Assess severity of the child’s illness, and determine whether there is adequate time for explanation and use of topical anesthesia. If emergent, explain procedure as it is being performed.

Assess the child and the family for prior adverse experiences during a procedure.

Assess the child for any allergies (including allergies to medication, adhesive tape, and topical solutions [e.g., chlorhexidine]); if present, initiate appropriate precautions.

Assess the child’s and family’s understanding of the procedure.

Provide developmentally appropriate teaching before procedure to the child and family (see Chapter 2).

Inform the child and the family what is expected of child during the procedure as developmentally appropriate (e.g., hold still, take a deep breath).

Explain normal and abnormal sensation that the child might experience during the procedure (e.g., the cleaning medicine will feel cold, or some children say it feels like someone is pushing on them).

If the child and/or family member is implementing the procedure, ensure an approximate length of time is provided to complete demonstration and teaching about the procedure.

Discuss any restraint that might be used during procedure (e.g., “I’m going to help you keep your hand still”) (see Chapter 96).

Inform the family that they may choose to stay with their child during the procedure. If a family member chooses to stay with the child during the procedure, it should be explained to them that their role is to be supportive to the child. Give the family member concrete interventions they can do to provide support (e.g., read a pop-up book, hold the child’s hand, sing songs, advocate for child if he or she needs a break, tell the child how much longer). Instruct the family member to inform the nurse if he or she feels uncomfortable, lightheaded, dizzy, or ill. Provide seating for the family member during the procedure if possible.

Child may be NPO (nothing by mouth) before the procedure, depending on the risk for aspiration.

Assess the young child for self-comforting behaviors, or ask the family what the child generally does to self-comfort. Ask the older child, using developmentally appropriate terminology, what comforts him or her (e.g., “If you are scared, what helps you to not be scared?” “What helps you to calm down/feel less stressed?”). Encourage the family to promote the use of self-comforting behaviors. Provide the child and family with information about other nonpharmacologic pain-relief measures, incorporating these measures during and after procedure (see Chapters 7).

Discuss pharmacologic pain-relief measures with healthcare prescriber (e.g., topical anesthetics, local anesthetics, conscious sedation), and prepare needed equipment.

Check laboratory values before procedure, if ordered, and notify healthcare prescriber of results.

Obtain consent if indicated (see Chapter 51).

Ensure that all the equipments, including emergency equipment, are of appropriate size and are functioning properly.

Ensure appropriate place for procedure other than child’s room whenever possible (e.g., treatment room) and that child is transported to this location in a safe and age-appropriate manner.

Follow the Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery (The Joint Commission, 2015):