Behavioral Approaches to Anxiety and Pain Management for Pediatric Venous Access

Abstract

Pediatric venous access causes unnecessary anxiety and pain in children and, in turn, can have detrimental consequences. Behavioral approaches to pediatric venous access distress management can be organized temporally. Specifically, preparation before the procedure includes providing children with sensory and procedural information in an age-appropriate manner and providing training in coping skills. It is important to consider the timing, format, and content of the approach to provide optimal preparation for the unique circumstances of the individual patient. In addition to the child patient, preparing parents and teaching them which specific behaviors might be most helpful to their child should prove valuable to both patient and parents. During the procedure, there are benefits to providing secure and comfortable positioning. In addition, researchers recommend that adults encourage children to cope and actively engage children in distracting activities. For infants, there is support for the distress-mitigation properties of swaddling, skin-to-skin contact, breastfeeding, and sucrose. After venous access, distraction and encouragement of coping should speed recovery. In sum, research in behavioral approaches to pediatric pain management has provided recommendations for minimizing children's anxiety and pain associated with venous access. Pediatrics 2008;122:S134-S139 P EDIATRIC PAIN FROM medical procedures results in short-term suffering, but there are recent data to indicate that there are also long-term detrimental effects. Specifically, early painful insults might have lasting negative effects on neuronal development, pain threshold and sensitivity, coping strategies, emotionality, and pain perceptions. 1,2 As an example, Bijttebier and Vertommen 3 showed that children with a history of negative medical experiences showed high anxiety before venipuncture and were distressed and uncooperative during the procedure. Childhood medical pain has also been linked to later adulthood fear, pain, and avoidance of medical care. 4 In addition, high pain at medical visits predicts missed future medical appointments and poor health care follow-up. [5][6][7] Fortunately, there is a rich body of data supporting behavioral strategies that mitigate the anxiety and pain associated with pediatric medical procedures generally, 8 and children's needle-related pain in particular. 9 Nonpharmacologic or behavioral approaches to acute pediatric pain are rooted in the gate-control theory. 10,11 The theory suggests that descending nerve impulses from the brain, such as thoughts, beliefs, emotions, and attention, can influence the ascending pain signal from the tissue damage. For example, anxiety might heighten pain experience, whereas attention focused on a pleasant activity might decrease pain. Thus, behavioral interventions typically involve teaching coping, inducing relaxation, or providing distraction. Although literature documenting the efficacy of behavioral interventions for children's acute medical pain exists, the data...

Effectiveness of cartoon distraction on pain perception and distress in children during intravenous injection

“…1 Pain in children with acute and chronic diseases is a major public health problem that has been increasing over the last 20 years. 2 In 1995 the American pain society challenged all health care system, to make pain the fifth vital sign along with pulse, temperature, blood pressure and respiration . In addition to the pain associated with medical procedures, they are often a source of anxiety, fear, and behavioral distress for children and their families, which can further intensify their pain and interfere with the procedure.…”

“…Medical procedures, particularly needles, are among the most feared experiences of children. 4 Reports from children, parents and nurses consistently indicate that many children do indeed fear the "shot 2 ." Estimates say that the percentage of pain is from 50-80% of all hospitalized children.…”

The Effect of Psychological Intervention on Perceived Pain in Children Undergoing Venipuncture

“…4 ) translated into the Czech language 27 . The scale can be used for children from 3 to 18 years old 30 . The researchers were ordinary members of the nursing team and thus did not arouse any increased attention among the children.…”

Child Life Services

“…13,[39][40] Strategies such as swaddling, oral sucrose, vibratory stimulation, breathing techniques, distraction, and visual imagery have been shown to decrease behavioral distress and pain experience in children during invasive medical procedures. [41][42][43] In addition to advocating for the appropriate use of analgesics, CCLSs are often directly involved in the utilization of nonpharmacologic pain management techniques and coaching or supporting patients and families before and/ or during distressing medical procedures.…”