Pain Management - Child Life Council

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Instructions for use of this template:
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This PowerPoint was created by child life specialists on the Child Life
Council’s Professional Resources Committee for use by professionals in the
field.
It may be used to educate multidisciplinary team members and students in
your practice.
You may use it “as is,” or you may customize it by adding graphics or photos,
selecting only a subset of slides, or integrating some of the slides into your
own presentation, as appropriate for your audience, please be sure to read
over the comments listed at the bottom of each slide to know how to
customize this for your institution.
Please include the next slide (slide 2) in your presentation, either at the
beginning, or end.
A note about the photos: Consents for use of the photos for this
powerpoint are on file with the CLC. You may use the photos along
with this template “as is,” as well as for modified versions of this
presentation that you create yourself. Please do not use the photos
for other purposes beyond your presentation (i.e. websites, flyers,
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Please remove this slide (slide 1) prior to use.
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
audience.
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
Pain
• 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
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Procedural
Emotional
Family
Coping Plans
Child Life’s Role in Pain Management
• Non-pharmacological pain management
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Guided Imagery/Relaxation
Positioning for Comfort
Emotional Support
Distraction
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
disagree
• 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
script
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:
10.1016/j.pedn.2007.04.010
Positioning for Comfort: Advantages
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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
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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:
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Straddling lap of caregiver
Side-Sitting
Examples of Positioning for Comfort
• IM injection in Thigh
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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
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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
explanations
– Reduces anxiety related to anticipatory pain
Distraction/
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
procedure
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
pain
• Tools like whistles, bubbles, and pinwheels can
encourage younger children to take bigger
breaths
• 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
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Additional Pain Management
Techniques
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
Infant
Comfort position
Emotional support
Sucrose water
Toddler
Comfort position
Distraction/Planned alternative focus
Emotional support
Pre-school
Comfort position
Distraction/Planned alternative focus
Emotional support
Deep breathing
School-age
Guided imagery
Distraction/Planned alternative focus
Emotional support
Deep breathing
Adolescent
Guided imagery
Distraction/Planned alternative focus
Emotional support
Deep breathing
Remember
Child Life can Help…
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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
Questions?

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