Administering treatments and procedures to pediatric patients can be difficult both for the healthcare provider and the patient. As a result, some physicians have developed methods to overcome challenges and have dedicated staff to address problematic cases.
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Kyla Driest, MD, MEd, assistant professor of pediatrics, Division of Rheumatology at Nationwide Children’s Hospital, Columbus, Ohio, finds that some children experience anxiety when getting an IV, especially if their veins have been physically difficult to access in the past. Likewise, joint injections can be nerve wracking.
“Although many older kids do well with joint injections, younger children or those with needle phobias may need sedation,” Dr. Driest says.
The majority of Nationwide Children’s Hospital patients receive their infusions at a pediatric infusion center from nurses trained in pediatrics. “These nurses are often better equipped to treat children and decrease needle-associated anxiety,” Dr. Driest says. Some of their methods include tailoring IV placements to the patient’s preferences when possible, employing distraction and therapeutic holding techniques, and providing reassurance and positive reinforcement, which includes establishing rapport with patients.
“They also have access to an IV team to help with more challenging IV placements,” she says.
Dr. Driest finds positive reinforcement works well in a variety of situations, including administering injectable medications. “I often instruct families to associate the medication with something the child enjoys, such as ice cream, a favorite blanket, a stuffed animal or music,” she says. “This [association] means they either give the medication while the child has the item [e.g., teddy bear, blanket] or afterward as a treat [e.g., ice cream].”
For some children, numbing creams may be helpful when providers administer infusions and injections. Typically, creams must be left on for 15–30 minutes before taking full effect. “With some particularly anxious children, waiting can heighten the stress associated with the treatment,” Dr. Driest says. “Icing may be a better option for these children, [because] it removes the waiting time.”
Ankur Kamdar, MD, a pediatric rheumatologist at UTHealth/University of Texas Houston Medical School, has found that giving infusions are often difficult for several reasons. For children who require chronic infusions or laboratory draws, sometimes achieving access for IV infusions can be difficult. Consequently, many parents and patients opt for a port-a-cath, a catheter threaded through larger veins. This approach makes it easier to gain access to veins. In addition, it is under the skin, so it isn’t visible.
However, a port-a-cath is a surgical procedure that can be painful. It may become infected, which may require antibiotics and removal. In addition, in a growing child, the port-a-cath may move, making access more difficult. Revision or replacement may be required.