Lessening the Pain through Play – RCEMLearning India

Authors: Jo Anderson, Laura Burton / Editor: Charlotte Davies, Liz Herrieven / Reviewer: Lauren Williams / Artwork: Seb and Alexander Burton / Codes: / Published: 01/06/2021 / Reviewed: 26/11/2024

Visiting hospital can be scary at any age. Facilitating a positive hospital experience for children is particularly important as many of them will require further hospital attendances and treatments in their lifetime. Therefore, where possible, we want children to have a positive association with interacting with healthcare professionals.

pencil outline of a yellow oblong coloured in with crayon or pencil. A sad face in the middle.

The application and use of enjoyable physical and mental activities (play), enables us to engage childrens interests and distract children from what is happening around them. Play can provide many benefits it reduces stress and anxiety, can be used to aid communication and can be a highly impactful, non-pharmacological tool to distract from the pain and distress caused by injuries or procedures.

Lessening the pain through play. Introduces normality in a strange environment. Lessens the impact of pain and anxiety. Yields results- assessment, treatment and recovery is faster and shorter stay in hospital. Allows the child to work through feelings and fears to make the hospital experience positive.

The RCPCH suggests that “Every department for children should have access to a play therapist”.

Do you work in a child friendly department and a child friendly environment?

Does your department encourage play? Does it offer a range of recreational activities for different ages e.g. books, magazines, toys? Have you painted some colourful walls or ceiling murals or put up posters, and ceiling mobiles? Older children may prefer a different environment is there a separate area for them featuring more age-appropriate decorations and activities? Can you create different coloured lighting or different levels of brightness? Do you have appropriate furniture?

One picture of room with superman and spiderman on the wall. Child's drawing of a leopard. Third picture with text prompts saying Pencil outline of a face with sound waves projecting

Children who are neurodivergent, have a learning disability or complex needs. Some children are particularly sensitive to the noise and stress of an emergency department. This cohort of patients will particularly benefit from strategies to aid with sensory regulation, processing information and deescalating any challenging behaviours. Is there a quiet area where patients with sensory-processing difficulties can wait to be seen? Can play be incorporated to reduce anxiety levels or help improve communication? RCEM have recently produced a Learning Disability Toolkit which explores this further.

Pain Management

What if they ask if its going to hurt? Be honest but dont frighten them. That means dont say they wont feel a thing, when you know theyll feel pulling as you pull the sutures through. Phrases like Some children say they feel can something, but some children dont feel anything at all. Why dont you tell me what it felt like after weve finished?. Whether this is an examination or a procedure, tell them what is going to happen and, if you can, show them. Some pictures might be useful. Demonstrate using the unaffected limb or on a toy, or you could tell a story to help explain. Involve them and make your examination fun for them play a game. More recently, virtual reality has been shown to be a highly effective method of play distraction in older children and adolescents. Gain their trust by examining the uninjured limb first. Leave the more distressing parts til last. Be adaptive and flexible in your approach.

children's drawings of health care professionals Alongside distraction, you can reduce childrens discomfort during procedures with the use of local anaesthesia or analgesia (Emla or Ametop, tetracaine cold spray, sucrose). They may not even know you are doing the procedure!

child reading book with play therapists whilst venepuncture performed

Distraction

Distraction is a form of play therapy. Distraction can help children and young people manage their emotions and stress. Distraction can alleviate anxiety, which in turn helps you to complete your clinical assessment, perform investigations and provide optimal treatment. Although initially you may think it means, distract yourself with this, so that I can do this, it actually is much more than that. Its more about focusing your energy on something else to redirect away from upsetting emotions. Think about how children work themselves up when you are going to put in a cannula, if you leave them to dwell on those upsetting feelings, they reach a peak and it is difficult to return from that. However, if you are able to re-direct their attention to something else, then the only true pain is that fraction of a second when the cannula goes in, if even that.
blue speech bubble containing Hopefully you now recognise that there are many different ways in which you can help to improve a child’s experience in your emergency department. Whether this is on a departmental level improving the environment by offering visual, auditory and physical distractions, or on a personal level engaging the child in play or discussion.