European Association of Children In Hospital (EACH) conference discusses restraining of children for medical procedures

By Joyce Rubotham

Is it acceptable to physically restrain a child for the purposes of a medical procedure?

This was one of the questions discussed at the annual meeting of the European Association of Children In Hospital (EACH). EACH is an umbrella organisation with member groups in fourteen European countries and Japan. Founded in 1988 EACH advocates on behalf of hospitalised children all over Europe.

Ireland’s memberships of the association is conferred through the charity Children In Hospital Ireland which is a founder member of EACH. Representatives from this charity attended the EACH conference in Utrecht at the week end.

The practice of holding a child down to allow for minor surgical procedures like suturing is routine in many hospitals across Europe.

If, for example, a child needs stitches, local anaesthetic is administered so the child does not feel pain. Often children will still resist treatment. The use of physical restraint is currently the only solution to this problem.

One nurse from a children’s hospital in Finland described how routine it is in her hospital for staff to restrain children.

Piet Leroy, Associate Professor at Maastricht University Hospital advocates a revolutionary new practice involving the use of mild anaesthetics and sedation to calm children. Minor surgeries and medical examinations should, he argues be performed without using physical force.

Professor Leroy is a father of three and a passionate advocate of helping children to have a stress-free experience in hospital. He hopes to remove the need for physical force, which is hugely traumatic.

The unfortunate reality is that once a child has a bad experience in hospital, they form a negative association with medical treatment. These children are more likely to resist future treatments even more fervently and become adults who put off necessary trips to the doctor and dentist.

The practice of holding children down may be contributing to long-term health costs. These children subsequently have an increased risk of deferring necessary treatments and becoming more ill.

Professor Leroy’s experience is that doctors, especially anaesthetists are opposed to the use of anaesthesia or sedation outside of the operating theatre.

Members of EACH were quick to point out that doctors once opposed the use of anaesthesia in babies. In the not so distant past, medical professionals did not believe that babies feel pain.

Babies underwent open heart surgery without general anaesthesia as recently as 1987.

The fact that babies feel pain was finally acknowledged by the medical profession in the late 1980’s. Mary O’Connor, former CEO of Children In Hospital Ireland, attended the meeting in Utrecht. She hopes that a similar change in the practice of restraining children is on the horizon.

EACH has played a crucial role in bringing about other changes in the way children are hospitalised. Individual EACH members all over Europe lobbied successfully to bring about the practice of “rooming-in”. It is now standard that a hospitalised child will be accompanied by a parent.

In 1988 member associations published a rights based documents with ten articles relating to the welfare of a hospitalised child. The EACH charter was endorsed and launched in Ireland by Minister for Children, Mr Brian Lenihan in 2002.

The member associations of EACH continue to lobby their respective governments to have the EACH charter incorporated into health legislation. Children In Hospital Ireland has been working closely with the HSE to influence and inform healthcare polices for children.

Article 7 of the EACH charter proclaims the right of the sick child to play; “Children shall have full opportunity for play, recreation and education suited to their age and condition”.

Children In Hospital Ireland maintains an active role in upholding this article of the charter. The charity trains and places volunteers in hospitals all over Ireland. Every week they send over 400 volunteers into twelve different hospitals all around the country. The volunteers provide play sessions to relieve the monotony and stress of hospital life.

Orla Kennedy is the current CEO of Children In Hospital Ireland. She represented the Irish charity on the EACH committee and was there to speak to the EACH delegation at the General Assembly in Utreacht. Orla is the founder and CEO of Imaginosity, the Dublin Children’s Museum.

Dr Joyce Rubotham (PhD) is a volunteer with and director of Children In Hospital Ireland.