Sometimes children or young people find aspects of their hospital visits challenging, uncomfortable or distressing. They may express this in ways including becoming anxious, crying, shouting or physically resisting staff. This is not only distressing for them, but also for parents and carers, and staff attempting to carry out treatment or consultations. Children and young people can be helped through painful or difficult procedures with support, including distraction and play.
This page from the play team at Great Ormond Street Hospital (GOSH) describes how we work with you to distract your child and some of the distraction techniques we may use.
Distraction is an approach that helps a child or young person cope with an invasive procedure or if they are facing a difficult experience in the hospital. It can also be helpful if a child is in pain or discomfort. Health play specialists (HPS) use distraction with the aim of taking your child’s focus away from a procedure (or their pain). They do this by creating a relationship of trust with a child and by helping them to concentrate on something else instead. There are various methods of distraction – some are very simple to do and others need more practice.
What happens before distraction therapy can start?
At GOSH, qualified health play specialists (HPS) usually carry out distraction during procedures, although any member of staff who has had training from the Play team can do it.
Before the procedure starts, a HPS will spend time with you and your child to get to know them better. The HPS will explain what will happen during their procedure. The HPS may use a doll, pictures, DVDs, books or real medical equipment to explain further. This also allows us to find out if there is a particular aspect of the procedure worrying your child. Some children are particularly afraid of needles, for example, whereas other children may have questions about anaesthetics.
It is important for us to know if your child is anxious about a procedure. It is also important to know if they have had a difficult or distressing experience before – at GOSH or at another hospital – so that we can be mindful of this when we plan how to help and support them.
Once we know a little more about your child, the HPS will be able to decide which particular type of distraction may suit them and the procedure they are facing.
The HPS will also work with you and your child and the medical team to see if an element of choice can be brought into the procedure. Offering choice can allow a child or young person to feel that they have an element of control over their situation. Choices that may be available to children attending GOSH might include choosing which hand a blood sample is taken from or being able to make a choice around the colour of a plaster cast
You might find it helpful to make a plan with your child for a reward or positive experience after the procedure has finished. This reward could be something small, such as a sticker or a balloon or just a big hug. Alternatively, you might plan for something larger such as an outing or a toy. Rewards can be useful for providing a focus for what happens after a procedure and thinking or talking about this can be a distraction in itself.
Types of distraction
There are many approaches and activities that health play specialists use as distraction during procedures or stressful times in hospital – some are more suitable for younger children, others work better for teenagers. Some are noisy or busy activities, some are quiet and more focussed. The key element with all distraction techniques is the connection between a child and an adult helping them, whom they trust.
- Books – All sorts of books can be used for distraction – the type depends on your child’s age. Some books are designed to encourage children to focus on looking for characters or items within their pages. Younger children may enjoy a pop-up book or a musical book. Older children or teenagers may prefer to listen to a story on a CD or audiobook app.
- Games – Many different games are suitable for distraction, but the procedure and setting need to have been considered and the game will need to be appropriate for your child’s age. Simple board games can be use where space allows. Younger children may prefer ‘I spy’ or simple counting or memory games, whereas older children or teenagers may be happier with a game on their phone or tablet.
- Music – Listening to or singing a favourite song can be used successfully with all age groups. Choosing some music to share or listen to can give children a sense of control. There is also ‘therapeutic’ music that may be available that use sounds from nature that may have a calming effect.
- Touch and feel toys – These are suitable for all ages and can be helpful for children with special needs. Playing with textured toys like squashy plastic balls or their own cuddly toys can be helpful. Toys that are engaging and attractive to look at, such as those with mirrors or LED lights, can also work well.
- Messy play – This approach is less commonly used during procedures but can be helpful to distract a child from anxiety or pain, for example, after surgery. Painting, drawing, water play or manipulating dough or slime can be very calming.
- Make believe or ‘small world play’ toys – These can work very well with younger children who can use them to act out a story during the procedure. Hand or finger puppets, dolls, soft toys, small figures or toy cars can all be used.
- Controlled breathing – This can be used for all ages and may involve blowing-up an imaginary balloon or keeping a feather up in the air. Other things can also be used to help children focus on their breathing, like party blowers or bubbles. Older children might want to just concentrate on how their breathing feels.
- Coaching/talking – Older children and teenagers may prefer to talk through the procedure as it happens, or they might prefer someone to talk with them about things that interest them. By concentrating on keeping the conversation flowing, their thoughts might be distracted from the procedure itself.
- Guided imagery – This is specific form of distraction, for which some health play specialists have undergone training, used to give the child an alternative focus, as well as elements of relaxation, choice and control.
During the procedure
To be ready for a procedure you, your child and the health play specialist (HPS) will decide on a method of distraction. Other things may be discussed including any pain relief that will be used or the position that your child will need to sit in.
During the procedure it is important that the HPS is able to take a lead in trying to distract a child. If lots of other people are also trying to talk to or distract them, it can become very noisy and chaotic which can become overwhelming and distressing for children. If this happens, distraction is less likely to be helpful for everyone involved.
After the procedure has finished, the HPS will discuss with you and the team, the type of distraction therapy that was used and whether it has worked well or not. This will be useful for planning future procedures.
What happens if distraction therapy doesn’t work?
Distraction is not an exact science. There are many variables in invasive procedures and hospital visits. Distraction is not always helpful for every child or may be more effective on some occasions compared with others.
If a particular type of distraction technique does not work for your child, health play specialists are willing and able to consider, plan and try (and keep trying) alternative activities or options.
Some children find it extremely difficult to divert their thoughts away from a procedure, no matter what else is happening around them. In these situations, a different approach is sometimes needed, or some additional planning with nursing or medical colleagues, you and your child.
Sometimes it is necessary to take a break from a procedure and try again later. This will depend upon the nature and urgency of the procedure. Taking a breather and some ‘time out’ – preferably away from the treatment area – can give your child a chance to calm down before trying distraction again, with continued support from the health play specialist. The professionals involved in caring for your child will talk to you about what is happening, what has to happen and what might best for your child is any plans for a procedure need to be changed.
In the longer term, sometimes play specialists may advocate for involving another therapeutic professional (such as a psychologist or music therapist) in helping children to cope with procedures or experiences they find very challenging.
How can I help my child?
You can help by supporting your child and encouraging them during distraction. If you are worried about the procedure yourself (some parents or carers have their own anxiety about needles, for example) it may help you to focus on the distraction too.
If you think you may be too anxious or upset to help your child, sometimes it is better that you are not in the room when a procedure is happening. Please talk to the play specialist or your child’s nurse if this is the case.
After the procedure, your child will need lots of praise, even if they were distressed. Focus on any aspects that your child managed well, such as staying as still as possible or joining in with a game or conversation. Ask your child what helped or did not help this time.
It also helps us if you tell us anything that has helped or worked well for you and your child previously, so that we can try to repeat these for future appointments.
Can I use distraction at home?
Yes, you can. Distraction approaches can be very useful if your child needs to have treatment at home or before visits to the dentist or other events that may become stressful. Talk to the health play specialist and watch the ways that they prepare and help your child using distraction. He or she will be able to suggest ways you can incorporate distraction approaches and activities into future hospital visits.