“It’ll Be OK…” Or Will It? What Parents Do to Soothe

Much as parents would love to protect their children from pain — even the pinprick “ouch” of a routine immunization — it’s a fact of life in early childhood. Before a child’s 6th birthday, a glinty needle holding protection against dread diseases may find its mark dozens of times. Other children endure much more, requiring surgery, lumbar punctures, bone marrow aspirations, and other difficult medical procedures.

Helping kids to cope would seem to be high on the agenda of parents, pediatricians, and pain specialists alike. Indeed, anesthesiologist Zeev N. Kain of the University of California, Irvine, has devoted much of his professional life to a quest to reduce the anxiety of parents, children, and professionals during pediatric medical procedures. He is currently piloting a study aimed at training parents, nurses, surgeons, and anesthesiologists in the art of soothing a child, based on scientific evidence of what works.

Image via Flickr user BryanF by Creative Commons License

Ironically, the interventions to be included have long been known to researchers. Speaking at an  international conference on pediatric psychological trauma, Dr. Kain reviewed the  work of Dr. Ronald L. Blount, professor of psychiatry at the University of Georgia, Athens, who proved as early as 1989 that what calms children the most is distraction before the procedure (silliness and off-topic banter; playing with toys, being read stories) and prompts to “breathe,” or “blow” during the procedure. (Puffing on a party blower is a perfect distracting, deep breathing tool, and cheap, too!)

What doesn’t work is also very clear and replicated numerous times in the literature. Not surprisingly, the list of ineffective interventions includes criticism, parental agitation, and bargaining. Childrens’ distress is also exacerbated when they are given control over when to start the procedure, and surprisingly, when parents and health professionals engage in that most intuitive of strategies, reassurance. Indeed, in Dr. Kain’s most recent sequential analysis of events in the operating room, reassuring statements to children seemed to be followed almost inevitably by an increase in crying, struggling, and other demonstrated expressions of distress.

So, instead of saying, “It’s OK,”  or “You’re going to be just fine,”  adults in Dr. Kain’s studies are learning how to distract kids even when the going gets tough and then to urge them to unfurl the crinkly party blower with gusto and a deep breath.

— Betsy Bates
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Filed under Anesthesia and Analgesia, Emergency Medicine, Family Medicine, IMNG, Pediatrics, Primary care, Psychiatry, Uncategorized

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