As a doctor in a busy pediatric Emergency Department, I’d like to personally thank the creators of Angry Birds. Not so much because I love to play
it—though there is a certain satisfaction in knocking those pigs from their platforms—I’d like to thank them because the love my patients have for the game
allows me to do my job better.
As an ED doctor, I’m used seeing children who are in pain, or are very anxious about being at the hospital. When I see a child who’s in pain or scared,
sometimes I ask the parents to let the child play his or her favorite mobile game. (Almost all parents have one or two loaded on their phone or tablet.)
More times than not, after a few minutes with a familiar game like Angry Birds, the child is far more relaxed, which makes it easier for me to quickly
clean a wound or stitch a deep cut. It’s one of the tricks of the trade that I and several other pediatric emergency department staffers have picked up
along the way.
But mastering distraction techniques specific to kids isn’t just to make my life easier, it’s proven to be one of the best ways to give children emergency
medical care. Last week, a study was released showing that adequate pain assessment and treatment in children is essential for all ED doctors to properly
do their jobs. The researchers suggest that pain and anxiety maintenance should start in the ambulance and continue until the visit is over. Not only do I
fully agree with the researcher’s findings, I’m proud to say that my colleagues and I at Boston Children’s ED have been using these techniques for some
time. As a staff that cares exclusively for pediatric patients our team is well equipped to deal with any and all emergency situations a child may
encounter, and do so as quickly and easily for the child as possible. Some of the study’s recommendations include:
Incorporate child life specialists to alleviate the anxiety and perceived pain related to pediatric procedures.
The ED child life specialists at Boston Children’s are amazing and are critical to making the ED experience easier for everyone involved—the patient, the
parent, the nurses and me! Child life specialists have specialized training in distraction techniques, including the use of games, which help the child
focus on something other than the potential of pain or what is going around her in the ED. Many of the procedures performed in the ED aren’t painful—like
stitching up an anesthetized area—but to a frightened child having a stranger touch or approach them with medical instruments can be very upsetting. But a
child distracted by a child life specialist trained in specific ways to engage them with play, Dora the Explorer videos or an Angry Birds game is usually
far more focused on fun than me and a suture needle.
Keep family present during painful procedures.
We encourage families to stay in the room for procedures, as long as they are comfortable doing so. Having a family member close by does a lot to alleviate
fear and anxiety in children, but depending on the situation, it’s not always easy to watch. Occasionally this might lead to a family member feeling a bit
faint, so I’ve learned to keep a close eye on the parents, too. A key philosophy of Boston Children’s is that our clinicians don’t just treat the patient
but whole family, and that extends to the ED as well.
Analgesics and anesthetics should be as pain free as possible.
Thanks to advances in pain medications we’re now able to give two important medications in a nasal mist form, rather than intravenously (IV). IV medication
may still be needed as follow up, but the mist is a fantastic way to provide initial pain treatment quickly and safely.
In many cases, we can also give an anti-anxiety medication as a nasal mist. This works very well for toddlers who need stitches, especially those with
lacerations on their face. The mist allows the child to relax, which often helps them focus on the smartphone/iPad movie or game, allowing myself or
another ED doctor to clean and stitch them quickly.
For more serious painful and stressful procedures, sedation or dissociative anesthesia could be needed. Because we focus entirely on pediatric patients,
Boston Children’s ED clinicians are very experienced in providing procedural sedation/dissociative anesthesia for variety of procedures. This allows us to
quickly provide the right medications, in the right dosages, to all our patients.
When they were busy revolutionizing the mobile device market, Steve Jobs and the folks at Apple probably didn’t realize they were also improving pediatric
emergency care. Intentional or not, these kid friendly devices have become very important additions to pain medications in managing the pain and anxiety of
young ED visitors, and as pediatric ED doctor I’m very thankful for all their hard work.
This blog originally appeared on
Thriving, a blog by Boston Children’s Hospital.