An Ouchless Emergency Room Visit?
New guidelines from the AAP aim to help children and parents alike keep calm and carry on in the ER
Taking your child to the emergency room can be a frightening experience—for both of you. To keep kids calm (and hopefully stop parents from freaking out, too), the American Academy of Pediatrics (AAP) released new guidelines for reducing children’s anxiety and discomfort in the ER.
First and foremost, the AAP encourages ER departments to pay more attention to managing children’s pain—something that tends to go undertreated. Why? One explanation is that ER doctors aren’t always comfortable administering pain medications to children, and they often have a hard time deciphering just how much pain a toddler or baby is actually experiencing. Also, a child’s pain is often overlooked if the ER is busy.
To rectify this problem, the AAP encourages doctors and other emergency personnel to put together a sort of “triage” for comfort and pain relief that begins with instructing parents to offer appropriate pain relievers or fever reducers before leaving for the hospital. If a child is transported in an ambulance, the report recommends EMT medics be allowed to administer pain relief, including numbing creams and other analgesics, to young children. (Currently, there is no standard for what medics can and can’t provide kids).
Upon arrival at the hospital, ER medical staff should assess young patients for pain and anxiety using age-appropriate scales: pain in a newborn can be evaluated using the Neonatal Infant Pain Scale, and pain in infants, young children, and those with cognitive impairment can be assessed using the FLACC (face, legs, activity, crying, and consolability) scale. A decision can then be made about what medications to administer.
Why so much attention to pain relief? “It can make such a huge difference in the experience of the child and the family,” Dr. Audrey Paul, pediatric ER physician and an associate professor of emergency medicine at Mount Sinai School of Medicine, tells NBC news. “It’s just about being educated and being aware [of the options].”
However, some young children brought to the ER may not require pain medication, but still could use an extra dose of comfort. The best way to provide this, says the AAP, is to allow the child’s adult caregivers to continuously stay with the child throughout the ER stay. When a comforting distraction is needed during needle pricks or other procedures, a pacifier dipped in sugar water—or breastfeeding, we presume, if fluids are allowed—might do the trick just fine, according to the report. Hospitals are also encouraged to provide calming amenities such as kid-friendly videos and music, and “distraction kits” equipped with items like bubble wands and pinwheels.
What else works to help everyone stay calm? The emergency department at Northwest Medical Center in Coral Springs, Florida, recommends three basic ways to make ER visits as ouchless as possible:
- Bring a bit of home: To make the hospital feel a little more familiar and comfortable, bring a blanket, lovey, or some other small comfort item for your child, pack extra diapers and a bottle (or a toddler-friendly snack), and don’t forget to grab something quick for you to eat like a granola or power bar.
- Speed things up: Because sometimes things can move fast in the ER, be ready with your child’s health history so your child can be promptly—and properly—treated. Information to have at your fingertips includes allergies to medications, known health issues, previous injuries, dates and reasons for prior hospitalizations, health insurance, and the name and phone number of your child’s pediatrician.
- Make a plan: No one wants to think about the possibility of taking a child to the emergency room, but taking time to organize emergency phone numbers, going on a test run to your local ER to understand the shortest route and where to park, and calling local EMTs (on their non-emergency line) to discuss how they transfer babies and young children can all go a long way to help you keep the focus on your child in the event of an emergency.
And, knock on wood, this will be a plan you never need to use.
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