No doubt Dr. Aziza, my pediatrician as a kid, was a nice man. But my main memory of him, 50 years later, is of having a tantrum and having to be dragged into his office when I realized I was going to get a shot. Seriously, I still have a vivid recollection of my terror of that needle. (My mom probably does, too.) I used to think it was me, that I was particularly fearful of sharp objects and pain. But I now know that this is actually pretty normal. What we healthcare providers like to call “iatrogenic pain,” which is a typically obscure way of saying “pain caused by us,” is a significant problem in pediatrics. Even the youngest infants not only have a predictable negative physiologic response to things like needle sticks, but they have lasting effects as well, including aversion to subsequent healthcare encounters and behavioral distress. In other words, when providers do nasty things to kids – and needle sticks for immunizations and blood draws are the most common nasty thing we do – kids get scarred by it and act out. (Sound familiar, mom?)
Fortunately, awareness of this problem is growing, and many people are doing something about it. I am proud to note that Children’s Minnesota has developed what we call the “Comfort Promise.” This is a commitment to offer all children and families at least one of several evidence-based interventions to minimize the pain of needle sticks when they come to our hospital or clinics. These interventions include topical numbing medicine, positioning, and behavioral soothing measures. For young infants, sugar water is also offered.
It does take a little extra time and effort for staff. But when surveyed, children and families said needle pokes were the most unpleasant part of coming to the hospital. So living up to our values “Listen, Really Listen,” and “Kids First,” in the past couple of years we’ve managed to do this for over 90% of patients in the hospital, and we are now spreading it out to the outpatient clinics.
Now if only we could do something about those nasty swabs to test for strep throat….
Starting With Curious 