Comfort Positioning

What is comfort positioning?  Why is it important? And, when do I use comfort positions?  These are some of the questions I will be answering as we explore comfort positioning.  

Comfort positioning can best be described as orienting oneself and one’s child in a way that is constricting but supportive in nature. A parent typically uses their arms or legs to accomplish this through a hug or hold and this type of positioning is encouraged during pediatric medical procedures. Medical procedures such as blood draws, stitches, and cast removals, to name a few, all can be very traumatizing for children. When a child is restrained or forced to lie on their back, they are put in a more vulnerable state-increasing feelings of fear, anxiety, and stress stress. Therefore, it’s important we try to help them feel as safe as possible as this will benefit their overall coping and compliance during the procedure.

First, there are several different types of comfort positions because a child in one developmental age group will have different needs than a child in another age group.  As Child Life Specialists, we recognize that one type may not even work for every child in a particular age group because their stressors are different.  For example, if a parent shares with me that their 6 year old will faint immediately if they see a needle, I will not recommend that the child faces forward to watch the blood draw happen.  That doesn’t set us up for success.  In that case, I would recommend the child be in a position where the blood draw site is as far from their viewpoint as possible.

Now, let’s discuss the reality of how often parents are informed of comfort positioning during their pediatric medical visits.  Well, honestly, NOT often.  Some pediatric clinics have Child Life Specialists or medical assistants that are well informed and will advocate for it but most blood centers, specialty clinics, and emergency departments do not have these types of advocates. So, that ultimately means you as a parent have to do the advocating.  But, I have a secret tip that will help ensure your advocacy is successful.  By telling your phlebotomist, nurse or whomever is performing the procedure that you are proposing an idea that will encourage compliance for your child and make their job EASIER, you will get buy-in!  Again-when you tell a health professional you can offer something that will make their job easier, they will stop to listen.  They don’t want your child screaming, crying, or kicking anymore than you do.  

Now let’s get into the fun stuff and discuss what each comfort position entails. 

Baby Being Held with Leg Exposed

This position is ideal for infants who require a blood draw or need their blood taken.  I recommend only using this supportive position when your baby is still quite small and not yet walking as you don’t want them squirming and moving around a lot.  Also, phlebotomists don’t prefer to take blood from the heel of the foot after a baby is past a certain age due to the increased risk of blood clotting in the test tubes.  

As you can see in the photo, this mother is breastfeeding.  If you feel comfortable, breastfeeding or giving your infant a bottle during the procedure increases their ability to remain at baseline.   

Chest-to-Chest with Leg Exposed 

This type of comfort position is ideal for toddlers that benefit from being close to their parents in times of distress. First, you will want to take your child’s pants off so their leg is exposed and easily accessible to the healthcare professional. Then, you will put your child in a froggy position with both legs facing you. Once you are chest to chest with your child, direct their attention away from the vaccination, the stitch insertion, etc.

Child Sitting on Parent’s Lap with Parents’ Legs Over Child’s

To note, this child would typically have one arm out that would be held by a medical assistant or RN who is completing the IV placement or blood draw.

In my experience, this is considered the go-to comfort position when it comes to blood draws and IV placements. Likely, because it is effective for many age groups and it ensures safety for all parties involved. When I say multiple age groups, I mean that. I have seen this type of comfort position used on a 5 year old and then it was proven to be successful on a 13 year old. As long as you as a parent are physically able to have your child sit on your lap and you can criss cross your legs around theirs, then you can try this out! I recommend always having a form of distraction handy as your child is still in a space where they can watch exactly what is about to happen. Check out my blog on distraction tools to learn more about this.

Child Giving Hug with Arm Exposed

This position is exactly as it sounds but instead of your child sitting on your lap like the toddler above, your child will stand. Therefore, this setup is great to utilize with your school age child because they have the ability to stand still. This isn’t to say that they will remain still though so be mindful of how your child responds when they are scared or nervous. If you think they benefit from your help in keeping their body still, just go back to the “go-to” comfort position I mentioned above.

Child & Parent Laying Together

This last comfort position is ideal for when children need to lie still for longer periods of time. This supportive positioning involves a parent lying on their side on the exam table with their child. The parent’s arm or leg is then strategically placed over their child’s to limit possible movement. For instance, this set-up can be helpful for procedures like an ultrasound, a cast removal, or an echocardiogram.

Take a peak at this video to learn more on how to set up for a comfort position and the additional options available to you and your child. :)