Research and commentary

Holding children for clinical procedures: a collaborative approach

Study recommends using a clinical pause to engage a child during difficult clinical procedures

Study recommends using a clinical pause to engage a child during difficult clinical procedures

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Bray L, Ford, K, Dickinson A et al (2018) A qualitative study of health professionals’ views on the holding of children for clinical procedures: constructing a balanced approach. Journal of Child Health Care. 22, 3, 1-16.


The study aimed to gain an international perspective of how health professionals report they would act if a child was upset and resisted a non-urgent procedure such as an X-ray or blood test.


An electronic questionnaire contained three vignettes presenting hypothetical, but realistic, scenarios of children resisting non-urgent procedures followed by the question: What would you do in this situation? The questionnaire, distributed through snowball sampling, was used to collect open text responses from health professionals.


Health professionals (n=712) responded including nurses, doctors, play specialists and allied health professionals and were from 11 different countries including the UK, Australia and Canada. In total 2,072 pieces of text were analysed.

The study found that health professionals can struggle to balance the views and agendas of those present at a child’s procedure. This often led to the priorities of parents and health professionals deciding the outcome. Health professionals acknowledged the need to balance children’s rights to make choices against the right of their parents, but this was difficult when parents were keen to proceed despite the child expressing high levels of distress.

Health professionals reported having conflicting feelings over finding time to inform and engage with children. Even those who reported the importance of using child-centred practices, such as preparation and distraction, were unsure how to proceed if these failed and the child remained upset and resistant.

Holding a child to get a procedure completed was reported by many health professionals as something that they would only do as a last resort, while others reported that holding a child resulted in a quicker and less painful procedure.


The authors suggest the use of a clinical pause to engage with children, evaluate options and balance the approach.

Enacting clinical pauses in healthcare procedures with children

Children have a right to participate in choices and decisions and be informed about what is happening in their healthcare (Söderbäck et al 2011). There is evidence that children and parents can be poorly or misinformed about clinical procedures (Lambert et al 2013) and that this can lead to heightened distress, anxiety and decreased co-operation (Cohen 2008). Despite the child’s reluctance, discomfort or dissent, procedures still go ahead (Bray et al 2015).

Providing time and enacting a clinical pause could help by providing space to allow a child’s concerns, information needs, and rights to be heard and taken into consideration.

The authors suggest that the clinical pause should be at the start of the procedure to inform and prepare children. Enacting this pause whereby children can discuss a procedure openly is important, not just for invasive or painful procedures but for all procedures to ensure children are supported adequately (Bice et al 2014). There is evidence of how even non-invasive procedures, that might seem trivial to an adult, such as X-rays, can be provoke anxiety in a child (Chesson et al 2002).

The clinical pause would allow professionals and parents to gain an understanding of how the child can be supported through a procedure. Some children may be quiet and withdrawn, some may push health professionals away and others may use words such as ‘no’ or ‘I do not want it done’ (Björkman et al 2013).

Ideally a continuous open dialogue between the child, health professional and parent would ensure a child’s choice, comfort and assent is checked continually.



  • Bice A, Gunther M, Wyatt T (2014) Increasing nursing treatment for pediatric procedural pain. Pain Management Nursing. 15, 1, 365-379.
  • Björkman B, Golsäter M, Simeonson R et al (2013) Will it hurt? Verbal interaction between child and radiographer during radiographic examination. Journal of Pediatric Nursing. 28, 6, e10-e18.
  • Bray L, Snodin J, Carter B (2015) Holding and restraining children for clinical procedures within an acute care setting: an ethical consideration of the evidence. Nursing Inquiry. 22, 2, 157-167.
  • Chesson R, Good M, Hart C (2002) Will it hurt? Patients' experience of X-ray examinations: a pilot study. Pediatric Radiology. 32, 1, 67-73.
  • Cohen L (2008) Behavioral approaches to anxiety and pain management for pediatric venous access. Pediatrics. 122, Supplement 3, S134-S139.
  • Lambert V, Glacken M, McCarron M (2013) Meeting the information needs of children in hospital. Journal of Child Health Care. 17, 4, 338-353.
  • Söderbäck M, Coyne I, Harder M (2011) The importance of including both a child perspective and the child’s perspective within health care settings to provide truly child-centred care. Journal of Child Health Care. 15, 2, 99-106.

Compiled by Holly Saron, PhD student and graduate teaching assistant, Edge Hill University, Ormskirk, on behalf of the RCN’s Research in Child Health community

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