Publicly available online educational videos regarding pediatric needle pain: a scoping review.

OBJECTIVES: The objectives of this scoping review were to: (1) identify publicly available educational videos on needle pain management; and (2) evaluate the content of these videos. METHODS: Reviewers screened publicly available educational videos on pediatric needle pain management available on YouTube and Google using a broad-based search strategy. Videos were categorized using the CRAAP Test: Current, Relevant, from a trustworthy source (Authority), Accurate and evidence-based, and for what Purpose does the source exist. RESULTS: Twenty-five relevant, educational videos were identified. The intended audience for most videos was parents (n=16, 64%), followed by clinicians (n=6, 24%) and children (n=3, 12%). Common examples of needle pain included immunizations or IV insertion, with interventions appropriate for infants through school-aged children. The most frequently described techniques were parent-guided distraction and behavioral factors such as comfort holds and parent demeanor. Most videos were Current (96%), Relevant (100%), created by a trustworthy source: Authority (76%), and all were Accurate, with Purpose relating to needle pain management. None of the videos addressed the unique needs of children with a preexisting diagnosis of needle phobia. DISCUSSION: Publicly available educational videos offer clinicians, parents, and children evidence-based techniques to manage pediatric needle pain. Further evaluation is needed to determine whether this form of education meets the needs of target audiences and whether this type of content can lead to improved management of pediatric needle pain.

Parent participation in a childhood immunization pain reduction method.

OBJECTIVES: This randomized controlled trial evaluated the effectiveness, feasibility, and acceptability of parent participation (PP) in an evidence-based method to reduce the pain of prekindergarten immunizations. METHODS: Healthy children aged 4 to 6 years were randomized to a multimodal distraction method during administration of routine vaccines with PP and 1 medical assistant (experimental group) or 2 medical assistants (standard-of-care comparison group). Children and parents rated the pain after injections, and a blinded observer coded children's pain from videotapes. RESULTS: In all, 76 children participated. Despite group randomization, more children in the medical assistant-only group received a 3-injection series (25; 68%) than in the PP group (6 [15%], P = .001). After adjustment for this imbalance, child-reported pain was higher in the PP group compared with the medical assistant-only group (2.95 vs 1.75; F = 5.87; df = 1.66; d = 0.64; P < .02). There were no differences between groups for parent-reported and observer-rated measures of pain or in intervention fidelity, duration of procedure, or child or parent satisfaction. CONCLUSIONS: Although child-reported pain was higher for the PP group, the magnitude of the difference may not be clinically significant. PP was feasible and acceptable to both parents and children, did not take any longer, and reduced the need for additional medical personnel. Together, these data provide preliminary support for PP for prekindergarten immunization pain management.

Attending to suggestion and trance in the pediatric history and physical examination: a case study.

Obtaining complete information lies at the heart of accurate diagnosis in all healthcare fields. Extracting information is a time-honored purpose of the history and physical examination. Practitioners may not be aware that these functions also provide opportunities to impart positive verbal and nonverbal suggestions. Paying attention to language promotes patient self-mastery and helps forge a therapeutic alliance for successful outcomes. Principles taught in hypnosis workshops can also help the practitioner avoid negative, undermining suggestions that could diminish diagnostic and therapeutic effectiveness.

Reducing immunization discomfort in 4- to 6-year-old children: a randomized clinical trial.

OBJECTIVE: The goal was to test a multifaceted distraction method designed to reduce injection-associated pain in school-aged children. METHODS: A clinical trial evaluated 41 children, 4 to 6 years of age, who were given 3 standard prekindergarten immunizations; 21 were assigned randomly to an office routine control group, whereas 20 received a multifaceted, discomfort-reducing intervention. The intervention added verbal suggestions of diminished sensation and a visual focusing activity to the use of ethyl chloride, an established pain-reducing measure. The distraction materials used for the intervention consisted of topical ethyl chloride spray, an improvised, plastic, multipronged arm gripper, and a vibrating instrument descending on the contralateral arm, which provided the focusing task and visual distraction. RESULTS: According to patient and parent Faces Pain Scale-Revised scores and nonblinded, video-taped observations scored according to the face-legs-activity-crying-consolability method, the intervention group showed highly significant reductions in pain and discomfort, compared with the control group (patient self-report, P < .0013; parent report, P < .0002; observation score, P < .0001). CONCLUSION: This multifaceted distraction intervention reduced significantly the pain and discomfort of childhood immunizations in children 4 to 6 years of age.

Pediatric suggestions: using hypnosis in the routine examination of children.

The recognition and utilization of trance phenomena in clinical pediatrics can energize the practitioner and be therapeutically beneficial for the child. The aim of this paper is to characterize and promote the purposeful inclusion of trance and suggestion in the routine pediatric examination. This includes, but goes beyond, the child-oriented examination skills customarily associated with being a "good," child-friendly pediatrician. While this paper highlights trance recognition from a clinician's perspective, emphasis is placed on utilizing spontaneous hypnotic moments whenever they occur to further the agenda of the encounter, diminish doctor visit anxiety, enhance self empowerment, and improve the milieu for pediatric care.