The Power of Distraction
Jack loved to play “I Spy.” Jack was fully engaged in a game when it was time for him to receive his pediatric immunization. There were no tears, only a slight glance toward the poke when the needle went in.
One important tool used with children to make procedures more comfortable is the technique of distraction. Distraction diverts attention away from a stimulus (like a painful procedure) onto the source of distraction. Distractions come from both external sources (physical stimuli through the five senses) and internal sources such as thoughts, emotions, fantasies and physical urges.
Distraction is caused by one of the following:
· greater interest in something other than the object of attention
· great intensity, novelty or attractiveness of something other than the object of attention
Just how does distraction work? It is believed that the brain has a limited capacity to focus attention on stimuli. Using up attentional resources through distraction leaves less room to focus on the painful stimuli. Distraction is particularly appealing because it can be easily administered at the right time and in a cost-effective manner.
Types of distraction
Distraction works when the stimulus adequately engages the child’s attention. Watching a movie, counting, singing, listening to music, playing video games, blowing bubbles, playing with toys, reading books, playing games and telling or reading a story are familiar ways to provide diversion. You will engage the child when you offer choices for distraction before starting a procedure. Keep in mind that too many demands, or too much distraction, for a child’s attention during a procedure may be counterproductive.
One Voice
Hearing more than one voice can be confusing and chaotic; each person has to speak louder to become heard, which leads to increased noise levels. One voice should be designated to do the speaking during a procedure. This one voice can be the MA, Nurse, Provider or Parent, etc.
When to use distraction
Distraction was found to lower children’s behavioral distress during both the anticipatory (something is about to happen!) and post-injection recovery phase (something just happened!) Interestingly, distraction was not helpful when the procedure took place. Use distraction during and after the poke/procedure to speed recovery and decrease the memory of pain. Distraction at the end of a poke or procedure has proven to be especially effective.
Distraction with props
· Cards – ask child to look at laminated cards and locate objects you describe.
· Bubbles – have parent blow bubbles asking the child to watch the path, color and size of the bubble.
· Counting – engage child in counting objects from distraction cards.
· Color light – ask child to look at colorful, swirling light.
· Bravery stickers – at the end of the procedure, provide the child with a sticker to put on Poke-A-Dot or in the Poke Plan Passport.
Distraction without props
· Colored Cloud - the child holds a big breath, and then imagines breathing a color out with the procedure. Try sky writing or aiming puffs at imaginary targets.
· Touch - a parent touches the child’s uninvolved arm, directing them to concentrate on these sensations.
· Tell a story – ask the child to fill in the details: What color is the castle? what kind of pet?, what animals are in the king’s barn?
· Counting – engage the child in counting objects (dots, ceiling tiles, letters in a sign).
· Trace – trace a letter or number on the child’s arm or leg and ask child to guess what letter or number was traced.
You can read more about age-appropriate distraction by reviewing the handout entitled “Helpful Tips for Caregivers.”
Parents or Caregivers as Coaches
Parents are often present to watch a poke or procedure and find it stressful and difficult to console their child. Children do not have as many coping resources as adults and benefit from adult instruction and encouragement to help them cope. You have witnessed to how parental behavior makes a difference in a child’s pain level and pain expression!
Children pick up on the feelings of the people around them, especially a parent, the most important person in a child’s world. The way parents act during a child’s procedure is significantly related to the amount of pain and distress the child experiences. Children whose parents provide distraction are less distressed and that is why it is important to engage parents as coaches.
Children benefit from adult instruction and “coping-promoting behaviors” like humor, commands to use coping strategies and talking about something other than the procedure. In contrast, empathy, criticism, apologies, giving control to the child and reassurance have been linked with increased child distress and are referred to as “distress-promoting behaviors.”
Now that you’ve learned about the importance of distraction and utilizing parents as coaches, provide parents with a specific task/role during the procedure when appropriate. Training parents in behavioral techniques that promote coping is very important. Not only does this education provide them with skill that can be used at the present time but it can be utilized in subsequent procedures.
1/5/11 Owner for ACS: