State of the art pain management in the 21st century demands that pharmacological management must be combined with supportive and integrative (non-pharmacological) therapies to manage a child’s pain. At our department we are using physical methods (e.g. cuddle/hug, massage, comfort positioning, heat, cold, TENS), cognitive behavioral techniques (e.g. guided imagery, hypnosis, abdominal breathing, distraction, biofeedback) as well acupressure and aromatherapy.
For “needle-pokes” (vaccinations, blood draws etc.) for instance we expect that kids are sitting upright (use sucrose in the age group 0-12 months), that we numb their skin with topical anesthesia (e.g. EMLA-patch, LMX 4% lidocaine patch, or J-tip) and use distraction, such as bubble blowing or blowing a pin wheel. Alternatives can be apps on your smartphone etc.
My personal favorite remains teaching children in self-hypnosis. However, in addition, I use in my clinical practice (inpatient, clinic and home visits) increasingly Apps on my iPhone or iPad:
My Top 10 Apps for Pain & Symptom Management in Children
#10 Chalkboard: Drawing on a realistic chalkboard with different color chalk – much more fun than it sounds. [$ 1.99] https://itunes.apple.com/us/app/real-chalkboard-hd/id455186311?mt=8
#9 Talking Tom: This is a cat that repeats everything you say in a funny voice. You can then record and share videos and send them by eMail / YouTube / Facebook. Kids really enjoy that they can make Tom the cat say funny stuff… [free] https://itunes.apple.com/us/app/talking-tom-cat/id377194688?mt=8
# 8 Simply Being: Provides relaxation, stress relief and benefits of meditation without prior experience. It allows the child/teenager to choose from 4 meditation times and gives them the option to listen to the guided meditation with or without music or nature sounds. Kids can also listen to the music or nature sounds alone. More for older children and teenagers. [$ 0.99] https://itunes.apple.com/us/app/simply-being-guided-meditation/id347418999?mt=8
#7 Drums: As the name implies, this is a drum kit. Great for kids with too much [or too little] energy. Rock on! [$ 0.99] https://itunes.apple.com/us/app/drums!/id311549739?mt=8
# 6 Tesla Toy: Tesla Toy is a fun interactive “particle toy”. When the fingers touch the screen they generate what looks like a powerful electrical field that makes the thousands of particles react beautifully.
Kids (& adults) are often mesmerized by this app for a long time. [$ 1.99] https://itunes.apple.com/us/app/tesla-toy/id395767185?mt=8
#5 Fruit Ninja: A “juicy” action game with squishy, splatty and satisfying fruit carnage! [$ 0.99] https://itunes.apple.com/us/app/fruit-ninja/id362949845?mt=8
#4 Koi Pond: One is gazing into a pond of crystal clear water with fish, turtles and more. Kids run their fingers across the cool surface of the pond and water ripples away from their touch.
The koi fish, disturbed, dart away… only to quickly forget and swim close once more… [$ 0.99] https://itunes.apple.com/us/app/koi-pond/id286420263?mt=8
#3 Easy Bake Treats: This is a highly recommended app. It let’s children make, bake, decorate, eat and share virtual cakes, cupcakes, cookies, cake pops and pizza. They pick their mix, fill the pan with batter and water, mix it all together and slide the pan into the virtual oven to cook. Then they can add candles to their cakes and cupcakes too! Candles can be lit and re-lit for even more fun!
Once they’ve baked and decorated their treats, kids can show off and share their delicious virtual creations with family and friends via email or Facebook. Highly addictive – kids can spend a very long time on this! [free] https://itunes.apple.com/us/app/easy-bake-treats!/id462795218?mt=8
#2 The Healing Buddies Comfort Kit™ app provides an interactive, virtual way for kids and teens to engage with the latest in integrative medicine techniques and activities to assist in the management of symptoms they may be experiencing.
Kids and families are increasingly interested in options to improve health and wellness that involve taking fewer pills and that involve supporting their body’s natural, internal healing systems. -combining kid-friendly activities and pre-recorded audio exercises and instructions that teach self-care skills. The Healing Buddies Comfort Kit™ (mobile app for iPad, iPhone and iPod Touch platforms) offers an interactive, virtual way for kids and teens at home, in a doctor’s office, or in the hospital, to learn and immediately benefit from self-care techniques to manage common symptoms like pain, worries, nausea, fatigue and trouble sleeping.
The Healing Buddies Comfort Kit™ contains several integrative medicine techniques adapted for use by children and teens that are quick and effective for symptom control so kids can get back to doing what they like to do–and need to do each day. The techniques included in this mobile app are designed by leaders in the field of Pediatric Integrative Medicine (Physicians, Nurses, Psychologists and Child Life Specialists) and have been tested for years in several leading Children’s Hospitals and Clinics. The app leads kids through these various techniques and activities, plus, the Healing Buddies™ make it a fun and engaging experience.
Techniques that kids will learn that are included in the Healing Buddies Comfort Kit™ include:
-Mental Imagery/Visualization: in this technique kids/teens will learn to use the power of their imagination to effect changes in physical and emotional activity.
-Relaxation Exercises: with these breathing and muscle control techniques, kids/teens will learn to calm down and balance the body and the nervous system which helps to reduce symptoms of pain and nausea, improves sleep and can have a powerful effect on controlling & even eliminating worries
-Acupressure: acupressure is part of the ancient Chinese medical system and involves applying pressure to “special points” on the body which in turn releases helpful chemicals and induces nervous system changes that can help to reduce pain, nausea, and anxiety
-Aromatherapy: aromatherapy, which involves smelling oils made from plants, has been around in most cultures for thousands of years. Smelling certain kinds of scented oils offers another tool for kids/teens to use to control unwanted symptoms/feelings
-Positive Self-Talk: this involves learning to be a “self-coach” and harnesses the power of positive thinking. [Disclaimer:
The creation of the mobile app has been a collaborative effort of my department at the Children’s Hospitals and Clinics of Minnesota with Ridgeview Medical Center and DesignWise Medical.] https://itunes.apple.com/us/app/healing-buddies-comfort-kit/id605421955?mt=8
and the winner is…
#1 Balloonimals: Absolutely groovy – kids love it! My favorite app to distract a child in pain or discomfort. Beautifully rendered balloon animals spring to life when you blow into the microphone on your iPhone/iPad or swipe with your iPod Touch. Watch the balloon inflate and then give your phone a shake to start constructing your Balloon animal. With each shake, your animal takes greater shape until… Voila! Your Balloon animal appears and is ready to play. Pet your “Balloonimal” to see what tricks it can do. https://itunes.apple.com/us/app/balloonimals/id307459878?mt=8
Also, check out the brand-new “Pain Squad” from SickKids in Toronto: http://www.campaignpage.ca/sickkidsapp/
Apps, which just did not make the list (but I still like them a lot): Art of Glow, Sand Garden, Build a Zoo, Naturespace, SkyView and Disney’s Small World
And…a groovy App just out in October 2014: Pain Squad Mobile App
The Hospital for Sick Children (SickKids) in Toronto needed to find a way to encourage their young cancer patients to complete daily reports on their pain. With a little back-up from Canada’s top police dramas, our innovative mobile app made this overwhelming task easy and fun. http://www.campaignpage.ca/sickkidsapp/
Stefan J. Friedrichsdorf, MD, FAAP Medical Director | Department of Pain Medicine, Palliative Care & Integrative Medicine | Children’s Hospitals and Clinics of Minnesota