Guidelines for Reducing Pain and Anxiety in Pediatric Emergency Medical Procedures

Reducing Pain and Anxiety in Pediatric Emergency Medical Procedures

In July 2025, the Journal of Emergency Nursing published significant new clinical practice guidelines by the Emergency Nurses Association (ENA) aimed at enhancing the care of pediatric patients undergoing needle-related procedures. This development is crucial, considering that around 35 million visits to emergency departments (ED) in the U.S. in 2019 were by children aged 17 and under, many of which involve needles that can instill fear, anxiety, and distress.

The guidelines, titled Interventions to Reduce Needle-Related Pain and Distress in Pediatric Patients, emphasize the necessity of effective pain management, which has often been found lacking in the treatment of young patients. The process of receiving medical attention should not add to their stress; thus, the document offers various evidence-based recommendations designed to mitigate the experiences of fear and discomfort.

Key Recommendations

1. Parental Involvement: Encouraging a parent to hold their child during procedures can provide comfort and a sense of security, helping to ease anxiety.
2. Distraction Techniques: Engaging children through distracting methods, like the use of toys, virtual reality, or storytelling, can significantly reduce pain perceptions.
3. Topical and Transdermal Anesthetics: Applying numbing creams prior to procedures or using transdermal patches can effectively manage pain at the site of needle insertion.
4. Cold Application and Vibration: Localized cooling methods, such as ice packs, accompanied by vibrational techniques, can minimize discomfort during notice.

Anna Valdez, PhD, RN, PHN, CEN, CFRN, CNE, FAEN, FAADN, the Editor-in-Chief of the Journal, stressed the importance of these resources being readily available to nursing staff. "This guidance allows nurses to deliver care informed by evidence, which is essential in the ED setting," Valdez emphasized. Furthermore, equipping parents with this knowledge prepares them to support their children effectively during stressful moments, especially in emergency scenarios when an intravenous (IV) line may be necessary, and the child is apprehensive.

Joint Position Statement on Intraosseous Access

Alongside the new clinical practice guideline, the ENA has also revised its joint position statement with the Infusion Nurses Society regarding the role of nurses in using Intraosseous Vascular Access Devices (IO VADs). This procedure is vital when conventional IV access is difficult or impossible to achieve due to the patient's condition. Proper training and standardized protocols are essential for emergency nurses to utilize IO VADs efficiently, facilitating quicker administration of medications and fluids during critical situations.

Conclusion

Improving pediatric emergency care necessitates a shift towards recognizing emotional and physical pain management strategies. The latest offerings from the ENA highlight a focused effort to create a smoother and less distressing experience for children receiving emergency treatment. Future articles in the Journal delineate broader topics, from staffing impacts on emergency department burnout to practical guidelines for minimizing nonemergent visits. By integrating informed practices alongside compassionate care, the medical community can profoundly impact pediatric health outcomes.

For more details, visit Emergency Nurses Association.