Positioning and Restraining Children for Procedures

Positioning and restraining children during medical procedures is essential for safety, accuracy, and emotional comfort. The goal is to minimize movement while reducing fear and distress. Here’s a structured overview:

General Principles

• Explain the procedure to both child and caregiver in age-appropriate language.
• Use comfort positioning whenever possible to reduce the need for physical restraint.
• Involve parents or caregivers as active participants to help calm and secure the child.
• Administer analgesia or sedation when appropriate to minimize pain and anxiety.

Comfort Holds (per CHOP guidelines)

• Chest-to-chest: Toddler sits facing caregiver, arms wrapped around caregiver’s back.
• Back-to-chest: Older infant or preschooler sits on caregiver’s lap, back against chest.
• Side-sitting: Child sits sideways on caregiver’s lap, one arm around caregiver’s waist.

Preparation Of Child and Parents

• Provide careful explanation and preparation beforehand.
• Provide support and simple guidance during the procedure.
• Administer adequate analgesia and sedation to minimize pain and need for excessive restraint.
• Encourage parental participation to ease anxiety.

1. Jugular venipuncture (For infants and young children)

• Place the child in a mummy restraint in which the top edge of the restraint is low enough to permit access to vein.
• The child is placed so that the head and shoulders extend over the edge of a table or a small pillow. With neck extended and the head turned sharply to the side.
• Alternate method for restraining arms and legs is with the parent holding the child’s arms and legs at the same time that the child’s head is restrained and positioned.
• Maintain control of the child’s head without interfering with the approach to the vein.
• After venipuncture, digital pressure is applied to the site with dry gauze square for 3-5 minutes or until bleeding stops
• Care must be taken not to apply excessive pressure that must compromise circulation or breathing during and after the procedure.

2. Femoral venipuncture:

•  Place the infant in supine with legs in a frog position to provide easy exposure of the groin area.
• Control the arms and legs of infant by the nurse’s forearms and hands
• Uncover only the side used for venipuncture. This protects the staff if the child urinates during procedure.
• Apply pressure to the site after withdrawal of blood to prevent oozing from the site.

3. Extremity venipuncture

• Position the in the child on parent’s lap Pen with child facing the parent and in the straddle position
• Place the child’s arm for venipuncture on a firm surface like treatment table, for support and on top of a soft cloth/towel.
• Have an assistant immobilize the arm/ have parent do this.
• Allow the parent to hug the child around the body to bold the child’s free arm.
• Place the child’s legs between the parent’s legs.
• If child must main supine, have the parent on one side of the bed and lean over the child’s supper body to apply restraint wing the hand to hold the arm for the venipuncture

4. Lumbar puncture

• In neonates, a side ling position with modified neck extension is appropriate because it causes less distress among neonates
• In children side-lying position with head fieved and knees drawn up toward the chest.
• Child is placed on the side with the back close to the edge of the examining table on the side from which physician is working.
• Maintain the child’s spine in a flexed position by holding the child with one arm behind the neck and other be
• In infants, sitting position is used.
• The child is placed with the buttocks at the edge of the table and with the neck flexed so that the chin rests on chest or the nurse’s arm.
• The infant’s arm and legs are in mobilized by the nurse’s hands.

5.Bone marrow aspiration

Positioning for a bone marrow aspiration depends on the location of the chosen site.

• Posterior illac crest:
• Place the child in prove position.
• Place a small pillow or folded blanket under the hips to facilitate obtaining the bone marrow specimen
• Administer adequate analgesia/anaesthesia, but if child awakens, immobilize the child by one person holding the upper body and second holding the lower extremities.

6. Otoscopic examination.

        There are two positions

• Child is seated sideways in the parent’s lap with one arm “hugging” the parent and other arm at side. The ear to be examined is toward the nurse with one arm the parent holds the child’s head firmly against his/her chest and with other arm hags the child (Fig. 3.128). Place the child on the side, back or abdomen with the arms at the side and the head turned so that the ear to be examined points towards the ceiling.
• Lean over the child and use the upper part restrain the arms and upper trunk movements of the body

7. Examination of mouth

• Place the child in supine position with arms extended above the head.
• Ask the parent to hold the arsis of the child.
• Have the child open the mouth and examine.

8.Testicular examination

• Place the child on examination table in taler position, which stretches the cremasteric muscle and prevents its contraction.
• Makar the child flexes his lower limbs and abduct the knees so that the feet meet together.
• Palpate and examine for existence of two testes.

Special Considerations

• Avoid excessive pressure that could impair circulation or breathing.
• Use minimal restraint necessary for safety.
• Always monitor for signs of distress or discomfort.
• Document the position used, who assisted, and the child’s response.

REFERENCES

1. Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
2. Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
3. Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
4. Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
5. Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
6. Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
7. AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884

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