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IntroductionWhenever a child is acutely sick or

injured, the impact is rarely isolatedto the child. It often ripples to theimmediate family and other closecaregivers. This “family unit” is anextension that includes the patientand deserves special thought andunderstanding during healthcareteam interactions. Done poorly, theycan inflame the situation and worsenthe experience and outcome for thepatient and family unit. Done well,they can make the encounter pain-less. Healthcare professionals whocare for that child can also be affected

by the episode. EMS providers havewide variations in comfort level andstress dealing with children and thoseconcerned for them. The purpose ofthis article is to introduce principlesand considerations for interactingwith pediatric patients during EMScare to help these encounters go moresmoothly.

General PediatricCommunication Principles

You probably realize first impres-sions can set the trajectory for theentire call. Anticipate the impressionof your uniform and appearancethrough the eyes of a scared child,babysitter, or parent. For example,EMTs who wear a dark uniform with avest, badge, and sturdy belt can beeasily mistaken for a police officer.Children may think your presence

means they’re in trouble rather thanto help them with their illness orinjury. Similarly, are police routinelypresent on your scenes? Defuseanxiety by letting them know they are

there to keep everybody safe ratherthan having the child nervous andworried about having done some-thing wrong. Your carriage, attitude,behavior, and honesty set the tone,rapport , trust , and cooperationhealthcare professionals will experi-ence downstream. It takes less effortto establish trust and sustain rapportin the beginning than rebuild it later,after it’s been lost.

Non-verbal children respond tosoothing voice. Just think of thegentle manner and warm voice ofFred Rogers from Mister Rogers ’Neighborhood! Use simple, age-appro-priate language.

Realize positively-oriented instruc-tions work better than language that isnegative or has punitive implication.“Hold still” works better than “don’tmove.”

Be judicious with asking permis-sion and give realistic choices whereyou can. For example, if you need toassess breath sounds, don’t ask “Can Ilisten to your breathing?” What if theysay “no”? Instead, offer the child anacceptable choice such as “I need tolisten to your breathing. Do you wantme to listen to your left or right lungfirst?”

When children have more devel-oped language skills, be honest andsympathetic. Young children areneither concerned nor understand

Interacting With PediatricPatients During Care

by Bryan Fischberg, Chris Flood-Gutierrez and Michelle Cumberby Bryan Fischberg, Chris Flood-Gutierrez and Michelle Cumber

The Gold Cross CONTINUING EDUCATION SERIESThe Gold Cross CONTINUING EDUCATION SERIES

Children may think your presence means

they’re in trouble ratherthan to help them withtheir illness or injury.

Children may think your presence means

they’re in trouble ratherthan to help them withtheir illness or injury.

After reading this article, the EMT willbe able to:

• Cite at least two common perceptionsof children receiving care;

• List a common fear held by children inmajor age groups;

• Offer at least two effective strategiesto communicate with children duringcare;

• Identify at least one method of posi-tioning children for comfort duringmedical procedures;

• Describe what a child life program orspecialist does for children in thehealthcare setting.

After reading this article, the EMT willbe able to:

• Cite at least two common perceptionsof children receiving care;

• List a common fear held by children inmajor age groups;

• Offer at least two effective strategiesto communicate with children duringcare;

• Identify at least one method of posi-tioning children for comfort duringmedical procedures;

• Describe what a child life program orspecialist does for children in thehealthcare setting.

EMT ObjectivesEMT Objectives

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rationale for the things you do. Theiranxiety is partially from the fear ofthe unknown. So, use sensorydescriptions rather than explana-tions. For example, if you’re going touse an alcohol prep, the adolescentunderstands you intend to sanitizethe skin but the preschooler justwants to know that the little clothinside the packet will feel cold, wet,and not hurt.

Help parents cope. They may feelanxious, fearful, angry, or guilty. Anyof these may impair their ability tounderstand the situation and implica-tions. Engage, explain the situation,frequently update, and reassureparents. Enlist their assistance to keepthe child comfortable and focused ordistracted, as appropriate. Empowerparents to talk, sing, and hold thechild when it doesn’t interfere withcare.

Your considerate use of languagecan make a huge difference. Use pro-nouns correctly. Don’t say “we aregoing to take our” medication whenyou really mean “I am going to give

you your medication.” Be mindful ofwords that have dual meanings. Con-sider the sentence “A nurse at the hos-pital is going to put you on a stretcherand give you IV dye.” A stretch-ersounds like a painful device throughthe imagination of a scared child. Isn’tivy (“IV”) the green stuff outside momtold me not to touch? Will I get introuble? My goldfish just died, whatdoes die (“dye”) mean?! Some otherchild-friendly language suggestionsare summarized in Table 1.

During transport offer the child asecurity object if it doesn’t get in theway of your assessment or care; e.g., afavorite toy, stuffed animal, blanket,etc. Be mindful to limit high speed,siren use, and other startling experi-ences only to those necessary, andgive warning whenever possible andpractical. If your agency offers a toy,either clean it or let the child keep itto manage potential infection controlrisks.

Major FearsTrauma and hospitalization can

illicit many fears among children andteens and can vary by age group.Infants and toddlers can respond

from separation of their parent orcaregiver so having them presentwhenever possible can be beneficial.From preschoolers to adolescentssome common fears are loss ofcontrol, mutilation or bodily injury,fear of the unknown, and death. Some

things to consider when treating achild are keeping bloody woundscovered, reassuring the child or teenthat they are ok , and explainingupcoming events with soft languageand simple terminology so that theycan understand what is going tohappen. Another common fearamong school-age children and ado-lescents is being unable to live up totheir parents expectations. So forexample if a father stresses that his 12year old son is not really hurt and tellshim to “just deal with the pain” thechild may feel ashamed if he breaksdown and cries while in the ambu-lance. Teens can also be very worriedabout their body image if it becomesaltered in any way, as well as separat-ing from their peer group. Reassuringthe child’s emotions and fears willhelp them cope with the trauma andits experience. A summary of keyfears by age group is in Table 2 (nextpage).

Considerations DuringManagement

To be most effective when dealingwith children during a trauma youshould take their age and develop-ment level into account. Being cog-nizant of the major fears that accom-pany each age group differently canenable an EMS provider to interveneappropriately. Childhood trauma hasan impact on the emotional, behav-ioral, cognitive, and social function-

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CEU Article: Child Interactions-continued from page 8

Be mindful to limit high speed, siren use,

and other startling experiences only to those

necessary, and givewarning whenever

possible and practical.

Be mindful to limit high speed, siren use,

and other startling experiences only to those

necessary, and givewarning whenever

possible and practical.

-continues on page 10

Routine Expression: Consideration and Replacement:

“Don’t move.” Negatively oriented.“This is the time to hold still.”

“This is going to hurt.” Induces an expectation of pain.“Some patients say it feels like [use a soft descriptive word].”

“Give you a shot.” “I need to give you some medicine using a small needle.”

Intravenous / IV Jargon that may be misunderstood.“A way to give medicine through a small plastic straw.”

“Flush your IV.”Jargon that may be misunderstood.“This special waterhelps keep the small plastic tube clear so it is ready for usto use the next time you may need medicine.”

“This medicine will burn.” Induces an expectation of pain.“Some children say theyfeel a warm feeling. Can you tell me how it feels for you?”

“This medicine will smell bad.”

Predisposes child for discomfort.“This medicine will smelldifferent than anything you have smelled before.”

ICU or PICUJargon misunderstood as “I see you” or “pick you.”“A place where you’ll have your own nurse and get extracare.”

Take vital signs Nothing is taken from the child.“Measure how well yourbreathing and heart are working.”

Incision or make a hole Threatens body integrity and image.“A small opening.”

Tourniquet Jargon.“Big rubber band.”

Burn May be misinterpreted as physical burn.“Sting” or “feel warm.”

Stretcher Misinterpreted as “stretch her” or child will be stretched.“Special bed on wheels.”

Table 1:

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ing of a child. These effects arestrongest for infants and youngerchildren. It is important not to mini-mize their experience with thetrauma or to presume they areresilient.

Age-Specific ApproachHere are some child development

reminders when working with kids ofdifferent ages:

Infants (0-12 months old)

Infants are controlled by theirsenses so keeping equipment warmand limiting noise can help to keepthem calm. At this age, the strongestbond is with the parent or caregiverso whenever possible have thempresent and engaged. If the parent isvery emotional and anxious theinfant will perceive the angst whichmay result in crying or fussiness.Another key factor is separation orstranger anxiety which sets inbetween 6-8 months and can

be present until almost two years ofage causing the infant or toddler tocry, become upset, get very quiet, orhide when a stranger is present.

Toddler (1-3 years old)

As infants approach the toddlerstage, their mobility and vocabularybegin to increase. By 18 months oldthey can run in a clumsy fashion andhave a vocabulary of approximately50 -75 words, which will steadilyincrease to about 200 by the age ofthree. One of the most famous wordstoddlers love to use is the word “no.”With increasing autonomy, “no” is areally strong word and a way for atoddler to exercise his independence.Although it can be frustrating to anadult, it’s a healthy and importantmilestone for toddlers and a way forthem to be assertive. During this stageof development , they often wantthings their way, want to bein control, and

won’t always share. Toddlers begin tounderstand simple time relationshipslike “after your nap,” or “in a minute.”But, at this stage, they do not appreci-

ate measures of time such as hours,days, or weeks. Egocentricity is a bigpart of a toddler’s and preschooler’scognitive development.

Preschooler (3-5 years old)

These years begin a time whenmagical thinking is flourishing—littleboys and girls become dinosaurs,princesses, and scientists; medicinecan become a magical potion; andstuffed animals and toys come alive.Through this process they test outnew identities, practice social skills,and use pretend play to make senseout of the world around them. Often,children will use magical thinking toexplain the cause of events they areunfamiliar with or frightened by aswell. For example, if a five-year old’ssister was hit by a car while riding herbicycle, the five-year-old may thinkthat he caused this to happen becausehe didn’t eat all his vegetables fordinner or didn’t clean his room whenhis mom asked him to. Children inthis age group can only see the worldfrom their point of view, and theircognitive ability is limited by egocen-trism. Other reminders that may helpwhen interacting with preschool agedchildren is that they have the ability totolerate brief separation from theirparents, they tend to ask many “why”and “what” questions, and have anawareness of body parts. Whenexplaining or answering their ques-tions, use softer language with simplevocabulary. Preschoolers can appreci-ate temporal relationships, butexpressed in simple, familiar terms.“We will be at the hospital in one DoraThe Explorer show.”

CEU Article: Child Interactions-continued from page 9

One of the most famouswords toddlers love to

use is ‘no.’ With increas-ing autonomy, ‘no’ is a

really strong word and away for a toddler to exer-

cise his independence.

One of the most famouswords toddlers love to

use is ‘no.’ With increas-ing autonomy, ‘no’ is a

really strong word and away for a toddler to exer-

cise his independence.

Major Fear Infant Toddler Pre-Schooler

School-Aged

Adolescent

Separation X XStranger Anxiety

>6-8 months

<2 years

Loss of Control X X X X

Injury andMutilation X X X

The Unknown X X X

Death X X XFalling Short of

Expectations X XAltered Body

Image XSeparation from

Peer Group X

Table 2: While many fears arebroadly common to children,this table identifies those that are key in specific age groups.

School Aged (6-11 years old)

As children approach the school ageyears they are able to use logic andstrategy for problem solving, and areable to understand the concept ofcause and effect. Once these conceptsare mastered, magical thinking willbecome less and less prevalent(towards the latter part of the agegroup). They can comprehend simplerequests, have a full awareness of bodyparts, need to know the “why’s”, andcan understand short step-by-stepexplanations. It is a good rule of thumbto use softer language and simplevocabulary with this age group as well.

Adolescent (12-18 years old)

This population can thinkabstractly. They expect adult-liketreatment desiring independenceeven though they may have child-likefears, and often pretend to know morethan they actually do. Often, they areconcerned with their own body imageand can struggle with identity, experi-ence moodiness, and have a greatneed for privacy. Within this agerange, peer groups and friends are animportant part of socialization andcan be very influential in a teen’s life,sometimes contributing to risk-takingbehaviors. Another reminder regard-ing all age groups is that under stress

all children and adolescents have atendency to regress to a younger agegroup and act out. Being patient andproviding a supportive environmentcan help the child or teen cope withthe stressful experience.

Intervening With PediatricPatients And Families

When working with pediatricpatients in the field, there are variousintervention methods to help lessentheir anxiety as well as that of familieswho are present at the scene. One of

the most important factors is to mini-mize parental or caregiver separation.Practicing family-centered care, whichmeans having loved ones close duringall experiences (when they are actingappropriately) is very beneficial forpatients, especially young children.Parents and caregivers know their chil-dren best and can be a significant helpwhile trying to calm a pediatric patientor help them cooperate with proce-dures. Especially when working withchildren who have developmental

delays or special needs, parents andcaregivers will know how to consolethem, what may agitate them, how theymay react in certain situations, andwhat will help soothe them. Simpletechniques such as speaking softly,approaching these patients slowly,dimming the lights on the ambulance,not using loud sirens, and appealing totheir unique needs are very importantconsiderations. Even asking families“what can we do to make this an easier

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CEU Article: Child Interactions-continued from page 10

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Under stress all children and adolescents

have a tendency toregress to a younger age

group and act out.

Under stress all children and adolescents

have a tendency toregress to a younger age

group and act out.

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or better experience for ...” will bemuch appreciated and help youunderstand what the patient needs.

Explaining the sequence of eventsfor parents is important to lessentheir anxiety, too. According to Baxter(2016), parents cause 17% of infant’sdistress and 53% of a child's distress.Children and adolescents can sense aparent’s anxiety; therefore it is imper-ative to help make sure they under-stand just as much as the child does. Itis important parents are kept in-formed and prepared for the nextsteps to come.

For many children, especiallyinfants through preschoolers, havinga familiar item with them is comfort-ing. These comfort items can include afavorite blanket, stuffed animal, doll,toy, or any other item the child wishesto have close to them. These items,along with their parent or caregiver,allow for something familiar in anunfamiliar environment and help tonormalize the surroundings as well.

Furthermore, when approachingchildren and adolescents, it is impor-tant to do so in a friendly, non-threat-ening way. Approach them slowly andbend down to their level, if possible.Building rapport with patients of allages is essential to develop trust andshow them that you are there to helpthem and not to hurt them intention-ally. In addition, when examining tod-dlers and preschoolers especially,examine them using the “toe to head”approach; this way they can see you atall times and understand what partyou are looking at and going to betouching. Explain what you are goingto do if you need to place your handson them and be honest; if somethingmay hurt, it is alright to tell them. Nottelling them or hiding the fact thatsomething may feel uncomfortablecan diminish the trusting relationship

you are working hard to develop withthem. It is helpful to reassure themthat they are not to blame for anyaccident or injury that has occurredand that they are not in trouble.Remember preschool children, espe-cially, use “magical thinking” tounderstand what is going on aroundthem and it is easy for them to feelguilty or shameful about what is hap-pening and feel like it is their fault.

Young children including toddlers,preschoolers, and young school agechildren specifically need simple,concrete explanations of what isoccurring and what their “job” isduring a test or procedure. They loveknowing what they can do to help! Forexample, when checking their oxygensaturation by pulse oximeter, one wayyou could approach it is by saying “weare going to place a special clip onyour finger that will light up red to seehow you are breathing. It doesn’thurt; it is only a clip. Your job is tohold nice and still.” Similarly, whenthe paramedic is placing an IV, youcan say “she is going to place a specialstraw in one of the blue lines in yourarm, called veins, so we can give yousome special drinks to help you feelstronger. You may feel a little pinch aswe place it but once the straw is in theright place, the pinch will go away.Your job is to hold nice and still.”These are two examples of simple,accurate descriptions of what a childmay experience. Should the child cryor scream it is appropriate for you tovalidate, and the child express, theiremotion. If you anticipate the child’sreaction may escalate, reinforceboundaries and expectations for theirbehavior. “It’s ok to cry or scream, butit’s not ok to bite, kick, or hurt me.”

Always remember to be honestabout what is happening, don’t givefalse promises unless you know forsure you can follow-up with it (suchas, “I will see you in the hospitallater” and then not be able to showup), and only tell a patient what theywill physically experience.

For example, if a child needssurgery, you don’t have to mentionthe breathing tube or exact details ofwhat will happen under anesthesia.You can say something along the

lines of “the doctors will give youspecial sleepy medicine so nothinghurts when they make your leg feelbetter.” As a child grows older, simpleexplanations are still beneficial,though more details can be used, ifthe patient is asking for them.

Furthermore, much considerationshould be given to respecting apatient’s modesty and privacy duringthe stressful times you are interact-ing with them. School-age childrenand adolescents specifically are twoage groups where respecting privacyis most vital for their development.Try your best to keep their bodiescovered, especially their privateparts, and only examine them if it isabsolutely needed. Include olderschool age children and teens in con-versations regarding their health andwhat they will experience. It canreduce anxiety and give them a senseof control during a situation that canbe perceived as overwhelming.

ONE VOICE ApproachWhen working with patients and

families both in the field and in thehospital setting consideration sur-rounding the environment and staffpresent to assist should also be made.To create a less frightening environ-ment, the ONE VOICE approach wasdeveloped for healthcare profession-als to use during tests or medical pro-cedures. Each letter of this acronymrepresents a different part of the envi-ronment to be mindful of duringthese stressful instances. Here is whateach letter signifies according to ONEVOICE 4 Kids, LLC (1996):One voice should be heard during

procedure Need parental involvement Educate patient before the proce-

dure about what is going to happenValidate child with words Offer the most comfortable, non-

threatening position (see Figure 3)Individualize your game plan Choose appropriate distraction to be

used Eliminate unnecessary people not

actively involved with the proce-dure

When members of the healthcareteam utilize the ONE VOICE

CEU Article: Child Interactions-continued from page 11

For many children, especially infants

through preschoolers,having a familiar item

with them is comforting.

For many children, especially infants

through preschoolers,having a familiar item

with them is comforting.

approach during medical procedures,the patient and family usually have amuch better experience and anxietyis often lessened. It can be traumaticto have many different staff membersin a room around a child doing oneprocedure or test which oftenbecomes very chaotic with multiplepeople speaking at once. When theONE VOICE approach is utilized, oneperson is responsible for speaking inthe room and only a minimal amountof people are present. The environ-

ment overall is much calmer for thepatient and they are usually morecooperative as well. If the scene is notso well-regulated, consider applyingONE VOICE for assessments or pro-cedures in the ambulance where youmight have more control.

Here is a link demonstrating theeffectiveness of using the ONEVOICE approach during an IV place-ment on a child: http://www.youtube.com/watch?v=2IdwPFyAuDg

Positioning For Comfort In the early 1980s, child life special-

ist Mary Barkey and Barbara Stephens,RN pioneered comfort positioningtechniques in the hospital settingafter observing how children wereoften brought into a room without afamiliar caregiver and held down bymultiple staff members for medicalprocedures. These were ultimatelytraumatizing experiences for themand their families (Child Life Council,20 08). They developed a ComfortMeasures Model for healthcare staffto use that included preparation forthe child and family prior to the testor procedure, utilizing the ONEVOICE approach, positioning thechild in the least threatening way(usually sitting up), and having the

child choose an engaging distractiontechnique (Child Life Council, 2008).The goal of this model is to increasethe comfort and cooperation of pedi-atric patients while performing testsand procedures. Comfort positionsprovide an active role for the care-giver during this stressful time andallow the child to be either in theircaregiver’s lap or next to them for

comfort. Examples of comfort posi-tions are shown in Figure 3.

Distraction Boxes In TheAmbulances

Many people will ask how they canmake the ambulance ride to the hos-pital more child-friendly. Here is how:distraction boxes! Boxes containing

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With the ONE VOICEapproach, one person isresponsible for speakingin the room and only a

minimal amount ofpeople are present.

With the ONE VOICEapproach, one person isresponsible for speakingin the room and only a

minimal amount ofpeople are present.

Figure 3:

items such as stickers, stress balls,bubbles, glitter wands, Play-Doh®,small infant rattles or toys,portable DVD player with DVDs,and even an iPad with commongames to play or Netflix availableto watch (if you can!). (See Photo 4.)These all help to enhance a child’sride to the hospital by making itmore engaging and fun if they areawake and appropriate for theseitems. Other times, simple com-munication about the child or adoles-cent’s life aside from the incident thatbrought them into your care is also agreat distraction for the ride.

What Is A Child Life Specialist? Child life specialists “are trained

professionals with expertise inhelping children and their families

overcome life’s most chal-lenging events” (Child LifeC ouncil , 2017). They helpexplain tests, procedures,surgeries, and diagnoses topatients and families usingdevelopmentally-appropri-ate terminology and realmedical equipment whilehelping to normalize thehospital environment topromote the most effectivecoping during such stressfultimes in their lives. “Using

therapeutic play, expressive modali-ties, and psychological preparation asprimary tools, in collaboration withthe entire health care team and family,

child life interventions facilitatecoping and adjustment at timesand under circumstances thatmight otherwise prove over-whelming for the child” (AmericanAcademy, 2014).

Child life specialists alsoprovide bereavement support forpatients and families, as well aslegacy building and memorymaking activities at the end of lifefor pediatric patients. Childrenprocess information aroundthem very differently from adultsand have unique needs for man-aging a hospitalization, stress,and trauma (Child Life Council,2017). Child life specialists under-stand these distinct needs andwork with patients and families toprovide the most positive experi-ence while hospitalized.

Child Life Specialists In TheEmergency Department

When a patient is brought tothe hospital, most of the timetheir first experience is in theemergency department. In somecases, their experience may beginin the trauma bay which isanother overwhelming experi-ence on its own. Child life spe-cialists working in the pediatricemergency department help alle-viate fears and misconceptionspediatric patients and familieshave while they are hospitalized.This serves to normalize the

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Photo 4:

Distraction BoxDistraction Box

Which NJ Hospitals Have A Child Life Program?

The Association of Child Life Professionals (ACLP) isthe national organization for the child life profession.The following is an alphabetical list of NewJersey hospitals with ACLP-registered child lifeprograms. This list may not represent all of thefacilities with programs.1 Bristol-Myers Squibb Children’s Hospital at

Robert Wood Johnson University Hospital2 Children’s Hospital of New Jersey at

Newark Beth Israel Medical Center3 Children’s Regional Hospital at Cooper4 Children’s Specialized Hospital at New

Brunswick and Mountainside5 Clara Maass Medical Center6 Englewood Hospital and Medical Center7 Goryeb Children’s Hospital at Morristown Memorial8 K. Hovnanian Children’s Hospital at Jersey Shore

University Medical Center9 Overlook Hospital

10 Saint Barnabas Medical Center11 St. Joseph’s Children’s

Hospital12 The Children’s Hospital at

Saint Peter’s UniversityHospital

13 The Joseph M. SanzariChildren’s Hospital at HackensackUniversity Medical Center

14 The University Hospital15 The Unterberg Children’s Hospital at

Monmouth Medical Center 16 Virtua Voorhees17 Voorhees Pediatric Facility

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environment and make it a less trau-matizing experience. When a pedi-atric patient is brought in as a trauma,if appropriate, the child life specialistwill be next to the patient explainingwhat is happening and helping tomake it a less traumatizing experi-ence. If the patient is too ill or uncon-scious, the child life specialist willprovide support to the family duringthat time.

ConclusionWe hope you have a greater aware-

ness of the issues and broader set oftools to deal with pediatric patients. Ittakes practice for these considera-

tions and practices to become naturaland habitual for most of us. But ,applied correctly, you can improvethe quality of care you bring to chil-dren and lessen the stress on theirfamilies and yourself in the process.

Bryan Fischberg , NRP is an EMSEducator for the Mobile Health Service atRobert Wood Johnson University Hospitaland Clinical Instructor in the Department ofEmergency Medicine at Rutgers-RobertWood Johnson Medical School. He is a LifeMember of, and acting EMS Chief for,Pennington Road First Aid Unit in the9th District.

Chris Flood-Gutierrez, MA , CCLS,CHTP is Child Life Coordinator for theBristol-Myers Squibb Children’s Hospital atRobert Wood Johnson University Hospital.Ms. Flood-Gutierrez has extensive experi-ence in the pediatric intensive care unit andperioperative settings.

Michelle Cumber, CCLS, CEIM is aChild Life Specialist for the Bristol-MyersSquibb Children’s Hospital at Robert WoodJohnson University Hospital. She primarilypractices in the pediatric emergency depart-ment.

ResourcesAmerican Academy of Pediatrics

(2014). Child life services, 133(5). Retrievedfrom http://pediatrics.aapublica-tions.org/content/133/5/e1471.full

Baxter, A . New and novel – addressingpediatric needle pain [PowerPoint Slides].Retrieved from It takes a vil lage:Comprehensive collaborative care childlife conference 10/14/16 at theChildren’s Hospital of Philadelphia.

Child Life Council (2017). Retrievedfrom www.childlife.org

Child Life Council (2008). Comfortmeasures for invasive procedures: A majorparadigm shift in pediatric practice. TheBulletin, 26(3), 1-16.

ONE VOICE 4 KIDS, LLC (19 96).ONE VOICE: Creating a less threateningenvironment for children undergoing medicalprocedures. Retrieved from http://www.onevoice4kids.com/

UF Health (2017). Nonpharmacologicmanagement of pain. Retrieved fromhttp://pami.emergency.med.jax.ufl.edu/e-learning-modules/non-pharmaco-logical-treatment-of-pain/#prettyPhoto

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The child life specialistwill be next to the

patient explaining whatis happening and

helping to make it a lesstraumatizing experience.

The child life specialistwill be next to the

patient explaining whatis happening and

helping to make it a lesstraumatizing experience.