01 Aug, 2025
Current paediatric medical practices that involve physically restraining children during procedures have come under increased scrutiny for causing avoidable psychological trauma. A renowned doctor from Griffith University’s School of Nursing and Midwifery advocates for a fundamental shift toward trauma-informed procedural care, highlighting the long-term emotional consequences of using force during medical interventions.
A recent editorial published in the Journal of Paediatric Nursing, titled "Rethinking Procedural Holding Through a Trauma-Informed Lens", it emphasizes that many children subjected to restraint experience fear, helplessness, and lasting emotional scars. It is argued that such practices, while historically normalized, are now considered outdated and ethically inappropriate, especially given the increased recognition of children’s rights in healthcare settings.1
Trauma-informed care involves applying the principles of safety, trustworthiness, collaboration, empowerment, and cultural sensitivity. This underscores that care should begin before the procedure, with clear, age-appropriate communication to help reduce anxiety. During procedures, non-restrictive strategies such as comfort positioning, distraction (e.g., play, virtual reality), and the use of topical anaesthetics can significantly alleviate pain and distress, often eliminating the need for restraint.2
Post-procedural care is equally vital. Reinforcing the child’s coping skills, allowing time for emotional processing, and debriefing with both the child and family help build resilience and foster more positive attitudes toward future healthcare experiences.3 Unfortunately, it is seen that most health professionals still lack formal training in trauma-informed procedural support and often default to physical restraint, sometimes involving multiple adults to hold down a distressed child.
Despite the growing movement toward child-centered care, an international survey revealed that over 80% of healthcare providers still rely on physical support methods during procedures, often with the involvement of parents and nurses.4 While these acts may be well-intentioned, they can result in children feeling unheard, powerless, and emotionally violated.
To conclude, a system-wide change is necessary—one that rethinks procedural norms, mandates training in child assent and trauma-informed techniques, and prioritizes the emotional and psychological well-being of paediatric patients in all healthcare settings.
References:
1- K. Plummer et al, Rethinking procedural holding through a trauma-informed lens, Journal of Pediatric Nursing (2025). DOI: 10.1016/j.pedn.2025.05.029
2- Coyne I, Hallström I, Söderbäck M. Children’s experiences of hospitalization: a comparative analysis of children’s and parents’ perspectives. J Clin Nurs. 2016;25(15-16):2357–67
3- Kennedy RM, Luhmann JD, Zempsky WT. Pediatric procedural sedation: a review and new concepts. Pediatr Emerg Care. 2020;36(6):300–7
4- Kortesluoma RL, Nikkonen M. ‘The most stupid thing was when I asked Jesus to help me stop the pain’: children’s experiences of pain. J Adv Nurs. 2006;54(6):643–52