William Lennarz, MD: Creating a Pain-Free Pediatric ER

A visit to the emergency room can be stressful, painful, and anxiety-provoking for anyone. For children, that stress can be especially difficult and can influence future health care encounters.

In an interview with MD Magazine®, William Lennarz, MD, Pediatrics Systems Chair at Ochsner Medical Center, describes the efforts among those in the pediatric emergency medicine specialty to reduce pain and anxiety during children's visits to the emergency room.

What is currently an area of innovation in pediatric emergency medicine?

I'm a pediatric emergency medicine physician—it's one of the younger specialties in pediatrics and emergency medicine. It's one of the few specialties that we can enter through training in either pediatrics or emergency medicine.

Those of us in pediatric emergency medicine believe that one of the skillsets we can bring to the table is making the experience in the pediatric ER much less painful, less anxiety-provoking, and more developmentally appropriate. So, one of the tool boxes or skillsets that we train in and utilize is when a procedure is going to be particularly painful or particularly anxiety-provoking we will use a range of methodologies anything from guided imagery by a child life worker to complete sedation, almost a form of anesthesia, where we put kids to sleep, for example to have bones set, in the ER.

These are things that used to have to be done in the operating room. Now a child can come to the ER with a badly broken arm, be put to sleep, have it set, and go home all in the same episode. So that's where the sedation comes in. A lot of people in pediatric emergency medicine talk about creating a painless ER for kids and a lot of it begins with understanding the developmental stage of children, because unlike people who take care of adults, we deal with kids whose comprehension and development and normal reaction is completely different depending on the age that they are.

What are the benefits to providing sedation in a pediatric ER?

Well, I mean, certainly the ability to do that kind of thing in the ER shortens the whole treatment versus being put in the hospital or going to the operating room, that kind of thing. But also, we know that children are traumatized by the stress of coming to the ER—some more than others, it depends on the individual—but each time a child has a health care encounter that is anxiety-provoking, as you can imagine, it impacts the next time they have an encounter with health care. And so, yes in that way it makes them more comfortable patients, even for more normal episodes.