Children with cancer endure many needle-based procedures that can be unpleasant, scary, and painful – causing anxiety in the child and their family. Allowing your child to have some control over such needle-based procedures can go a long way in helping them cope with their pain and anxiety.
In this blog we will discuss how you can use Topical Anesthetics and Distraction to help manage your child’s needle pain.
“It is important for parents to be informed so they can focus on the role that they can play in their child’s pain management. Advocating for their child to minimize their pain and discomfort, be it physical or psychological, is critical and should not be minimized by the clinical care team.” ~ Jonathan Agin, Bereaved Parent/Advocate
Using Topical Anesthetics
by Janessa DeCoste, RN, Nursing Coordinator, Kids Cancer Care
It’s 9:00 am on a busy day in the pediatric cancer clinic; six-year old Bobby and his mom arrive to check in for their scheduled chemotherapy. I greet them and chat with Bobby about the latest superhero toy that he’s holding in his hands. After we are settled in the clinic I complete my initial assessment and ask the list of questions. Any fevers? Any unusual rashes? How is your appetite? Have you been going to the bathroom? And then finally I ask okay are you ready for your port access? A look of pure panic comes over Bobby’s face, and at the same time mom realizes that they forgot to apply topical anesthetic cream on Bobby’s port (we call it “freezie cream” with the kids, sometimes it’s called numbing cream) before they left for the clinic so that it would be properly numb before the port access.
What should I do?
Should I apologize and say, “I’m sorry – but we have to get started as soon as possible, and we really don’t have time to wait for the anesthetic cream to set in.”
Or do I reassure the family and say, “Okay let’s get this cream on as soon as possible and then we can access your port once the cream is ready. I will call Jenna from Childlife to help us.”
I quickly weigh the options in my head and make the call to go with the second one.
As I relay my suggestion to Bobby and his mom to apply the anesthetic cream and that I will call Jenna from Childlife to help with the procedure, a look of pure relief comes over their faces. Today they remain in control of this small decision in a bigger battle.
Topical Anesthetics: A Brief Overview for Parents
The following are a few options for topical anesthetics that may be utilised to help numb the area and decrease the pain where the needle will be placed:
- Anesthetic patches and creams like EMLA™, Maxilene™ and Ametop™. In order to be effective, these products have to be applied 30-60 minutes before the painful procedure. Parents can purchase these over-the-counter at most pharmacies.
- Topical vapocoolant (cooling/numbing) sprays (e.g., Pain Ease™), available in some hospital settings, are applied to the skin immediately prior to procedures. Parents can ask their health care provider if this is an appropriate option and if it is available to them.
- Parents should ask their health care providers about any other medications, anesthetics, or sedation that might be appropriate for the procedure.
In the event that there may not be time to wait for topical anesthetics to be fully effective, there are a variety of other options that can be used to help with the pain associated with the needle injections.
- Buzzy® is an alternate way to numb the site where the needle injection will take place by using a technology called “gate control theory”. Using the body’s own nervous system, the gate control theory invokes the concept that the final common pathway for sharp pain to the brain can be shut out by the nerves that transmit cold and vibration senses. This in turn helps to dull or eliminate the pain.
- Distraction, positioning, hypnosis, and touch can be helpful non-pharmacological interventions.
By Jenna Schwanke, CCLS, Outreach Specialist & Certified Child Life Specialist, Kids Cancer Care
I head to the clinic to help with Bobby’s port access, I remember him from his last chemo treatment. I recall Bobby being a curious little guy; during his last port access he wanted to know everything that was happening and watched the whole thing so I grab my doll and port access kit as well.
“Hi Bobby! I’m Jenna – remember me?”
Right away I see that mom is flustered and looks a little anxious as the morning hasn’t gone exactly as expected. Bobby is sitting on his mom’s lap, looking equally anxious. My first goal is to help calm both Mom and Bobby. While Bobby is still on his mom’s lap I pull out my deep breathing dragon and get mom to demonstrate how to take five deep breaths. As Bobby physically feels his mom taking these deep breaths and feels her body relax, I see him relax a bit too. Once they appear to be physically a bit calmer, I get out my doll and ask if Bobby remembers what a port access is.
“NO” he yells and buries his face in his mom’s shoulder.
Bobby is not curious about the procedure today. I encourage mom to keep taking deep breaths and to talk to him calmly.
I pull out three toys from my bag – an iPad, bubbles, and a story book. Once mom places him on the bed, she asks him to choose what he would like to do – he chooses the iPad. I help him and his mom find a game to play together.
Distraction: A Brief Overview for Parents
Distraction can be a successful way for you to minimize the pain and distress of needle-based procedures for your child with cancer. There are a number of key factors that play a role in the success: 1) child’s age 2) child’s coping style and 3) the person who is helping to distract the child (e.g., a parent or “moderator”).
Having developmentally appropriate distractions is really important in being able to help your child cope with the procedure. Here are some examples:
- 0-12 months: soft music, rattles, soothing voice/touch, swaddling, cuddling
- 1-3 years: bubbles, sound/pop up books, musical/light up toys, blowing pinwheel, singing, storytelling, holding hands, comfort positioning
- 3-5 years: bubbles, I Spy books, watching movies, music, squeeze toys, singing, storytelling, counting, comfort positioning, interactive games or apps
- 6-12 years: I Spy books, watching movies, electronic games, music (using headphones), jokes/riddles, squeeze toys, bubbles, counting, deep breathing, imagery
- 13-18 years: Watching movies, music (using headphones), electronic games, reading, squeeze ball, deep breathing, imagery, muscle relaxation
Know Your Child’s Coping Style:
It is also very important to take into account your child’s coping style and interact with your child accordingly. Here is one way to differentiate coping styles:
- “Sensitizers” are children who feel more in control and comfortable if they can watch the procedure and know exactly what is going on.
- “Avoiders” are children that would prefer to be distracted and ignore the details of what is happening.
These preferences are not set in stone; be aware that your child can change their preference from day to day.
Tips for the Parent / Moderator:
Children are like sponges and pick up on the feelings of those around them, particularly their parents. Using a calm voice, taking deep breaths and keeping your body relaxed can both physically and emotionally decrease the distress in your child, and allow for the distraction techniques to successfully help them through the procedure.
Follow us on social media using the hashtag #KidsCancerPain.
Together, we are “Making Cancer Less Painful for Kids”.
Janessa DeCoste, RN, Nursing Coordinator, Kids Cancer Care
Janessa is the nursing coordinator with Kids Cancer Care located in Calgary, Alberta. She coordinates the medical and nursing aspects associated with camp and community programs for children affected by childhood cancer and other hematological disorders. Most of the year-round work she does focuses on ensuring that Kids Cancer Care engages in best practices in the field of pediatric hematology and oncology in a unique setting. She loves having the opportunity to see children and their families outside of the clinical setting not only surviving, but thriving.
Jenna Schwanke, CCLS, Outreach Specialist & Certified Child Life Specialist, Kids Cancer Care
Jenna is a family outreach specialist and Certified Child Life Specialist with Kids Cancer Care located in Calgary, Alberta. She spends her days planning and overseeing safe and fun programs and activities for families in Calgary who have been affected by childhood cancer. She loves being able to provide these programs, as it helps provide respite for those on a tumultuous cancer journey. It never ceases to amaze her how many inspiring kids and parents she has met along the way.
Jibb, L. A., Nathan, P. C., Stevens, B. J., Seto, E., Cafazzo, J. A., Stephens, N., … Stinson, J. N. (2015). Psychological and Physical Interventions for the Management of Cancer-Related Pain in Pediatric and Young Adult Patients: An Integrative Review. Oncology Nursing Forum, 42(6), E339–357. https://doi.org/10.1188/15.ONF.E339-E357