Tricks for Working with Kids
Crying and screaming and biting and kicking, oh my, in the sleep lab? It seems we've had a bit of a difficult streak with the youngest of our patients. For some reason these things always seem to run in streaks.
Children in the sleep lab demand a totally different skill set than adults. My lab does about 40 percent pediatric studies, so we have lots of opportunities to excel and achieve. I once had a 2-year-old patient who was a moving target for hook-up. He was literally hanging off his dad's neck, climbing his dad like a tree to get away from me. It was hysterical. Now it's laugh-out-loud funny but then not so much. I also had a 3-year-old child once who ran and crawled under the bed to get away from me. Her parents were unable to coax her out for hook-up. She would only come out when no tech was in the room.
Most pediatric studies are not so dramatic. Older children are generally cooperative and are able to follow instructions. Babies up to 2 years of age for the most part are not misbehavors. They are too young to understand and if you don't hurt or scare them you can fare pretty well. It's that tricky age range from 2 to 4 where the drama lies. In the past month one tech was kicked and bitten on separate occasions by different kids. I felt so bad for her and thanked God it wasn't me.
What are we to do when faced with these difficult kids? Well there is no hard and fast rule but I do have a few tips based on my experiences. I also would highly recommend reading the article "Making Polysomnography More Child Friendly: A Famil-Centered Care Approach" by Elizabeth K. Zaremba, et al, from the department of pediatrics, University Hospitals of Cleveland, Case University School of Medicine, Cleveland, Ohio. It is brief but one of the best approaches I've seen for coping with peds in the sleep lab. It mirrors the way we practice in my lab. Some tips:
1) Do scatter a few toys on the bed along with the wires & things needed for hook-up. It definitely changes the mood of the room and brightens the child's view immediately upon entering. I have seen it time and again. It is worth the effort.
2) Do encourage the child to play with the wires and become familiar with them.
3) Do encourage the parents to make a game of it and keep the atmosphere playful if possible.
4) Be prepared to take a break or two when/if the child becomes cranky.
5) Do encourage parents to hold infants/child during hook-up.
6) I frequently ask if anything 'hurts" and if everything is "ok" just to give the child the opportunity to supply feedback and talk with me and address any issues right then.
7) When all else fails or I see the child is most likely not going to be able to cope with the hook-up procedure, I assure the parents that we are making every attempt to help the child cooperate/tolerate the procedure but that in the end if we can not get past hook-up then we will reschedule and try again another night. Once I have this conversation it alleviates some tension and things often go a little better. We rarely have to send a child home for intolerance or bad behavior. I believe attitude is half the battle.