Postprocedural support

      • Postprocedural support
        • Encourage expression of feelings
          • Playing with medical objects provides children with the opportunity to play out fears and concerns with supervision by a nurse or child life specialist
        • Positive reinforcement
          • Children need to hear from adults that they did the best they could in the situation—no matter how they behaved. 
          • It is important for children to know that their worth is not being judged based on their behavior in a stressful situation. 
            • Reward systems, such as earning stars, stickers, or a badge of courage, are appealing to children.
        • Play activities for specific procedures
          • Fluid Intake
            • Make ice pops using child’s favorite juice.
            • Cut gelatin into fun shapes.
            • Make a game out of taking a sip when turning page of a book or in games, such as Simon Says.
            • Use small medicine cups; decorate the cups.
            • Color water with food coloring or powdered drink mix.
            • Have a tea party; pour at a small table.
            • Let child fill a syringe and squirt it into mouth, or use it to fill small, decorated cups.
            • Cut straws in half, and place in a small container (much easier for child to suck liquid).
            • Use a “crazy” straw.
            • Make a “progress poster;” give rewards for drinking a predetermined quantity.
          • Deep Breathing
            • Blow bubbles with a bubble blower.
            • Blow bubbles with a straw (no soap).
            • Blow on a pinwheel, feather, whistle, harmonica, balloon, or party blower.
            • Practice band instruments.
            • Have a blowing contest using balloons, boats, cotton balls, feathers, marbles, ping-pong balls, or pieces of paper; blow such objects on a tabletop over a goal line, over water, through an obstacle course, up in the air, against an opponent, or up and down a string.
            • Suck paper or cloth from one container to another using a straw.
            • Dramatize stories, such as “I’ll huff and puff and blow your house down” from the “Three Little Pigs.”
            • Do straw-blowing painting.
            • Take a deep breath and “blow out the candles” on a birthday cake.
            • Use a little paint brush to “paint” nails with water and blow nails dry.
          • Range of Motion and Use of Extremities
            • Throw beanbags at a fixed or movable target or throw wadded-up paper into a wastebasket.
            • Touch or kick Mylar balloons held or hung in different positions (if child is in traction, hang balloon from a trapeze).
            • Play “tickle toes;” have the child wiggle them on request.
            • Play Twister game or Simon Says.
            • Play pretend and guessing games (e.g., imitate a bird, butterfly, or horse).
            • Have tricycle or wheelchair races in a safe area.
            • Play kickball or throw ball with a soft foam ball in a safe area.
            • Position bed so that child must turn to view television or doorway.
            • Climb wall with fingers like a “spider.”
            • Pretend to teach aerobic dancing or exercises; encourage parents to participate.
            • Encourage swimming if feasible.
            • Play video games or pinball (fine motor movement).
            • Play hide and seek: hide toy somewhere in bed (or room if ambulatory), and have child find it using specified hand or foot.
            • Provide clay to mold with fingers.
            • Paint or draw on large sheets of paper placed on floor or wall.
            • Encourage combing own hair; play “beauty shop” with “customer” in different positions.
          • Soaks
            • Play with small toys or objects (cups, syringes, soap dishes) in water.
            • Wash dolls or toys.
            • Pick up marbles or pennies* from bottom of bath container.
            • Make designs with coins on bottom of container.
            • Pretend a boat is a submarine by keeping it immersed.
            • Read to child during soaks; sing with child; or play game, such as cards, checkers, or other board game (if both hands are immersed, move board pieces for child).
            • Sitz bath: Give child something to listen to (music, stories) or look at (View-Master, book).
            • Punch holes in bottom of plastic cup, fill with water, and let it “rain” on child.
          • Injections
            • Let child handle syringe, vial, and alcohol swab and give an injection to doll or stuffed animal.
            • Draw a “magic circle” on area before injection; draw smiling face in circle after injection but avoid drawing on puncture site.
            • If multiple injections or venipunctures are planned, make a “progress poster;” give rewards for predetermined number of injections.
            • Have child count to 10 or 15 during injection.
          • Ambulation
            • Give child something to push:
              • Toddler: Push-pull toy
              • School-age child: Wagon or a doll in a stroller or wheelchair
              • Adolescent: Decorated intravenous (IV) stand
            • Have a parade; make hats, drums, and so on.
          • Extending Environment (e.g., for Patients in Traction)
            • Make bed into a pirate ship or airplane with decorations.
            • Put up mirrors so that patient can see around room.
            • Move bed frequently to playroom, hallway, or outside.


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