Pediatrics : Guided imagery

        • Guided imagery
          • Assist the child in an imaginary experience
            • Including as many senses as possible (e.g., “feel the cool breezes,” “see the beautiful colors,” “hear the pleasant music”).
          • Have the child describe the details and write down or record scripts
          • Encourage child to concentrate only on the pleasurable event during the painful time; enhance the image by recalling specific details by reading the script or playing the tape.
          • Combine with relaxation and rhythmic breathing
        • Positive self-talk
          • Have the child say positive things during a procedure or painful episode
            • “I will be feeling better soon,” or “When I go home, I will feel better, and we will eat ice cream”).
        • Thought Stopping
          • Identify positive facts about the painful event (e.g., “It does not last long”).
          • Identify reassuring information (e.g., “If I think about something else, it does not hurt as much”).
          • Condense positive and reassuring facts into a set of brief statements, and have child memorize them (e.g., “Short procedure, good veins, little hurt, nice nurse, go home”).
          • Have child repeat the memorized statements whenever thinking about or experiencing the painful event.
        • Behavioral contracting
          • Informal: May be used with children as young as 4 or 5 years of age:
            • Use stickers or token as a reward
            • Give time limits for the child to cooperate
              • Give a child who is uncooperative or procrastinating during a procedure a limited time (measured by a visible timer) to complete the procedure.
              • Proceed as needed if child is unable to comply
            • Reinforce cooperation with a reward
          • Formal: Use written contract, which includes the following:
            • Realistic (seems possible) goal or desired behavior
            • Measurable behavior (e.g., agrees not to hit anyone during procedures)
            • Contract written, dated, and signed by all people nvolved in any of the agreements
            • Identified rewards or consequences that are reinforcing
            • Goals that can be evaluated
            • Commitment and compromise requirements for both parties (e.g., while timer is used, nurse will not nag or prod child to complete procedure)
        • Containment
          • Swaddle the infant
          • Place rolled blankets around the child 
          • Maintain proper positioning
        • Nonnutritive sucking
          • Offer pacifier with sucrose before, during, and after painful procedure
          • Offer nonnutritive sucking during episodes of pain
        • Kangaroo care
          • Skin-to-skin contact between infants and parents
        • Complementary and alternative medicine
          • Classifications of CAM are grouped into five classes
            • Biologically based: foods, special diets, herbal or plant preparations, vitamins, other supplements
            • Manipulative treatments: chiropractic, osteopathy, massage
            • Energy based: Reiki, bioelectric or magnetic treatments, pulsed fields, alternating and direct currents
            • Mind-body techniques: mental healing, expressive treatments, spiritual healing, hypnosis, relaxation
            • Alternative medical systems: homeopathy; naturopathy; ayurveda; traditional Chinese medicine, including acupuncture and moxibustion


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