How Often Are Hospitalised Children Physically Restrained During Painful and Stressful Procedures?
Danton Matheus de Souza, Lucy Bray, Vanderlei Amadeu Rocha and 3 others
PMID 40785482WHAT IT FOUND
Physical restraint was observed in 22.3% of 1210 procedures in stable hospitalised children, rising to 32.9% during painful ones.
Restraint clustered on airway suctioning, tube insertion and nasal lavage, and was most likely in infants and children crying or in distress.
Key findings
01Physical restraint was used in 22.3% of the 1210 procedures observed, with 270 restraints recorded and an average of three per child over six hours.
02The likelihood of restraint was higher during painful procedures (32.9%) than stressful ones (8.9%), and increased with higher pain scores.
03Infants, children with higher care dependency, and those showing stress behaviours such as crying before a procedure were more likely to be restrained.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for RNs
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What it does not show
The presence of the researcher may have influenced healthcare professionals' behaviour (Hawthorne effect), potentially leading to under-reporting of restraint use. The study was conducted in a single hospital in Brazil, limiting generalisability to other settings or countries. The participants were clinically stable children in a low-complexity unit, so findings may not apply to critically ill children in intensive care. No data were collected on whether parents or family members participated in applying the physical restraint. The sample had a prevalence of infants with respiratory issues, which restricts deeper analysis of other age groups or conditions.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not assume that the 22.3% restraint rate reflects the true frequency in daily practice. The authors note that the presence of an observer may have caused healthcare professionals to restrain children less often than they normally would, meaning the actual rate in unobserved care could be higher.