Creating a Child-Friendly Environment: Tips for Pediatric Nurses

One important aspect of providing high-quality pediatric nursing care is creating a child-friendly environment. Designing and maintaining a child-friendly environment not only reduces fear and anxiety in young patients, but also promotes better health outcomes.  

How can a pediatric nurse create a child-friendly environment? It requires integrating your personality, clinical expertise, compassion, and imagination into your nursing care. 

A child-friendly environment helps children feel safe, comfortable, and engaged during medical encounters with their pediatric nurse and care team.  

Below are some essential tips a pediatric nurse can use to create a child-friendly environment for pediatric patients.  

1. Understand the developmental stages of infants and children 

Children have different needs and perceptions at different developmental stages. Having a thorough understanding of these stages allows pediatric nurses to modify their personal interactions and nursing interventions appropriately.  

Birth-to-18-months old: Infants require physical comfort and need to feel secure. Ways to achieve this include swaddling, gentle rocking, soft music, or singing a lullaby. Providing timely feedings and diaper changes (when medically feasible) are also important. Minimize an infant’s exposure to bright lights and noise in your facility as much as possible to create a calmer environment. 

Toddlers (18-months-to-3 years old): Toddlers are known for their curious nature but are also easily frightened. Providing age-appropriate toys and books, allowing them to explore their surroundings safely, and using simple language can help reduce their anxiety level and build a sense of trust. 

Preschoolers (3-to-5 years old): Preschoolers have robust imaginations but can easily become fearful of unexpected noises or movements. Explaining medical procedures through visual aids, such as toys, models or pictures; utilizing play; and communicating in a storytelling type of manner, can make medical procedures less intimidating for them. 

Grade school-age children (5-to-12 years old): Children in this stage can understand more detailed information. However, it’s important to use clear, age-appropriate language (not too complicated). You’ll also want to involve these patients in their care decisions when appropriate. These strategies can boost their comfort and cooperation. 

Adolescents (12-to-18 years): Adolescents value their privacy and autonomy. Respecting their privacy, listening to their concerns, encouraging their involvement in their care decisions, and providing honest, straightforward answers and information about their care are crucial. 

2. Create a warm and welcoming physical environment 

The physical environment of a medical office or hospital room plays a significant role in a child's level of comfort. While room design and furniture choices are already in place and out of a pediatric nurse’s control, it helps to find ways to make enhancements to the setting to make it more welcoming and less intimidating. 

Bright and cheerful decor: Colorful walls, playful decorations, and child-friendly artwork help to create a warm and inviting atmosphere. While wall color cannot be changed, integrating decorations such as non-toxic, stick-on figures and designs and having a variety of colorful, age-appropriate toys and books on hand, can help provide a more joyful experience. 

Age-appropriate-sized medical equipment: Using the correct-size blood pressure cuffs, IV catheters, injection needles, and oxygen masks in pediatric sizes, are some examples of items that should already be in place in your clinic or hospital floor. It’s essential to utilize the right size item for each patient not only to provide comfort, but also to provide optimum patient care. 

Comfortable furniture: Ensure that chairs, beds, and other furniture are appropriately sized for children and comfortable for both children and their families.  

Engaging play areas: Utilize designated spaces for play with age-appropriate toys, books, and games. These areas help distract children from the fear and stress of being in a medical setting. While some organizations provide child-life specialists who provide may these items, other settings may require staff order these items to have on hand. It’s essential to keep these items clean and in good working order. A team member should be designated with the task of ensuring regular disinfection of shared items along with removing and replacing any items that are broken.  

Personal items permitted when possible: Allow children to bring and keep close in hand, one or more of their cherished personal items from home. Having a favorite blanket, toy, or book in their hands can go a long way to help a child feel in control and less threatened by the experience. 

3. Communicate with age-appropriate language  

Effective communication is crucial for a pediatric nurse. Nurses must be skilled in providing education and reassurance to their patients and their families. Consider the following: 

• Use simple language. Avoid using medical jargon. Use clear language and simple sentences that children can understand. 
• Provide patient education. Use age-appropriate language, books, toys, models, or photos to help educate your patients regarding their care and to meet them at their stage of development.  
• Be honest and transparent. Explain procedures in a truthful way but avoid using frightening language. For example, you can say, "This shot will feel like a quick poke or pinch,” instead of saying, "This shot will hurt." 
• Incorporate play. Use play to explain procedures to reduce a child’s anxiety level. Dolls, stuffed animals, books, models and medical play kits can help children understand what to expect with pending medical procedures. 
• Practice active listening. Pay attention to children's verbal and non-verbal cues. Acknowledge their feelings and provide them reassurance. 

4. Involve the family 

Family involvement is essential when providing pediatric nursing care. A supportive family presence can significantly reduce a child's anxiety and improve their overall experience. 

• Encourage presence. Allow parents or guardians to be with their child as much as possible during their stay and medical procedures. 
• Provide support. A pediatric nurse also provides emotional support to families, by keeping them informed and involved in their child's care.  
• Give family education. Educate families on how to care for their child at home. Remember to educate regarding pain management, safe medication administration, how to recognize the signs of complications developing, and when to call the physician or return to the clinic or ED for any questions or concerns. 

5. Use distraction techniques 

Distraction is a powerful tool in pediatric nursing. It helps divert a child's attention away from painful or frightening procedures and reduces their level of anxiety. 

• Toys, books, and games: Provide a variety of toys, games and books to engage children during their office appointment, emergency department (ED) visit, or hospital stay. 
• Technology: The use of tablets or smartphones to show videos, play games, or listen to music can help ease the burden for older children and those who are familiar with the use of technology. However, don’t assume all parents approve of the use of technology as some parents may discourage screen time for their young children. 
• Interactive activities: When feasible, encourage activities such as drawing, coloring, crafting or painting. These activities can provide a sense of calm and distraction, while also engaging the patient in their care. 

6. Pain management strategies 

Providing effective pain management is essential in pediatric nursing. A pediatric nurse should integrate a combination of pharmacological and non-pharmacological techniques into their care plan, such as: 

• Medication: Administer pain medications as prescribed and monitor for their effectiveness and any side effects. 
• Comfort measures: Use techniques such as swaddling, rocking, and holding for infants, and distraction, guided imagery, or deep breathing for older children. 
• Topical anesthetics: Consider the application of topical anesthetics (as per your organization’s policy and if they’re not contraindicated in your patient) before IV catheter placement or other painful procedures to help reduce pain. 

7. Maintain a child-centered (patient-centered) approach 

A child-centered approach focuses on the needs and preferences of each child. This approach ensures that the care provided is respectful and responsive to the needs of each patient. Consider the following: 

• Personal preferences: Take the time to learn about the child's likes and dislikes and strive to incorporate them into your nursing care plan. 
• Empowerment: Allow children to make choices when possible. Providing a choice for selecting a bandage color or choosing the order of procedures, can provide the child with a sense of control. 
• Positive reinforcement: Use praise and rewards to reinforce positive behaviors and cooperation. 

8. Train and educate staff 

Continuous training and education for all healthcare staff involved in pediatric care is fundamental for maintaining a child-friendly environment. 

• Ongoing education: Provide regular training on child development, communication techniques, and pain management. 
• Simulation training: Use simulation exercises to practice responding to various pediatric scenarios in a safe and controlled environment. 
• Multidisciplinary approach: Foster a team approach for creating a child-friendly environment. In addition to nursing, you’ll want to include pediatricians, child life specialists, and other healthcare providers, to ensure comprehensive, age-appropriate care is provided to all pediatric patients.  

Creating a child-friendly environment in pediatric nursing can reduce the anxiety and fear level of young patients and significantly improve the healthcare experience for children and their families. 

Reviewed by Carole Jakucs, MSN, RN, CDCES, PHN on June 26, 2024