Use of Restraints
Restraints are devices used to limit a child’s body movement. The Children’s Hospital of The King’s Daughters Health System is committed to preventing the use of restraint at every opportunity and will always attempt to use the least restrictive forms of restraint when possible. There are different reasons why a child might need to wear a restraint. Some of these reasons are listed below:
- To prevent a child from pulling out lines and tubes
- To prevent a child from disturbing his wounds or bandages
- To keep a child in the correct position in bed when positioning is important for his healing
- To keep a patient from harming himself or others
Alternatives to restraints:
Restraints are never used as the first alternative to manage these types of situations. There are other measures that can be taken by the family or staff to try to prevent restraint use. These are some of the things you can do to help your child:
- Talk to your healthcare providers about your child and let us know if he/she has any special needs. Tell us what works best to calm your child.
- Speak to your child about medical procedures or equipment in a manner he/she can understand.
- If at all possible, stay with your child to provide comfort and to reduce anxiety. If you are not able to stay around the clock, ask a close adult family member or friend to visit when you cannot stay with your child.
- Provide your child’s favorite play activities to distract attention away from his/her medical devices or condition. Our Child Life Department has toys, games, video games, videotapes, and music that you can borrow.
- Please tell us if your child is in pain. We want to do everything we can to control your child’s pain.
- Reduce the amount of noise, light, and/or visitors in your child’s room to help decrease excitement.
Your nurse can contact a Child Life Specialist if your child is having difficulty coping with hospitalization.
If restraints are still needed after these measures, the least restrictive device will be used for each situation. The usual types of restraints are listed below:
- Mittens (when pinned down)—used to keep the child from scratching himself or removing tubes or bandages.
- Elbow Restraint—used to keep the child from rubbing his eyes after an operation or removing tubes or bandages that are above the waist.
- Soft Cloth Wrist or Ankle Restraints—used to prevent a child from removing tubes or bandages.
- Neoprene Velcro Extremity Restraints—used to limit the movement of the patient’s arms or legs when the soft cloth restraints are not effective or when soft cloth restraints are too large.
- Jacket/Vest Restraint—used to keep a child in the right position in a bed or a chair.
- Enclosed Bed—this special bed has padded rails and a soft net around the sides to prevent injury from hitting against the rails or falling out of bed when a child cannot control his movements.
The nurse will watch your child closely while in restraints. The nurse will make sure that:
- the right type and size of restraint is used. The nurse will use the least restrictive type of restraint possible.
- the restraint is applied correctly. A slip knot is used if the restraint needs to be tied to the bed. This knot can be quickly untied in an emergency. The restraint will not be tied to the side rail. It could be pulled too tight if the rail is put down. The knot will be tied out of the child’s reach.
- the restraint is not too tight or too loose. The nurse will check the warmth and color of all restrained body parts. The nurse will check that the child can breathe deeply and easily if a jacket restraint is used.
- the skin under the restraint is okay. Each restraint will be removed at least every 4 hours for skin care and exercise of the restrained body part.
- your child’s need for food, liquids, bathroom visits and walking are being met as appropriate.
- the least restrictive restraint possible is used. Restraints are changed to a less restrictive device as soon as possible.
- the restraints are removed if the reason the restraint was needed is no longer present (for example, medical device or sites that needed to be protected are no longer present or your child is alert and his/her behavior no longer is a safety issue).
While you are with your child, you can:
- talk to the nurse about removing some or all of the restraints while you visit. The nurse will decide if removing the restraints is safe. You may be able to control your child and prevent him/her from pulling on tubes or bandages while you are in the room. You will need to pay very close attention to your child when the restraints are removed. Tell the nurse if you need to leave the room for any reason. The nurse may need to reapply the restraints to keep your child safe while you are gone.
- reassure your child that the restraint is not a punishment.
- do the activities that are listed as alternatives for restraint measures on the first page
- give skin care and exercise to the restrained areas after the nurse removes the restraint and checks your child’s skin. The nurse will show you how to rub the area to improve blood flow. The nurse may give you some lotion to put on the skin. The area can be moved around for a few minutes to keep the muscles working (range-of-motion). The nurse will show you how to do these exercises. The nurse will reapply the restraint.
Call the nurse if your child:
- seems more confused or upset
- needs to eat or drink, get up, or use the bathroom
- needs pain control measures
- is having trouble breathing
- your child’s skin is cold and clammy
- your child’s skin or nail beds are a blue or white color around or below the restraint
- is more cooperative and you think it may be safe to remove the restraints
Remember to tell the nurse when you leave your child’s room for any reason.
Disclaimer:
This information is not intended to substitute or replace the professional medical advice you receive from your child's physician. The content provided on this page is for informational purposes only, and was not designed to diagnose or treat a health problem or disease. Please consult your child's physician with any questions or concerns you may have regarding a medical condition.
Reviewed: 04/2010