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Techniques for a firm and delicate handling of children

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Illustrated techniques for soft contention of children when they will be submitted to physical examination and receive injections.

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Techniques for a firm and delicate handling of children

  1. 1. Dario Palhares Pediatrician of the University Hospital, University of Brasília dariompm@unb.brEnglish correction by Neil Hume Wilson Cartoons by Íris Almeida dos Santos makiwa4u@hotmail.com irisalmeida@unb.br
  2. 2.  An emotionally strong link with the mother and the family is an important phase of the maturation and growth for all children Children of less than 3 years old therefore generally avoid any unknown adults
  3. 3.  A small child that goes easily with any adult is an alert sign for probable parental negligence. Also, children that are cared for in nurseries tend to behave more aggressively, resulting from the cold and impersonal manner in which they are treated.
  4. 4.  In a hospital environment, children commonly behave aggressively, due to reasons such as:a) the place is frightening and coldb) the place is boringc) the amount of time waiting is irritatingd) the child is already sick and feeling ill,e) the hospital is related to discomfort and painful procedures (injections, venous punctures, etc.)
  5. 5.  So, health care professionals must know and practice techniques of delicate handling. Children must always be handled in a firm and gentle manner and NEVER hurt There are many simple techniques, all being inspired by martial arts.
  6. 6.  For the physical examination of the thorax and abdomen, the child needs to remain laying down on the back while the adult holds the arms above the head. Frequently, the child still shakes, trying to kick the examiner who needs to place one arm on the knees of the child, while they feel and auscultate the abdomen and thorax.
  7. 7.  The examination of the oropharynx is the most hated part of the physical examination, because the spatula provokes vomiting and the positioning on the base of the tongue is of considerable discomfort. The responsible adult holds the arms downwards and with their own body mass blocks the child from attempting to kick. It is reasonable that the examiner always asks the other adult to hold the hands of the child because even ‘good’ and cooperative children can, in a reflex act, try to take away the spatula, and this can hurt the pharynx. The examiner takes a position the same as to intubate the child and simply holds the forehead with an open hand. As the joints of the neck present a low mechanical efficiency, this is a simple and effective manner in which to restrain the child´s head firmly. If the child closes the teeth, the spatula should be laterally introduced into the mouth until it finally reaches the base of the tongue. If the patient vomits, immediately remove the spatula, turn the head laterally and wait for the child to stop vomiting. Clean the child with paper towels or gauzes. Babies are particularly susceptible to vomiting, especially if they have just received milk.
  8. 8.  The moment of receiving injections is one of the most stressful in the hospital practice. Children don’t cooperate and need to be restrained in a firm, safe and gentle manner. As practically all injections are given in the gluteus, the best position for relaxing the gluteus is to stand up. The adult must be seated on a chair and firmly hold the child face to face. Important details required for this position are: that the legs of the adult cross the legs of the child outwards and the feet get crossed; the adult holds the child and their arms from behind. As the shoulder is a joint of reduced posterior mobility, the adult must impede the child from making a movement such as trying to remove the syringe, which is definitely very harmful for them. Force is not particularly required, but just maintaining the correct position.
  9. 9.  Laying the child down in a position with the buttocks up should definitely be avoided as this is a position where the gluteus gets unnecessarily tense, making the injection even more painful.
  10. 10.  Older children easily accept oral medications, especially if they drink some water or fruit juice immediately following it. However, giving medications to babies can be a challenge, as they spit out the dose. Thus, administering the medication on the anterior surface of the tongue should be avoided, as this facilitates the baby to spit it out. Also, giving the medication in a posterior place of the tongue may induce choking. The most suitable technique is to use a syringe and to drive the flow of the medication towards the middle part of the hard palate. The medication will fall on the middle-posterior surface of the tongue and will be swallowed.

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