When I first started nursing in an emergency department I was amazed at how we treated injured toddlers.
I’m being a bit liberal with my use of the word ‘toddlers’ here, basically I mean any child between the ages of around 1 to 5 years of age.
I was amazed for a few different reasons – firstly, at just how frequently toddlers injure themselves! Fortunately most of the ‘injury presentations’ (as opposed to fevers etc) are for fairly minor things such as head lacs from running into tables, finger lacs from sharp objects, lip and facial lacs from trampolines/sports/running etc, or splinters/foreign bodies in fingers and nostrils. Of course there are much more serious things like burns or getting stuck into the parents tablets too, but management of these presentations are quite different from other injuries.
I’ve had kids myself so I know how hard it is to reason or negotiate with a 2 year old child. Basically it’s impossible! A normal conversation would go something like this “just hold out your hand, and….” at which moment the child would thrust his hand as high as possible into his jumper and cling to his parents, making sure you can’t get anywhere near the injured body part.
Sometimes the parent desperately tries a futile attempt at bargaining for the child’s obedience by promising treats: “lollies! Want lollies? Mummy’s gonna buy you McDonalds! Want a new toy? A new toy?!!!” which really isn’t enough insentive for a two year-old to lie still and hold out their hand for an injection of anaesthetic and a round of suturing!
And so it makes sense that you have to treat injured toddlers a little different than adults.
Traditionally, as I soon discovered, this often involves either sedating the child chemically (using medications like midazolam or ketamine, carrying out the procedure, and monitoring them closely in a resuscitation bay), or the tried and true ‘wrap em up’ method.
I was quite amazed the first time I came across this method, which basically involves wrapping a child up tightly and holding them down, while the child bucks and screams and the procedure is carried out. Sounds traumatizing, right? Well it can be… One advantage of this method is that if the procedure is minor, like gluing a lac to a forehead, the child can be unwrapped and out the door in only a few minutes. One major disadvantage (particularly for more complicated injuries), is that it’s distressing to the child, it’s distressing to the parents, it’s distressing to the other patients who can hear what’s going on, and it’s distressing to the staff!
But I digress…
Distraction Therapy
The method I see most commonly these days (particularly where I work) is distraction therapy. Normally this involves one person being a dedicated ‘distractor’, armed with several distraction inducing implements such as books, noise makers, glowing rods, videos or anything that’s particularly interesting for kids to look at and touch.
If you time things well, you can distract the child quite well with these things while the procedure is simultaneously carried out. There’s no negotiating involved, and a whole lot less screaming! Sometimes (particularly for painful procedures) you can couple this with a small dose of intra-nasal fentanyl to help with pain relief or mild sedation.
Of course it’s largely dependent on the type of injury, nature of the child and a whole host of other factors, but it’s good to at least have an option that’s not quite as archaic and traumatising as holding down a thrashing child.
What has worked well for you when dealing with injured toddlers?
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