Pain Management - Child Life Council

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Council’s Professional Resources Committee for use by professionals in the
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Our Thanks to:
The Child Life Council’s Professional Resources
Committee, who provided a template to help in
the creation of this presentation for our
Child Life and Pain Management
What is Child Life?
Child life specialists address the psychosocial
concerns that accompany health care
experiences by promoting optimal child
development and minimizing adverse effects.
Using play and psychological preparation as
primary tools, child life interventions facilitate
coping and adjustment under circumstances
that might otherwise be overwhelming.
Certified Child Life Specialist
Professional Standards of Practice
• Minimum bachelor’s degree or master’s degree* with
specific coursework in human growth and development,
family studies, psychology, and related fields
*By 2022, all newly Certified Child Life Specialists will be required
to hold a master’s degree
• Minimum of 480 hour internship
• National Certification examination
• Professional development hours to maintain certification
• Adherence to the code of ethics and standards
established by the Child Life Council
• Procedural pain is universal to all pediatric
patients and needle stick pain is the most
common source of pain in hospitalized
children (Wong and Baker, 1988)
• Pain is subjective
Wong, D., Baker, C. (1988) Pain in children: comparison of assessment scales.
Pediatric Nursing.14 (1): 9-17.
Gate Control Theory of Pain
• Experience of pain can be influenced by
thoughts and emotions
• In order to help control the “gate” of pain,
other tools can be utilized to distract/“trick”
the skin or body to focus on additional
sensations, such as cold or vibration, to
minimize the sensation of the poke or pain
The gate control theory of pain. (January 01, 1978). British
Medical Journal, 2, 6137, 586-7.
How Child Life Can Help
• Play
– Therapeutic
– Medical
• Diagnosis education
• Preparation
• Support
Coping Plans
Child Life’s Role in Pain Management
• Non-pharmacological pain management
Guided Imagery/Relaxation
Positioning for Comfort
Emotional Support
Deep Breathing
• Other pain management techniques
– Sucrose Water
– Lidocaine (injectable/topical)
– Vibration and cold
“CCLSs are often directly involved in the
utilization of nonpharmacologic pain
management techniques and coaching or
supporting patients and families before and/or
during distressing medical procedures.”
American Academy of Pediatrics
Brown, C., Ipsan, C., Lostocco, L., Vinocur, C. D., Chitkara, M. B.,
Percelay, J. M., Betts, J. M., ... Alexander, S. N. (January 01,
2014). Child life services. Pediatrics, 133, 5.)
Guided Imagery
• Guided imagery induces an altered state of
consciousness where a patient develops
heightened focus on a particular idea for the
purpose of relaxation and/or distraction.
• 3 events associated with guided imagery:
– Absorption- patient totally involved
– Disassociation- separate self from pain
– Suggestibility- suggest scenes, patient can agree or
• Patient must be in control to do guided imagery
Guided Imagery
• Guided imagery is most useful for longer
procedures or for beside pain management
• It is most effective with older children who are
able to use their imagination to follow the
Positioning for Comfort
• Comfort positions allow for good control
during a procedure while still allowing the
child to receive comfort from the parent
• Helps the parent and child to feel more at
ease and in control
• Some positions, like laying on the back, can
make children feel very vulnerable
Sparks, L. A., Setlik, J., & Luhman, J. (2007). Parental holding and positioning
to decrease IV distress in young children: a randomized controlled trial.
Journal of pediatric nursing, 22(6), 440-447. doi:
Positioning for Comfort: Advantages
Fewer health care team members needed
Greater immobility of the child
Close physical contact with a caregiver
Caregiver has an active role and can support
the child in a positive way
• Creates a sense of control for the child
Stephens, B. K, Barkey, M. E., & Hall, H. R (1999). Techniques to comfort children during stressful
procedures. Advances in Mind-Body Medicine, 15, 49-61.
Positioning for Comfort
Children may still cry, but tend to display less stress
Can be initiated as soon as a child has received some
trunk and head control (3-5 months)
Parents/caregivers should not be asked to hold down a
child’s arms or legs; it is important to make sure parents
feel comfortable with these positions
Parents/caregivers can lie next to child on bed for
procedures which require supine position
Compliment parents!
Positions can always be adapted to meet the needs for
each procedure
Examples of Positioning for Comfort
• IV /Blood Draw:
Straddling lap of caregiver
Examples of Positioning for Comfort
• IM injection in Thigh
Leg is bent over parent’s lap, keeping thigh
muscle relaxed
Lacey, C. M., Finkelstein, M., & Thygeson, M. V. (2008). The impact of positioning on fear during
immunizations: Supine versus sitting up. Journal of Pediatric Nursing, 23, 195-200.
Examples of Positioning for Comfort
• Port Access
Sit forward-facing on parents lap
Parents can cross legs over child’s legs to
prevent kicking
Examples of Positioning for Comfort
• NG Drop
– Hug parent during nasal aspirate
– Child can also be held on parents lap facing
outward with parents arms and legs wrapped
around the child
Examples of Positioning for Comfort
• Urinary Catheterization
– Child lies with head in parent’s lap on table
Emotional Support
• Comforting touch
• Encouraging words
• Developmentally appropriate medical
– Reduces anxiety related to anticipatory pain
Planned Alternative Focus
• Does not mean “Hey, look over here so you do
not know what is happening!”
• Gives an alternative to focusing on pain
• Gives the patient a “job” and promotes sense
of control over an appropriate aspect of the
Items useful for Distraction
• Toddler – bubbles, light spinner, cause and effect toys,
toys with lights and sounds, sensory toys, etc.
• Preschool – bubbles, light spinner, toys with lights and
sounds, young versions of i-spy books, ViewFinder and
cartoon slides, stress ball, pinwheels, whistles, iPad
games and activities
• School-age – i-spy books, iPad games and activities,
conversation, music, singing, stress balls, pinwheels,
whistles, etc.
• Adolescent – iPad games and activities, conversation,
MadLibs, music, singing, hangman, Pictionary, stress
balls, etc.
Deep Breathing
• Deep breathing is a useful coping technique
that can be used in the midst of pain
• It can be helpful for both chronic and acute
• Tools like whistles, bubbles, and pinwheels can
encourage younger children to take bigger
• Visuals, like birthday candles, can also be
beneficial for younger children
Using Interventions Effectively
• Give parents and patients clear instructions
• Rationalize/describe techniques as being
helpful or less threatening; ‘helping you hold
still’ or ‘giving you a big hug’
• Involve the parents and include them in what
is happening
– Decreasing stress level of parents
– Parents are the experts of their child
Additional Pain Management
Cold Spray
Sucrose Water
Pharmacological Numbing Agents
Heat and Cold
Soothing Items
Customize this slide to include more information regarding
additional pain management techniques available at your
facility (such as JTip, ELMA, LMX, Buzzy, freezy spray, cold
spray, SweetEase, pacifiers, hot or cold packs, etc).
Bedside Pain Management
• Sometimes pain can be chronic
– Some tools that can be used in the procedure
room can also be used
• Bubble blowing
• Play with familiar toys
• Relaxation
• Teaching and rehearsing coping techniques
can also be very beneficial
Developmental Level of Patient
Possible Pain Management Technique
Comfort position
Emotional support
Sucrose water
Comfort position
Distraction/Planned alternative focus
Emotional support
Comfort position
Distraction/Planned alternative focus
Emotional support
Deep breathing
Guided imagery
Distraction/Planned alternative focus
Emotional support
Deep breathing
Guided imagery
Distraction/Planned alternative focus
Emotional support
Deep breathing
Child Life can Help…
Reduce patient and parental anxiety
Teach techniques to facilitate coping
Offer support during painful procedures
Set clear expectations
Child Life Department
• Insert contact information/unit information

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