Needles, IVs, scary machines and the great unknown of medical procedures. Thinking about any of these is enough to upset many kids. For a child who has had a bad experience and yet needs regular treatment, going to the hospital can be downright traumatic.

Just ask Daniel and Jessica James, whose daughter Piper spent her seventh birthday undergoing a procedure that turned out to be an emotional disaster for them all. Thankfully, when the family came to Sacred Heart Children’s Hospital for a repeat of the testing, the experience was a night-and-day difference.

“If this is the kind of stress relief and care my daughter can get, I will avoid our local hospital and seek the care present in your hospital,” her father, Daniel, wrote in a letter to Sacred Heart. “A four-hour drive means nothing to me in an effort to comfort my daughter.”

Providing a pain-free experience is something Sacred Heart Children’s takes seriously. “Parents have enough to think about when their child needs testing or procedures,” says David Burns, M.D., anesthesiologist. “The last thing parents need to be concerned about is whether the child is going to be terrified and what to do if he or she is. We’ve essentially eliminated those concerns here at the Children’s Hospital.”

Piper James is one of the many kids benefiting from Providence’s commitment to taking the fear and discomfort out of the hospital experience.

Piper's Story

When Piper started elementary school and began having regular stomach pain, her parents and teachers suspected the culprit was anxiety. After she missed several days of school due to severe pain, and her outgoing personality was replaced by lethargy, her parents consulted a pediatric gastroenterologist at Sacred Heart Children’s Hospital. Because the suggested course of action would require multiple scans, the specialist recommended having them done at the family’s local hospital in Montana to avoid the travel to Spokane.

The scans required Piper to have an IV, and without any type of sedative, her panic escalated. Piper screamed and thrashed throughout the process of setting the IV and the rest of the testing. Nearly five hours after arriving at the hospital, she fainted from sheer exhaustion. The parents—wrought with anxiety and frustration—swore they would never do that again.

Unfortunately, because their daughter’s pain continued, the James' still had to find treatment. They made the drive to Spokane, hoping that a facility created for children would make all the difference. Once inside the Children’s Hospital, Piper once again started screaming in fear.

“My stress went through the roof,” Daniel remembers. “Then a staff member approached us and indicated everything would be OK because there were pain-easing options for Piper to choose from.”

She could have a small drink that would make her feel silly and slightly sleepy; she could have nitrous oxide (“laughing gas”) or they could use an instrument that blows air at her skin to numb it. Piper chose the nitrous.

Then a child life specialist, Jan Foerster, began playing games with her on an iPad. When Dr. Burns came in, he asked the young girl what she would like to dream about while she was resting. Piper also got to choose a yummy smell that would be on the mask delivering the nitrous (strawberry!) and, when the sleepy gas started, Foerster strategically placed the iPad where the patient wouldn’t see what caregivers were doing. The IV was quickly set and the procedure was underway.

The entire process, from administering the anesthetic to setting the IV, took less than 10 minutes. Piper kept repeating, “It didn’t even hurt!”

When the James' returned for the second scan a week later and the need for surgery was confirmed, pediatric surgeon Winston Chan, M.D., rearranged his schedule to perform the procedure the very next day so that the family didn’t have to make an additional trip to Spokane.

“Top to bottom— the whole experience couldn’t have been any better,” Daniel says.

After sitting out of her dance and tumbling classes for two months, Piper returned to her favorite activities and won first place in the gymnastics floor routine. “She’s in perfect health,” says her dad. 

Caregivers with a vision

Providing this kind of safe and nurturing environment is exactly why pediatricians created the Children’s Hospital more than 10 years ago. Today’s pediatric experts continue making advances in care for kids. The latest example is the Pediatric Pain Committee, a group of 15 provides, led by Dr. Burns, focused on initiatives to eliminate all unnecessary pain from the hospital experience.

“There are conditions that require regular exams that are uncomfortable for kids to undergo,” Dr. Burns says. These can include bladder scans for those with urinary tract infections or any procedure that will require a Foley catheter.

He remembers Piper James and how terrified she had been, and how nervous her parents were after their previous experience. He talked with her about the nitrous, which he advocates for many patients because:

  • It provides the relaxation a patient needs without the long-term drowsy impact of pain medication
  • You can administer it more than once - nitrous is not going to build up in your system

There are no requirements to refrain from eating or drinking in advance, as there are with sedation.

Also unlike sedation, there is no time (or expense) in the recovery room.

The only caution is the duration of the nitrous, because the longer a person receives it, the higher the chance of experiencing nausea. When the doctor turns off the gas, it only takes 90 seconds for patients to return to a normal state.

At Children’s Hospital, advocates of using nitrous oxide for young patients have identified opportunities to expand its use and have started to train nurses in the Children’s Emergency Center. It can be used for a variety of purposes, including starting IVs, injecting a local anesthesia or placing a catheter or a feeding tube. Dr. Burns says it’s good for many things that are relatively quick and mildly discomforting.

“It opens up a whole lot of possibilities,” he says. “It’s pain and anxiety relief without compromise.” 


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