Pediatric emergency medicine trisk 4314 4314

CHAPTER 130 ■ PROCEDURES
THERESA M. FREY, MATTHEW R. MITTIGA

PREPARATION AND ASSESSMENT OF THE CHILD
A significant challenge to the effective and efficient performance of procedures in
pediatric emergency department (ED) patients is the fear and anxiety generated in
both children and their caregivers at the prospect of potentially painful
procedures. Even when pain can be well controlled, fear can derail even the
simplest of procedures. Optimal preparation and assessment of the child and their
caregivers can allay fears and anxiety and contribute to procedural success and a
positive patient and family experience. Even relatively short procedures can
become prolonged and difficult to successfully complete without accurate
assessment and optimal preparation.
Certified child life specialists are experts in this preparatory/assessment role
and have been increasingly used as part of the care team in EDs with significant
pediatric patient volumes. In the absence of a child life specialist, ED staff should
be prepared to provide the needed preparation, support with positioning, and
distraction techniques to increase the probability of success. The child’s
developmental maturity and coping skills should be assessed to determine the
capability for understanding, tolerating, and cooperating with the procedure. Key
considerations for successful preparation of the child and their caregivers include
(1) a developmentally appropriate explanation of the procedure using hands-on
methods when possible, including pretend medical equipment and models (e.g.,
dolls); (2) honesty with the child and caregivers about the painful portions of the
procedure with details regarding the planned behavioral coping strategies to be
employed during the procedure; (3) encouragement of questions about the
procedure; and (4) assessment and intervention for parental anxiety, which easily
transfers to the pediatric patient if not addressed.
Pain management and coping strategies might include swaddling or oral
sucrose in younger infants and breathing techniques, distraction, and visual
imagery in preschool and school-aged children. Children are less fearful and

distressed when in a sitting position than in a supine position. Positioning a child
in a caregiver’s lap can be beneficial if the procedure allows. Potential distraction
items include bubbles, toys that light up, books, videos, conversation with the
child, and mobile devices with age-appropriate applications. Since younger