Paging Dr. Angry Bird: How mobile technology is improving pediatric emergency care

Lois Lee, MD, MPH
Lois Lee, MD, MPH

As a doctor in a busy pediatric Emergency Department, I’d like to personally thank the creators of Angry Birds. Not so much because I love to play it—though there is a certain satisfaction in knocking those pigs from their platforms—I’d like to thank them because the love my patient’s have for the game allows me to do my job better.

As an ED doctor I’m used seeing children who are in pain, or are very anxious about being at the hospital. When I see a child who’s in pain or scared, sometimes I ask the parents to let the child play their favorite mobile game, (almost all parents have one or two loaded on their phone or tablet.) More times than not, after a few minutes with a familiar game like Angry Birds, the child is far more relaxed, which makes it easier for me to quickly clean a wound or stitch a deep cut. It’s one of the tricks of the trade that I and several other pediatric emergency department staffers have picked up along the way.

Dr. A. Bird

But mastering distraction techniques specific to kids isn’t just to make my life easier, it’s proven to be one of the BEST way to give children emergency medical care. Last week a study was released showing that adequate pain assessment and treatment in children is essential for all ED doctors to properly do their jobs. The researchers suggest that pain and anxiety maintenance should start in the ambulance and continue until the visit is over. Not only do I fully agree with the researchers findings, I’m proud to say that my colleagues and I at Boston Children’s ED have been using these techniques for some time. As a staff that cares exclusively for pediatric patients our team is well equipped to deal with any and all emergency situations a child may encounter, and do so as quickly and easily for the child as possible. Some of the study’s recommendations include:

Incorporate child life specialists to alleviate the anxiety and perceived pain related to pediatric procedures.  The ED child life specialists at Boston Children’s are amazing and are CRITICAL to making the ED experience easier for everyone involved—the patient, the parent, the nurses and me! Child life specialists have specialized training in distraction techniques, including the use of games, which help the child focus on something other than the potential of pain or what is going around her in the ED. Many of the procedures performed in the ED aren’t painful—like stitching up an anesthetized area—but to a frightened child having a stranger touch or approach them with medical instruments can be very upsetting. But a child distracted by a child life specialist trained in specific ways to engage them with play, Dora the Explorer videos or an Angry Birds game is usually far more focused on fun than me and a suture needle.

Keep family present during painful procedures. We encourage families to stay in the room for procedures, as long as they are comfortable doing so. Having a family member close by does a lot to alleviate fear and anxiety in children, but depending on the situation, it’s not always easy to watch. Occasionally this might lead to a family member feeling a bit faint, so I’ve learned to keep a close eye on the parents too. A key philosophy of Boston Children’s is that our clinicians don’t just treat the patient but whole family, and that extends to the ED as well.

Analgesics and anesthetics should be as pain free as possible. Thanks to advances in pain medications we’re now able to give two important medications in a nasal mist form, rather than intravenously (IV). IV medication may still be needed as follow up, but the mist is a fantastic way to provide initial pain treatment quickly and safely.

In many cases we can also give an anti-anxiety medication as a nasal mist. This works very well for toddlers who need stitches, especially those with lacerations on their face. The mist allows the child to relax, which often helps them focus on the smartphone/iPad movie or game, allowing myself or another ED doctor to clean and stich them quickly.

For more serious painful and stressful procedures, sedation or dissociative anesthesia could be needed. Because we focus entirely on pediatric patients, Boston Children’s ED clinicians are very experienced in providing procedural sedation/dissociative anesthesia for variety of procedures. This allows us to quickly provide the right medications, in the right dosages, to all our patients.

When they were busy revolutionizing the mobile device market, Steve Jobs and the folks at Apple probably didn’t realize they were also improving pediatric emergency care. Intentional or not, these kid friendly devices have become very important additions to pain medications in managing the pain and anxiety of young ED visitors, and as pediatric ED doctor I’m very thankful for all their hard work.

Kids aren’t just small adults—they benefit from special skill and care provided by staff with pediatric expertise. If your child needs emergency care close to your home, consider going to one of Boston Children’s community hospital partners north, south and west of Boston:

  • Beverly Hospital: 85 Herrick Street, Beverly – 978-922-3000
  • Norwood Hospital: 800 Washington Street, Norwood – 781-769-4000
  • South Shore Hospital 55 Fogg Road, South Weymouth -781-624-8000
  • Winchester Hospital 41 Highland Avenue, Winchester – 781-729-9000

At our conveniently located community hospital partners, Boston Children’s physicians are on-site to care for your child. The doctor is in constant communication with Boston Children’s ED, as well as our specialists and inpatient unit. If your child needs care at our main campus in Boston, our renowned Critical Care Transport Team’s uniquely equipped ambulance is on hand to bring your child to our Boston location.  




One thought on “Paging Dr. Angry Bird: How mobile technology is improving pediatric emergency care

  1. Angry birds sounds like a great plan – Where’s Wally? Is one of ours & the ever successful bubbles.

    Do you use metered dose intranasal diamorphine or the DIY atomiser set-up?

    Dr Sharryn Gardner – Paeds ED Consultant Liverpool area

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