Clinical Practice Guidelines

Minimal handling

  • - The sick child deteriorates with handling and distressing procedures.
    - Increased distress in an unwell child can

    • Increase heart rate, respiratory rate and blood pressure
    • Cause de-oxygenation (especially in neonates)
    • Tip a child's condition from moderate to severe

    - Minimal handling is particularly important in:

    • Respiratory conditions, such as croup, asthma

    Principles:

    • Keep the child with parent or care giver.
    • Try and keep the environment quiet and moderate lighting.
    • Allow the child comfort feeds if safe to do so.
    • Minimise interventions, including examination and investigations that are not going to impact acute management
    • Group cares - eg observations and oral medications
    • Use comfort techniques for painful procedures such as intravenous catheters - EMLA or Angel cream, distraction
    • Don't forcibly alter a child's posture - especially in respiratory conditions such as croup. Children will naturally adopt the posture that facilitates the least airway obstruction.