
                         Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: TUESDAY, November 7, 1995                   TAG: 9511070028
SECTION: EXTRA                    PAGE: 1   EDITION: METRO 
SOURCE: JANE BRODY
DATELINE:                                 LENGTH: Medium

KIDS' IMAGINATION HELPS THEM HANDLE PAIN

Mary Kachoyeanos and Margaret Friedhoff, nurses who specialize in the management of pain at Children's Hospital of Wisconsin in Milwaukee, have found that helping children to cope with pain gives kids a sense of mastery and self-control that they can apply to other stressful situations as well as to future health problems involving pain.

Experts in controlling pain in children condemn the common practice of restraining children who resist painful treatments. Restraint, they say, only increases a child's anxiety and fear and the stressful reactions induced by pain, which in turn can complicate and delay recovery.

While most people think first of drugs to curb or prevent the perception of pain, children are often highly responsive to pain-control strategies that involve their imaginations and sense of play.

The Milwaukee nurses, who summarized their findings in the journal Maternal-Child Nursing, point out that not only are these methods completely safe and effective, but they also ``cost nothing to implement and actually save staff time.''

Behavioral and cognitive methods can also be used as supplements to drugs, reducing the amount of pain medication needed to comfort the child. Many of the techniques the Milwaukee nurses describe can also be applied by parents both in medical settings with the aid of health professionals and on their own at home when a child is in pain.

Some of the most effective methods for minimizing children's pain capitalize on a child's natural imaginative skills and high degree of suggestibility. These approaches usually work with children 3 years old and older.

The simplest technique is to distract the child from the pain by telling a story, either with the child or to the child.

A young child can often defuse momentary pain, like that associated with an injection or removal of a wound dressing, by turning off an imagined ``pain switch'' just as the child might turn off a light switch.

Or the child might ``blow away the pain.'' The child is taught to blow out as hard as she can at the first sensation of pain, which distracts the child by forcing her to concentrate on responding to the pain signal.

Another method for calming a child who faces a painful experience is controlled breathing: The child is taught to take slow deep breaths through the nose and then to let the breath out slowly, through pursed lips.

Children are very susceptible to the power of suggestion, which makes the ``magic glove'' technique especially effective. An imaginary glove is placed on the child's hand, finger by finger. Then the child is told that the glove can help to lessen the discomfort of a medical procedure. If pain is widespread, a ``magic blanket'' might be used to cover the painful area.

A related technique, tactile transference, is already likely to be used in its most basic form by most parents, who would naturally try to comfort a child by touching or stroking him.

In a more sophisticated form, the child's hand is stroked at the same time as the parent or health professional strokes the area where pain will be inflicted, for example where a needle is about to be inserted.

The child is told that when the needle goes in, the child's hand will be stroked. The child is usually able to transfer the soothing experience of the hand stroking to the area where the pain is actually being inflicted.

``Active distraction'' techniques include having the child blow bubbles or count the tiles on the ceiling or the instruments in the examining room. Grasping a comforting parent's hand is also helpful if the child is told to squeeze hardest when it hurts the most.

Behavioral techniques enable children to work through an anticipated painful or anxiety-provoking medical procedure before undergoing it. These methods can be used alone or in conjunction with the cognitive methods described above.

The Milwaukee nurses point out that ``there is no exact recipe'' for helping children through a painful experience, nor are the techniques they suggest always limited to a particular age group. For example, they say they have successfully used the magic-glove technique with preschoolers, school-age children and adolescents.

Sometimes trial and error is necessary for finding the most effective techniques for a particular child. But, the nurses say, one or more nondrug methods will be found to help a child in any situation. And the rewards of using these methods are considerable, they add.

by CNB