How to Make Your Emergency Department Pediatric-friendly

How to Make Your Emergency Department Pediatric-friendly


Regardless of whether your hospital specializes in emergency pediatric care, it will come at no surprise when ailing children and adolescents come filtering through your door.

This means you should be prepared to deal with the unique challenges of a pediatric patient base, starting with assessing the level of pain they’re experiencing.

However, children are notorious for not being able to communicate the severity of their pain, therefore resulting in the hospital’s underestimating of the appropriate pain management that they need. According to the American Academy of Pediatrics “Children’s pain is underestimated because of the underuse of appropriate assessment tools and the failure to account for the wide range of children’s developmental stages.”

To alleviate the stresses that are inevitable in an emergency room setting and to avoid making pediatric patients more uncomfortable, learn about these recommendations for a pediatric-friendly ER.


Create a Soothing Environment with Themes and Color Schemes


The first impressions of an ER can have an impact on a child’s experience and set the tone for the rest of their stay. For example, Dr. Elise Herman of Ellensburg Pediatrics uses the decor of her clinic to create a low-key, soothing environment. Through the use of soft earth tones, animal art, and themed rooms, the children feel more like they are in a playroom and less like they are in a sterile, cold, hospital environment.

Each of the pediatric care rooms has its own theme adding to the relaxation effect of the clinic. One is an animal room, another a tropical Hawaii room, and another a cowboy/cowgirl room.

In other areas of the hospital where there were not enough funds to dedicate to a themed room, the hospital uses comfort toys in a room with a playful mural.

If your ER can’t dedicate rooms to child-friendly themes, try to dedicate a small section of your waiting area to children. A section with colorful walls and furniture can help with the stresses of an ER as can some toys and games for the children to play with. If you are unable to paint an entire patient room in child-friendly tones, perhaps some inexpensive wall art can be used in a procedure room that is reserved for pediatric patients.


Provide Distractions such as Stuffed Animals and Kid-friendly Tablets


In addition to murals, soothing paint and toys/games, there are other inexpensive distractions your hospital can put in place to help preoccupy children. Large easy-to-clean stuffed animals can provide a cuddly friend, as can kid-friendly tablets with games preloaded specifically for kids. The use of children’s movies playing in procedure or waiting rooms is also helpful, as is child-pleasing music that sets a more relaxed tone than the quiet and chaos of an ER.

Try to have a distracting toy, device, game, or movie for children of all ages. Where one child may be distracted by blowing bubbles or a large stuffed animal, another may be more relaxed while being left to play a game on a tablet for hours. Ask the parents what the child likes and see if you can’t furnish something fun to keep their attention off the pain.


Involve the Parents in the Care Process


Managing a parent or caregivers involvement in the emergency room process can also prove effective in a stressful ER setting. Whereas adults generally leave their loved-ones behind when they are taken into the procedure room, involving a parent can help to keep the child relaxed and trusting of the process.

Physically involving a parent also makes them more comfortable, making the experience better for all parties. For example, having a parent hold their child while they receive a vaccine allows the child to feel safe, providing a less anxious experience that lets medical staff address the problem more quickly.

In addition to involving the parent during the care of the child, set up your staff to “treat the entire family” rather than just the pediatric patient. Consulting with parents, keeping them informed of the process, and getting their input in decision-making keeps all parties calm and allows them to feel in better control of a somewhat uncertain situation.


Have a Training Program for ER Staff on Pediatric Anxiety-reduction Techniques


In addition to the initial environment first impressions, the training of your hospital staff will set the tone for the anxiety your pediatric patients endure at the hospital. 

The American Academy of Pediatrics (AAP) recommends focused staff training on how to interact with children and how to reduce their anxiety.

Medical staff pediatric care techniques:

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    Telling children about the process they are involved in and next steps
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    Encouraging children to ask questions about any steps in their care
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    Showing children the medical supplies staff will be using in treatment
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    Offering children options (where appropriate)
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    Distracting them with special jobs, games, or toys during procedures

Child-life Specialists

Recently, liaisons between the providers and families are being brought in to hospital settings to comfort children during procedures. These “child-life specialists” help to make hospitals more competitive while also helping to increase patient satisfaction scores. These professionals can be brought in to improve strategies when dealing with a pediatric patient base but also to make the life of clinical staff easier when dealing with anxious patients.

The employment of child-life specialists is also recommended by the AAP in five specific areas:

  1. Decrease anxiety and pain perception using developmentally appropriate education and preparation to patients and families
  2. Teach the child and staff simple distraction techniques, deep breathing, progressive relaxation, or guided imagery
  3. Help the child to develop and execute coping plans during difficult events in the ED
  4. Educate the child about the ED environment and his or her diagnosis
  5. Support family involvement in the child’s care.


This important person, says the AAP, is the only one in the hospital that is not in a position to cause emotional or physical pain to the child.

Understanding Children Pain Scales

Pain is an obvious first step to appropriate treatments, but assessing pain in children can be more challenging. For starters, pain is subjective and is influenced by “social, psychological, and experiential factors,” says the AAP report. Secondly, the most common pain scale -- which is a verbal numerical scale ranging from 1-10 -- may not be applicable to young children.

Thus, the AAP recommends one of the following well-validated pain scales for EDs caring for children:

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    FACES
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    Wong-Baker FACES
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    10-cm Visual Analog Scale
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    Neonatal Infant Pain Scale (for pain in neonate)
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    FLACC (for pain in infants, young children, and those with cognitive impairment)

Making Your ER Pediatric-friendly


All hospitals want to make the patients experience as safe and comfortable as possible. With the implementation of these steps, you can create a more pediatric-friendly ER. Consider the first impressions of young children and families entering a emergency room setting and try to design comfortable, soothing, waiting rooms and procedure rooms that distract from their ailments. Within these spaces, provide toys, games, stuffed animals, electronics, movies and other children’s activities that help to make them relaxed and take their attention away from their pain. Involving the children’s parent or caregivers is encouraged, and hospital staff should understand where a parent can help reduce stress and how to utilize them during care episodes. Last but not least, having nurses and doctors trained on pediatric anxiety-reduction techniques or professional child-life specialists on staff can help make the emergency room a much less scary place that fosters a healthy environment.




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