My 6-year-old daughter, Nyah, recently persuaded me to buy her a kitten, whom she has elected to call Sneaker. A couple of weeks ago, I took him to the veterinarian for his vaccinations. The vet skilfully distracted him with some kitten treats and, to my surprise, the vaccination was soon complete, with Sneaker entirely oblivious to having been poked by the needle.
When I recounted this story to Nyah, an impassioned monologue on the topic ensued to the tune of: ‘Why don't doctors and nurses do that to me when I go to the hospital? I hate pokes. They should learn from the vet. They give me a lollipop afterwards when I'm crying but they should give it to me before so I can eat it instead of getting hurt, right mummy?’ As might be becoming clearer, my daughter is, unfortunately, no stranger to the emergency department.
In the current issue of the Journal of Paramedic Practice, we shine a light on paediatric emergencies, with two feature articles and a comment. In the first feature, Patrick Ennis shares a pilot of the Paramedic Advanced Resuscitation of Children (PARC) course (p. 470). The second feature shifts its focus towards neonates, with Emerson and Laws investigating the effect of placental transfusion on neonatal resuscitation attempts (p. 480). In our comment on p. 466, Whitley et al discuss the complexity of pain management in children, highlighting the many factors that affect pain perception in this young patient population.
Just as one of the simplest yet most important aspects of a paramedic's role when caring for an adult patient is the moment when they hold a person's hand or make them a warm comforting cup of tea, such soft skills are vital when caring for children. So what is the equivalent of a cuppa for a young person? A lollipop perhaps but a sugary treat can of course make a child hyper or restless. A possible alternative may be to keep a small ‘treasure chest’ of toys for children to choose an item that may help to distract them and reduce their anxiety and their fear of experiencing pain. As my daughter pointed out, distraction is a good strategy. It can even be employed simply by chatting with the child, offering them a ‘visioning’ exercise, allowing them to listen to music, or asking them to count a set of items in the ambulance.
Another approach is to talk through procedures with your young patients, not only regarding what is happening so they feel prepared and know what to expect, but to educate them by explaining various instruments or procedures in simple language, allowing them to hear their heartbeat, and other such techniques.
You can communicate with patients (and their families) and with colleagues in front of them, using positive words, rather than words that may provoke uncertainty and anxiety, or imply a negative message. However, perhaps one of the most effective techniques is to simply remain calm. Anxiety is contagious and children can be very sensitive to it. If it is a busy or stressful shift and you feel frazzled, take the time to use your own self-calming strategy such as taking deep breaths from your belly, so that your soothing energy can put your patients, young and old, at ease under your care.