Parent’s Guide to Pain Prevention

Mom, Child and PediatricianDoes this situation sound familiar?

“You have a doctor appointment for a check-up today after school.”

“Am I going to get a shot? I hate shots. I don’t think I want to go to the doctor today.”

Before the age of 2 years old, the CDC recommends children receive 24 immunizations. While this sounds like a lot of shots, and it is, immunizations are one of the Public Health initiatives that have resulted prevention of the most deaths and disability early in life.

Often children need sports physicals, annual check-ups or other appointments to ensure they are up-to-date on their health care needs. Not all of these appointments will require immunizations or blood draws, but children become focused on that task early in life.

There is a phrase in pain management that I have adopted as my personal mantra – “If you can anticipate pain, you can prevent pain.” On a daily basis I work with students, staff and families to learn how to anticipate and prevent (or reduce) pain in everyday life. Pain management is not just about medication, today there are many tools available to help control pain.

Here are some tips to prevent (or reduce) pain:

Infants

The Five S’s

  • Swaddling
  • Side/stomach position
  • Shushing
  • Swinging
  • Sucking

The Five S’s are frequently used to comfort a crying infant. Typically injections are given in the thighs and blood draws are often heel sticks in this age group. By swaddling their upper body and leaving their legs out, you can provide some comfort for the baby. Laying them on their side and shushing or singing quietly in/near their ear can also provide comfort. Allowing them to suck on a pacifier alone or with sugar water (sweet ease™), formula or breast milk can provide pain relief during the procedure. Allowing them to breastfeed during the procedure has been shown to provide great pain relief. Finally, gently swinging them after the poke can help to calm them after the procedure.  While we may not be able to use all of these techniques with every infant, think about which ones will be appropriate as you prepare for your next well baby check-up.

Older Infants to Toddlers

Music provides pain relief in a couple ways. Many times music evokes an emotional response, it can trigger memories or it can relax or excite us. Music is a great tool to use during painful procedures like needle sticks. If you have a smart phone, music can be easily found through a variety of applications, websites or music downloads. If you have ear buds available that can increase the success of relieving the child’s pain. If you do not have an electronic device, you always have your voice and your child’s voice. You might choose to sing or hum a song that is soothing to the child or you may choose one that is fun and upbeat. Once they are old enough, ask the child to sing along and tap the beat with their finger, hand or toes. The more you involve them, the more successful the music will be!

Toddlers through Teenagers

Distraction is a big word for dividing someone’s attention from one task to multiple tasks. Take the child’s attention off the object of pain (needle poke) and distract them with something fun. The items that can be used for distraction are almost limitless – books, movies, games, applications, and other toys.  You can bring a book with you that your child has not seen recently, or a new book they have never seen.  While you read to them, ask questions about objects on the page. If you forget to bring a distraction item, most clinics that cater to pediatric patients will have something available that you can borrow.  Look around the room you are in – is there a picture you can ask your child about? Or a fish mobile to have them watch? Do you have a cell phone with applications the child likes? Are there books or magazines in the waiting area they can bring with them to read during the procedure? Use your imagination; unless you are in a solid white room, the available distractions are limitless!!

Buzzy Bee

A final option to consider is Buzzy Bee. It works by using cold and vibration to make temporary changes to the central nervous system that works to prevent the pain signal from getting through to the brain. It is cute and fun to look at, so it also provides some distraction. Many clinical sites at UW Health have Buzzy Bee available.

During September, Pain Awareness Month, we will be selling Buzzy Bee in the outpatient pharmacies and at the Gift Shops. Look for one at a site near you. If you cannot find one locally, Buzzy can be purchased at www.buzzy4shots.com.

Remember, if you can anticipate pain, you can find a way to prevent it, or at least decrease the amount of pain your child experiences.

What are some ways you comfort or distract your child during needle pokes?

Parent’s Guide to Pain Prevention
About Peggy Riley, RN, MN, MPH
Peggy Riley has been a Pain Clinical Nurse Specialist for 6 years and a Pediatric Pain Clinical Nurse Specialist for the last year. She is passionate about partnering with patients, families and staff to achieve the best pain relief for each person.

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What Parents Should Know About Enterovirus D68

Sick BoyParents have been seeing a lot in the news this week about Enterovirus D68 (EV-D68), the virus that has been causing respiratory illness in several states primarily among children, and even hospitalization among kids with severe symptoms. What symptoms should parents look for? And what can parents do to help prevent infection?

Here are answers to some common questions about Enterovirus D68:

Q. What are enteroviruses? Why is this one special?

A. Enteroviruses are common viruses that can cause a number of different viral illnesses, colds, diarrhea, meningitis, etc. This particular one is not seen very often and is associated with prominent respiratory issues – breathing fast and wheezing – that is not common with the typical cold illness.

Q. Since kids with asthma and other respiratory issues seem to be more susceptible to Enterovirus 68, can parents of kids with these issues take any preventive measures?

A. Hand hygiene (frequent hand washing) is important, as is avoiding exposure to others who are sick. Exposure to smoke makes everything worse.

Q. Does the flu shot protect against Enterovirus 68?

The flu shot protects against the flu. EV68 is not the flu virus. But it’s still a good idea to get the flu shot as soon as it becomes available. (Call your child’s UW Health clinic to schedule an appointment, or if you have MyChart, you may schedule online.)

Q. What symptoms should parents look for, and when should they see a doctor or seek emergency care?

A. Parents should look for cold-like symptoms. Seek care when your child is having breathing difficulty, or is breathing fast, not getting air, or wheezing.

Additional Resources

You can learn more about the Enterovirus through the following resources:

What Parents Should Know About Enterovirus D68
About Nasia Safdar, MD
Dr. Nasia Safdar is a UW Health infectious disease specialist and UW Hospital medical director of infection control.

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Four Steps to Foster Resiliency in Kids

Mom and Teen TalkingWe want to raise children who are resilient and can adapt well in the complex and sometimes challenging world we live in, but they don’t become this way automatically. There are four basic steps parents can focus on to help their kids cope effectively with difficult situations they will encounter whether in school or as they navigate social interactions with peers.

Validate feelings

Keep open lines of communication with your children. One way to do this is when they share a worry or upset, don’t immediately discount their concerns by saying things like, “don’t worry,” “don’t be upset,” “you’re not scared,” or “everything will be fine.” They may be worried about facing bullies or feeling “uncool,” or trying to cope with academic pressure or managing relationships with peers. Remember to validate the experiences and emotions by saying something simple like, “it’s okay to be afraid, a lot of kids experience this too” or “it makes sense you would feel upset.” And then pause, listen and give them space to share their thoughts. This helps them feel safe and comfortable to talk with you and more likely to discuss challenges and difficulties in the future.

Help them learn to problem-solve

There are always going to be obstacles to overcome and challenges to face. Maybe it is peer pressure to do something like shoplift at the mall. Or, it could be watching peers treat another student poorly. Take the opportunity to create teachable moment to help your children learn critical thinking and resourcefulness through problem-solving. Remember, it’s not about you solving the problem for them. It means helping them think of ways to solve their own problems. You could say, “Let’s think of some ways you could handle this situation” or “if someone says a mean thing, how could you react?” It’s ideal if they can generate some solutions, but sometimes you can also offer different options and ask, “What do you think might happen if….?” This also gives you an opportunity to teach them life skills of how to cope with any difficult situations they may encounter in the future.

Practice relaxation and mindfulness together

It is a stress filled world and it’s never too early to introduce children and teens to mindfulness techniques they can use to calm and center themselves. For kids, it’s not necessarily about establishing a formal practice. Instead, it’s about learning simple exercises to help when they are feeling anxious or stressed. Check out these exercises especially for kids from UW Health’s mindfulness instructors.

Encourage compassionate self-talk

Many kids struggle with negative thoughts and self-criticism. Parents can help their kids build a positive sense of self. Focus on their strengths more than on their shortcomings. Help them focus on their positive attributes and the good aspects of a situation. Communicate that you see what is right with them, no matter what they have done in the past, no matter what problems they are currently facing. Your belief in your child’s capacity to handle any difficulty is a powerful one. Share it with them and give them a lot of positive attention when they do manage something difficult. This helps children believe in themselves and builds up a supportive inner dialogue.

While it can be challenging to get kids to open up and talk with you, you can try a few different strategies to help. Make family meals a priority to help create a calm, relaxed space where you and your child can talk about the day.

Many parents of teens also find that car rides, even just to run errands, create an environment where kids may open up more and not feel “put on the spot.” And when your kids finally do open up, try to remember to remain neutral, even if your child tells you something that may be upsetting. Kids, especially teens, may be reluctant to share in the future if you react strongly when they do. Keeping calm and non-judgmental during the conversation can help create a sense of trust that you’ll listen and hear what they’re saying. That’s not to say there shouldn’t be consequences if their actions or behavior warrant it. But, set the stage for that conversation to be had at a later time.

Helping kids develop deep, strong roots now will carry them successfully and independently into the future. And remember, if your child shows signs of anxiety over a longer period, or even show a change in behavior or personality, don’t hesitate to seek professional help.

Watch my recent interview on this topic from NBC 15.

How do you help your child build a positive sense of self?

Four Steps to Foster Resiliency in Kids
About Shilagh Mirgain, PhD
Dr. Shilagh Mirgain, PhD, is a health psychologist with UW Health

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Teen Moods: Angst or Depression?

Teen Angst or DepressionThe hormone highs and lows that are associated with adolescence can cause mood highs and lows. Adolescence is a time of experimentation, changing relationships, and finding your own identity; sometimes this is accompanied by conflict (i.e. lots of family arguments).  How can you tell the difference between normal teen moodiness/angst and a more serious mental health disorder, like depression?

Depression can present in many different ways, and it may vary from how it presents in adults.  For example, recurrent ailments like headaches and stomachaches which have no physical cause can sometimes be the result of depression.  The official diagnosis of depression requires more than two weeks of depressed mood (sounds like most teens, eh?) or a loss of interest or pleasure in daily activities.  The key is that the mood represents a change from the person’s baseline and causes significant impairment in function (either social, occupational, or educational). According to the Center for Disease Control and Prevention’s national survey Youth Risk Behavior Surveillance (YRBS), 28.5% of high school students felt sad or hopeless almost every day for 2 or more weeks in a row so that they stopped doing some usual activities during the 12 months before the survey.

Other signs/symptoms that health care providers look for (and you can look for too) include change in weight or appetite, change in sleep, fatigue or loss of energy, feelings of worthlessness, and decreased concentration.  Some specific warning signs you should keep an eye out for and seek help immediately include:

  • Withdrawing from family and friends, and spending a lot of time alone.
  • Dangerous use of alcohol or other drugs.  Although experimentation is common, substance use in combination with mental health disorder can lead to increasing risk taking behaviors.
  • Concerns about self-injury and suicide.  Specific things to look for include off-hand comments about death/suicide or giving away possessions.

A special note on suicide:  Suicide is the third leading cause of death of teenagers nationwide, behind unintentional injuries and homicide. According to the YRBS, 15.8% of high school students seriously considered attempting suicide, 12.8% made a plan about how they would attempt suicide, and 7.8% attempted suicide at least once in last year. Risk factors for suicide include: prior suicide attempt, family history of suicide, substance use, social isolation, and easy access to lethal methods like firearms. LGBTQ youth are also at high risk.

What’s a parent to do?

Regularly ask your teen questions about their feelings, school, and activities.  If you notice a change in mood or behaviors, acknowledge it and ask if there is anything you can do to help.  Do not judge them if it is a small thing causing them distress.  Let the teen know that, no matter what, you are there to support them.

If you think your teen is having depression or another mental health disorder, contact his or her health care provider. If you are concerned about suicidal behavior, this is a medical emergency and you should go to the nearest emergency department.

Have you noticed changes in mood or behavior of your teen?

 

Teen Moods: Angst or Depression?
About Paula Cody, MD, MPH
Dr. Paula Cody is fellowship trained in adolescent medicine and is a pediatrician at the UW Health John Stephenson Teenage and Young Adult Clinic.

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Thanks for Sharing (Giveaway)

This giveaway is no longer accepting entries. Congratulations to our winner Barb! 
ss_156891005_surveyThere’s just one more week left before school starts for most kids in Wisconsin. We hope you enjoyed reading the tips, recipes and advice from our experts this summer.

This summer you contributed over 230 comments! We enjoyed reading your suggestions for best place to hike and your family’s favorite things to grill. Here were a few of our favorite comments from readers:

On ways to beat boredom and summer anxiety Barbara shared:

Our favorite boredom buster is playing active family games with a funny flair like 1 handed croquet or kids vs adults ladder ball.

On being grateful for summer Rachel wrote:

So grateful to be able to spend time with my kids this summer. We do something together everyday, from hiking to playing checkers. Time is going so fast, enjoy those small moments in life.

On transitioning to high school from middle school, Holly commented:

This is a helpful article – I wish I would have information like that last year.  :-) My son was a freshman and we were expecting the worst, but were pleasantly surprised to find out that high school was much better for him in many ways!

For our final giveaway this summer, we want to hear your suggestions for improving our blog, what you topics you want to know about and how we can make next year even better.

Take our 9 question survey and we’ll choose one winner to receive a $50 Amazon gift card.

And just because it’s time to go back to school, doesn’t mean the fun stops here. We’re busy getting new topics ready to share with you this fall. Our e-newsletter will switch back to a monthly digest. You can visit the blog anytime or get daily updates from us on Facebook or Twitter. We hope you will continue to share your comments throughout the year.

Smiling Sun

Enter this week’s giveaway

Take our survey and we’ll choose one winner to receive a $50 Amazon gift card.
Prize: 1 $50 Amazon gift card
Rules: Giveaway closes on Sunday, August 31, 2014 at 11pm CST. Open to Wisconsin, Iowa and Illinois residents only. One entry per email address is permitted. The winner will be selected using random.org and announced on the following Monday as an update to this post. Winner will be notified via email and asked to provide a mailing address to receive the prize; if the winner does not respond within 7 days, the winner forfeits the prize and another winner will be selected. Subscribe to the blog and you’ll get new posts delivered to your inbox as soon as they’re posted.

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