Editor's note: For more coverage of the 2021 AAP National Conference & Exhibition, visit https://www.aappublications.org/news/2021/08/18/nationalconference2021.
Visiting the emergency department (ED) is stressful for any child or adolescent. But if a youth has a developmental disorder like autism, the experience may be too much to handle.
“I'm sure that many of my colleagues have had situations where many of these patients have presented, and they've escalated in terms of agitation, aggression and stress. And it's been to the point where the emergency department has come to a standstill to try and de-escalate them,” said Kaynan Doctor, M.D., M.B.B.S., FAAP, a pediatric emergency medicine attending physician at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Del.
Dr. Doctor gives pediatricians an inside look into how patients with developmental disorders experience the ED during an on-demand session titled “How to Ease Stress of Health Visits for Children With Developmental Disorders” (OD0168). He also offers strategies that can be used not only in the ED but also in an office setting.
Attendees will watch a video that shows an ED visit through the eyes of a young patient with autism. The youth portraying the patient has autism and was eager to be part of the video, said Dr. Doctor, a member of the AAP Section on Emergency Medicine.
“We used a few special effects in the video to enhance some of the stresses,” he said. “So when he looks at the lights, they become very bright. Sounds are even more emphasized.”
Dr. Doctor then discusses strategies pediatricians can use to make visits more conducive for patients who struggle with sensory sensitivities, social interactions, unpredictability and long wait times. Among them are limiting the number of health care professionals in the exam room, keeping equipment out of sight, bypassing the waiting room, turning down the lights and having a “sensory suitcase” that includes items like noise-cancelling headphones, bubbles and play dough.
Pediatricians also should ask parents what could agitate their child and seek suggestions on how to keep the child calm and cooperative, he said. If things do go south, it’s important to have a plan to de-escalate the situation.
Dr. Doctor then shows another video that illustrates how the ED visit with the young patient goes more smoothly when stress-reduction strategies are implemented.
“If you can adapt the care in one of the most stressful environments, namely the emergency department … there is a way that we can actually make those changes in any clinical setting,” he said.