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In some EDs, child-life specialists help children with nonpharmacologic
methods for pain management including psychological preparation for
procedures, “comfort” holds, distraction, and educating staff (and sometimes
even families) about the most appropriate language to use for a specific
child. The strategies employed by child life have a positive impact on patient
and family satisfaction, staff satisfaction, and cost. Sinha found that for
laceration repair, the use of child-life specialists was associated with a
reduction in parental perceptions of pain in younger children and a decrease
in self-reported anxiety for older children. In a 2014 policy statement, the
AAP concluded that hospitals should use child-life services as a quality
indicator and strive to have child life as part of an integrated family-centered
care model.
Most pediatric centers advocate family member’s presence during painful
procedures. Research demonstrates that family presence does not increase
the pain or distress of the parent or child, nor does it adversely affect the
clinicians’ abilities to provide safe and effective care. Giving the family the
option to remain in the room during procedures and resuscitations increases
the family’s overall satisfaction with the visit, and should be incorporated
into the plans for PSA.
Distraction of a child during a painful procedure may help reduce pain
and distress. This includes having the child perform rhythmic breathing or
blowing bubbles. Age-appropriate distraction reduces self-reported anxiety
and parental perception of pain in children during laceration repair. For
younger children, parents can also help with singing and storytelling.
Visually intriguing toys, paintings on the walls or ceiling of a procedure
room, and music or videotapes may also distract a young child. Music
therapy is effective in reducing anxiety and pain for children undergoing
procedures, and recent work has also used virtual reality goggles to distract
older children during procedures. Guided imagery, in which children are
coached to imagine a pleasant memory or scenario, may also be helpful. For
example, one could ask the child to think of the funniest movie he or she has

ever seen and to imagine the pain getting less intense with each laugh. Or,
the child could be asked to imagine the pain as a color that is fading away
and is painted over with the child’s favorite color. Hypnosis has been used to
treat pain in children for several years, and it has been successful in children
as young as 2 years of age. Hypnosis has proven value for chronic pain