Interprofessional Approach Little Big Med
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- Education
This is part 1 of a 2 part series. Please be sure to listen to part 2!
In this episode, host Jason Woods speaks with Dr. Daniel Tsze and Child Life Specialist Hilary Woodward about how to approach pain in the pediatric patient. This could be pain from the presenting complaint or from the procedure being performed. The discussion focusses primarily on the non-pharmacologic techniques that have been shown to improve the experience for patients, caregivers, and care providers.
Dan and Hilary are both part of the PECARN (Pediatric Emergency Care Applied Research Network) and this episode is published in partnership with the PECARN Dissemination Working Group.
Guests
Hilary Woodward MS, CCLS -New York-Presbyterian Morgan Stanley Children’s Hospital at Columbia University Medical Center
Daniel Tsze MD, MPH – Associate Professor of Pediatrics (Emergency Medicine), New York-Presbyterian Morgan Stanley Children’s Hospital at Columbia University Medical Center
Show Notes
* Techniques – non pharmacologic* Environment – Remember that the environment can have a huge impact not he patient! (I.e. colors on the walls, pictures/posters, cartoons). The attitude and approach from the caregivers and clinical providers also contributes. * Before procedure* Opportunities for patient to interact (safely) with procedure materials. Can use either (or both) of the techniques below:* Medical play – free play with safe procedure materials, possibly with some child-centered narration as patient manipulates what is provided (i.e. “you’re putting that on the doll’s arm”); helps with desensitization & child-directed understanding (figuring out organically how the materials work) and increases patient’s opportunities for control. * Developmentally appropriate teaching – practice procedure on stuffed animal/doll etc., while explaining what will happen and clarifying patient’s questions/misconceptions as needed. May consider hand-over-hand techniques to give patients some knowledge/experience with sharps (if caregiver consent provided, safety guidelines in place, patient assessed by clinician to be an appropriate candidate developmentally and in regards to temperament)* Explanation of what you are going to do. How much do you tell a child and how does this change based on * Can start with “small spoonfuls” of info, focusing on what the patient’s sensory experience will likely be (i.e. how will it feel, what will they see/smell/taste; “some kids say it’s like _______”). Monitor verbal/non-verbal cues to guide when/if/how to share more* Patient and caregiver input is vital – ask what they would like to know more about, and offer choices of coping techniques (consider needs of self-identified “attenders” vs. “distractors”)* Don’t forget the basis like splinting, ice packs, which also have analgesic effects* Positioning for comfort* Chest to chest in a chair for scalp lacs, procedures on extremities* Parent sitting in a chair works well – make sure that patient’s feet are dangling so that they don’t have leverage to push up* Make sure to brace the extremity you are working with (rest extremity on the bed or on a bedside table, ideally at close to a 90 degree angle)* Consider asking a “helper” to hold head or extremity steady* Patient’s back against parent’s chest for facial lacs, procedures on extremities* Have parent lay on stretcher with their whole body (feet included) on the bed; child lays or sits between parent’s legs, with their bottom on the stretcher (NOT on parent’s lap) – then parent can cross their legs over child’s legs* As with chest-to-chest, make sure to use appropriate bracing and a “helper” as needed for steadying* Do you talk with parents ...
This is part 1 of a 2 part series. Please be sure to listen to part 2!
In this episode, host Jason Woods speaks with Dr. Daniel Tsze and Child Life Specialist Hilary Woodward about how to approach pain in the pediatric patient. This could be pain from the presenting complaint or from the procedure being performed. The discussion focusses primarily on the non-pharmacologic techniques that have been shown to improve the experience for patients, caregivers, and care providers.
Dan and Hilary are both part of the PECARN (Pediatric Emergency Care Applied Research Network) and this episode is published in partnership with the PECARN Dissemination Working Group.
Guests
Hilary Woodward MS, CCLS -New York-Presbyterian Morgan Stanley Children’s Hospital at Columbia University Medical Center
Daniel Tsze MD, MPH – Associate Professor of Pediatrics (Emergency Medicine), New York-Presbyterian Morgan Stanley Children’s Hospital at Columbia University Medical Center
Show Notes
* Techniques – non pharmacologic* Environment – Remember that the environment can have a huge impact not he patient! (I.e. colors on the walls, pictures/posters, cartoons). The attitude and approach from the caregivers and clinical providers also contributes. * Before procedure* Opportunities for patient to interact (safely) with procedure materials. Can use either (or both) of the techniques below:* Medical play – free play with safe procedure materials, possibly with some child-centered narration as patient manipulates what is provided (i.e. “you’re putting that on the doll’s arm”); helps with desensitization & child-directed understanding (figuring out organically how the materials work) and increases patient’s opportunities for control. * Developmentally appropriate teaching – practice procedure on stuffed animal/doll etc., while explaining what will happen and clarifying patient’s questions/misconceptions as needed. May consider hand-over-hand techniques to give patients some knowledge/experience with sharps (if caregiver consent provided, safety guidelines in place, patient assessed by clinician to be an appropriate candidate developmentally and in regards to temperament)* Explanation of what you are going to do. How much do you tell a child and how does this change based on * Can start with “small spoonfuls” of info, focusing on what the patient’s sensory experience will likely be (i.e. how will it feel, what will they see/smell/taste; “some kids say it’s like _______”). Monitor verbal/non-verbal cues to guide when/if/how to share more* Patient and caregiver input is vital – ask what they would like to know more about, and offer choices of coping techniques (consider needs of self-identified “attenders” vs. “distractors”)* Don’t forget the basis like splinting, ice packs, which also have analgesic effects* Positioning for comfort* Chest to chest in a chair for scalp lacs, procedures on extremities* Parent sitting in a chair works well – make sure that patient’s feet are dangling so that they don’t have leverage to push up* Make sure to brace the extremity you are working with (rest extremity on the bed or on a bedside table, ideally at close to a 90 degree angle)* Consider asking a “helper” to hold head or extremity steady* Patient’s back against parent’s chest for facial lacs, procedures on extremities* Have parent lay on stretcher with their whole body (feet included) on the bed; child lays or sits between parent’s legs, with their bottom on the stretcher (NOT on parent’s lap) – then parent can cross their legs over child’s legs* As with chest-to-chest, make sure to use appropriate bracing and a “helper” as needed for steadying* Do you talk with parents ...
23 min