Diagnosed with eosinophilic esophagitis and rumination disorder, 3-year-old Mercy White has been hospitalized six times between her first and second birthdays, and she sees multiple subspecialists who manage her care. So, it’s no exaggeration to say that Mercy has had countless needle procedures in her young life, and she’ll likely have many, many more.
“Mercy has a lot of anxiety surrounding needle procedures, and negative experiences just reinforce past trauma,” said her mom, Jody White. “We know she has sensory issues and she responds better when we do certain things, but until recently, there wasn’t a way to make sure these procedures went smoothly.”
Then, Mercy saw Christina Low Kapalu, PhD, child psychologist.
“As part of the ongoing evaluation for Mercy’s medical condition, she is going to have to go through frequent medical procedures,” Dr. Low Kapalu explained. “We have the opportunity to shape her future experiences with medical procedures by preventing pain now. If we can make sure these procedures are as comfortable as possible, Mercy will be less likely to have negative experiences at the hospital or with medical procedures and as she gets older, she will have less stress.”
Jody said she’s used comfort positioning with Mercy and she often has requested changes to accommodate her sensory issues, like dimming the lights. But it wasn’t until Dr. Low Kapalu explained the Comfort Promise to her that she realized she could request a personalized pain management plan for Mercy.
The Comfort Promise is a standard of care being implemented at Children’s Mercy. It uses a bundle of four evidence-based strategies—topical anesthetics, comfort positioning, distraction, and sucrose or breastfeeding for children 0 to 12 months—to reduce or eliminate pain during routine needle procedures including immunizations, injections, intravenous access and lab blood draws.
“I was like that’s a thing?” Jody said. “And if we create a plan, I just have to give her providers this and they will honor it? Dr. Low understood that as Mercy’s mom, I am advocating for her quality of care and things that will make her experience better.”
Dr. Low Kapalu helped Jody detail what works well for Mercy including a sensory sensitivity pause, which lives in Mercy’s medical record and is available for all staff to view. It gives staff some tips on sensory strategies that have been helpful for past procedures, like making sure she has her comfort object, letting mom sing to her, and quietly communicating with her.
“These are all things I’ve done for more than a year, but I didn’t have it on paper until recently,” Jody said. Dr. Low Kapalu also helped Jody complete a P4, or procedural pain plan, which is another tool that can be used to support children during needle procedures.
The plan is a written document that identifies which pain management strategies work for Mercy. The P4 is provided to the parent or guardian so they can take it with them to every medical visit. “The plan can be offered to patients and families at Children’s Mercy, and once it’s created, the parent/guardian can share it with other providers outside the hospital,” Dr. Low Kapalu said.
“What I want others to know about the Comfort Promise, is that while it may seem like more work up front, the planning will make needle procedures go more smoothly for all involved,” Dr. Low Kapalu explained.
“Children and teens are less distressed, more cooperative, and less likely to develop needle phobia in the future. By putting all of the unique patient needs in the medical record, those interacting with Mercy will know important information about her even if they haven’t met her before. In turn, our work goes smoother.
“Families are the experts in what their child needs,” Dr. Low Kapalu added. “Mercy and Jody are great examples of this. Jody knew exactly how to use these strategies in a way that works for Mercy, she just didn’t know there was a mechanism to request that the strategies be used by each provider, at every visit.”
Jody agreed. “We recently used the Comfort Promise when Mercy had an upper GI scope. We had the plan in place and the staff followed it to the letter. It was the smoothest procedure she’s ever had, and she’s had six of these,” Jody said. “We will use the Comfort Promise again. It definitely made a difference for Mercy.”
To learn about Children’s Mercy’s commitment to the Comfort Promise initiative, visit our Making Needle Procedures More Comfortable for Children page. This webpage includes age-specific guidelines for comfort during needle procedures. Families can reach out to Child Life or the child’s provider for help completing a procedural pain plan, or P4.