This document discusses different pain management techniques for children, including relaxation, distraction, guided imagery, and massage. Guided imagery involves having a child visualize positive images to help relax their mind and body. It is most effective for children who are cognitively developed enough to engage their imagination. Massage can also help relax muscles and relieve stress through gentle touch. Both guided imagery and massage are meant to be complementary to pharmacological therapies for pain management in children.

1. Steering in a Different Direction Norma Scobie

2. Brain storm Relaxation Breathing / Massage Distraction Bubbles Toys / books Visualization /Guided Imagery Pain Switch

3. RELAXATION massage Breathing Exercises Bubbles (add guided imagery)

4. Distraction Pop-up books Interactive story telling Bubbles Toys especially interactive

5. Imagery “ Engaging the child’s imagination & concentrating on a specific event to modify a particular response” (Doody et al., 1991) “ The internal experience of an event without the external stimuli” (Zahourek, 1988) Flow of thoughts –see, feel, smell, taste, hear (Murphy, 2001)

6. Imagery Visualize, imagine, fantasize, day-dream, pretend GI provides relaxation & distraction technique & allows child to maintain some control (Jonas et al., 1998) Cost-effective, child-controlled Most common form – worry (Rossman, 2000)

8. Imagery Preparation- realistic goals, practice Environment – quiet, undisturbed, comfort –support limbs, blanket Implementation – relaxation Evaluation – image, emphasis, timing, effect

9. IMAGERY Some limitations Requires the child to have attained cognitive dev. to engage Need to have reached pre-operational level (2-7yrs) (Whitaker & McArthur, 1998)

10. Precautions and potential problems Providing superficial relief of mental health problems Causing tension by using images that promote fear Withholding other treatment modalities Caution with delusional or hallucinating subject Contact lenses

11. Response indicators Eyes closed (not always at first) Eye movements (under closed eyes) Slowing of resps Relaxed & absence of muscle tension Speech: normal to calm with no sign of apprehension

12. Response indicators Easy flowing description of imagery Appropriateness of affect and imagery

13. Technique Rapport and trust “ I know a way that we can make this easier – Would you like to try it?” Identify interest focus – FUN Deep breaths and progressive muscle relaxation Child describes imagery

14. TECHNIQUE Inform the child as to what is happening whilst s/he is “in imagery” Reinforce and / or reframe imagery where necessary Round off imagery Count backwards 4,3,2,1 Eyes open – look at the floor then up

15. Important to realise THIS IS NOT A REPLACEMENT FOR GOOD PHARMACOLOGICAL THERAPY It is complementary

16. Imagery & massage Achieve enhanced state of health when touched in a caring way (Montagu,1986) Effect of touch provides pleasure & relaxation of mind, body & relieves stress (Rouse, 1993) Inc circulation blood & lymph, slows pulse, lowers B/P, releases muscle tension, tones & strengthens, relieves cramp(Price & Price, 1995)