Four ways parents can increase their protective role and pain-reducing effect at medical procedures

Many people believe that medical procedures have to hurt, particularly if they involve needles or other sharp instruments. They can hurt, of course, but you may be surprised to know that pain is not a given.  Fear and pain are natural protective mechanisms that parents can help switch off -- and the earlier you start, the easier it is.

Checkout this video from Professor Denise Harrison and the Be Sweet to Babies team (Baby vaccination; the secret to a calm and peaceful immunization). 

 

Do your homework and go prepared.  It’s not hit and miss whether a child learns to cope – it’s a combination of their previous experiences, how well prepared they are, and what the adults say and do.  Instead of relying solely on the healthcare professionals, find out in advance how you can be a positive influence, reduce the perception of threat and help your child feel safe and comfortable.  You may be surprised how much research has already been done.

Get all the important tips from a tiny tot in It doesn’t have to hurt from the Centre for Paediatric Pain Research in Canada.

Children sense and watch what’s going on around them and adults need to stay calm; it is the key to a child’s sense of security.  As a parent, I also know it can be hard and may require faith, combined with an Oscar-winning performance, to present the medical world as a safe and friendly environment. “You have to be brave for your child” is how one experienced mum put it.

It’s not helpful when parents identify with their child’s potential or actual suffering and show their own emotions.   If you are releasing a cascade of anxiety-producing hormones, then your young child will too, amplifying any fear and pain.

Remembering to breathe and watching the natural rhythm of your breath can make a big difference.

There is a long, history of parents being excluded from the care of their children in the medical setting.  Fortunately times have changed, and parents no longer have to hand over their children and their power to the healthcare providers.  You can speak up, maintain your authority and become a vital member of the team.  Calm, informed parents provide the ideal protection from fear, pain and trauma for children.

“It’s not about being demanding.  It is what works for my son.  We are positive and confident when we go for procedures and we have never had a problem.  It has changed our perspective on the hospital.”   Parent and health rights lawyer Liz Bishop, who has more to say in the video Listen to a parent’s experience.

When parents and health professionals all work together as one harmonious team, each bringing their complementary areas of knowledge and expertise, medical procedures can become a source of resilience and mastery for children.

From Everybody Stay Calm

REPLACE THE OLD MALADAPTIVE CYCLE Procedures→Threat→Fear→Distress→Pain→Aversion→Avoidance WITH Procedures → Normal→Sense of safety→Coping→Happy to go back again→Mastery

Angela Mackenzie

Paediatrician/author

29 June 2015

Reasons to focus on refugee children during Refugee Week

Refugee Week is here. “With Courage let us all combine is the theme and is taken from the second verse of our national anthem, emphasising both the pluck it takes to flee persecution and establish yourself in a new country and the courage required by all Australians to build a protective and safe environment for refugees in these politically difficult times”. (Media Release, Refugee Council of Australia).

Australia has a policy of mandatory detention of asylum seekers. Children and their families can wait for extended periods of time in detention resulting in their health and safety coming under threat. Recent Federal government and human rights exposure surrounding asylum seeker refugees has travelled across Australian airwaves, receiving prominent media coverage. Much of it sparked from the Human Rights Commission’s findings of The Forgotten children: National Inquiry into Children in Immigration Detention, 2014. This report comes ten years after A last resort? : National Inquiry into Children in Immigration and the beginning of offshore detention.

By looking at refugee children during Refugee week we create awareness surrounding their vulnerability. Reading about children currently in detention is all the more important because information is not freely or easily shared by Australians who work or have worked in detention centres. Doctors who work in detention facilities now face 2-year jail terms if they reveal details of any abuse or substandard care they have witnessed.


Refugee week is a springboard for better understanding. The Refugee Week 2015 resource kit provides more information. We have also included some public awareness links here with a child focus, more involving healthcare are in the AWCH library database and earlier blog “B” is for Bowlby and “boat people”. You might like to read AWCH submissions to several inquiries into the impact of detention on children and young people and read the Never again: Let’s end the detention of children once and for all joint statement. ChilOut website does much to help people nut out the issues. A fact sheet from Asylum Seeker Resource Centre Children in detention, gives an overview of who is being held and the impact of detention on mental health and safety of children.

Photos courtesy of ChilOut website: http://www.chilout.org/gallery

Listening to people who were child refugees, now older and living in our communities, is a learning experience many will take up during Refugee week. The Asylum Seekers Centre partnered with the City of Sydney are hosting an event, “Different Pasts, Shared Future: an evening of stories, music and inspiration”. It celebrates the contribution of refugees and asylum seekers in Australia. Holroyd High School principal, Dorothy Hoddinott, AO, winner of the 2014 Human Rights medal and Nooria Wazefadost, a former student of Holroyd High and member of the Hazara Women of Australia Association, will be amongst the speakers.

School children and college students around Sydney, Wollongong and Melbourne are finding out what it is like to be a refugee by taking part in the Refugee Council of Australia’s incursion. Their Schools Program involves Refugee speakers who share personal stories giving students the opportunity to learn from their experiences and contributions to Australian society.

For a visual approach, take a look at drawings by children in detention or see Out of Sight website. Perhaps you have links to share?

Refugee Week 2015 with a theme that combines unity and courage offers a more holistic approach to help free children from detention.

Jillian Rattray & Anne Cutler

Association for the Wellbeing of Children in Healthcare (AWCH)

http://Library.awch.org.au

June 2015

Keeping Kids’ Needs in the Picture

When it comes to medical imaging why won't kids just smile for the camera? Children have trouble staying still at the best of times and when feeling unwell, unfamiliar experiences can become especially daunting. Their parents are often anxious too, about their child's health and radiation risks. As children can have increased risks from radiation exposure so it's important that scans are completed with a minimum number of takes.  So how do we get kids to comply?

Paediatric hospitals have the benefit of staff who are trained and experienced with kids. Many employ Child Life Therapists specifically to prepare children for procedures like scans and help them to develop coping strategies. University trained Child Life Therapists have extensive knowledge of both child development and medical procedures. This places them in a unique position to bring the two together as harmoniously as possible.

But what about the non-paediatric facilities where staff are trained for, and treat, mostly adults? In 2012 The Royal Australian and New Zealand College of Radiologists approved a new policy on Paediatric Imaging to guide those clinicians in how to limit radiation, trauma and possible pain to children in their care. It is also recommended reading for parents wanting to understand the options for children but please note the ages mentioned are a guide only. Younger children have achieved successful scans without sedation and appropriate preparation.  For further research read here: Minimising the use of anaesthesia / sedation in paediatric imaging and radiotherapy : The role of play therapy and patient education or if you want quick information, see our tips below …

When your child needs a scan:  How you can navigate these potential pitfalls.

1) RADIATION:   

• Check with the doctor: is the scan necessary? Is it need immediately?  Are there any alternatives with less radiation?   

• If booking with a private radiology practice for a non-urgent scan, ask if Radiography staff have experience with children.  How, specifically, do they help kids with scans? If you don't feel assured of a child friendly approach, then shop around (if possible).

 

2) INJECTIONS:

•  Check in advance whether the scan requires an injection of contrast. This will allow you to prepare your child for every aspect of their treatment.
• If yes, then request a numbing cream such as Emla or LMX4 be used.
• Is your child needle phobic? Discreetly let the staff know. If child life therapists are not available, try distracting your child with a book, game, or reassuring words.

 

3) SEDATION:

There are instances where it's necessary to sedate children, either to avoid pain or because zero movement can occur.

• Check the necessity for sedation, which type, and the risks associated.
• Prepare your child for having that type of sedation
• If general anaesthetic will be used, prepare your child for an overnight hospital stay.

4) BREATH HOLDS:

• Is your child required to perform breath holds for their scan? These are generally needed for abdominal and chest scans. Learning this skill in advance of scanning helps the radiographer get the pictures they need. This means less retakes and less radiation.
• Take the time to coach your child in breath holding in advance. Try to make it fun by doing it in the bath or pool, using counting games and blowing bubbles.

5) WAITING LISTS:

• Non-urgent scans at paediatric hospitals may involve waiting lists. If you’d like the scan sooner ask your referring doctor if it can be done by another hospital or clinic. Consider your options in consultation with them.

For further assistance with preparing children for scans and injections, or appropriate distraction techniques during those procedures, contact Child Life Therapy at your child's hospital. If attending a private clinic you can consult a Child Life Therapist in private practice.

Blog written by: Renee Campbell

Renee Campbell is a university trained, registered Child Life Therapist with the Australian Child Life Therapy Association (ACLTA) and a member of the ACLTA Certification Committee.

Renee has over 7 years’ experience as a Child Life Therapist (formerly Play Therapist) at the Sydney Children’s Hospital Randwick (SCH) where she helped establish their MRI Play Therapy program. In that time she conducted research into children’s coping in medical imaging and helped children as young as 4yrs old to have their scans without anaesthetic.

Currently, Renee remains employed at SCH part-time in the Medical Day Unit assisting children and adolescents to cope with invasive procedures. She also has a private practice helping children with healthcare needs and parents of newborns with sleep guidance.