title: Beyond the drugs: nonpharmacologic strategies to optimize procedural care in children.
abstract: OBJECTIVE
  Painful and/or stressful medical procedures mean a substantial burden for sick children. There is good evidence that procedural comfort can be optimized by a comprehensive comfort-directed policy containing the triad of nonpharmacological strategies (NPS) in all cases, timely or preventive procedural analgesia if pain is an issue, and procedural sedation.
  
  
  RESULTS
  Based both on well-established theoretical frameworks as well as an increasing body of scientific evidence NPS need to be regarded an inextricable part of procedural comfort care.
  
  
  CONCLUSIONS
  Procedural comfort care must always start with a child-friendly, nonthreatening environment in which well-being, confidence, and self-efficacy are optimized and maintained. This requires a reconsideration of the medical spaces where we provide care, reduction of sensory stimulation, normalized professional behavior, optimal logistics, and coordination and comfort-directed and age-appropriate verbal and nonverbal expression by professionals. Next, age-appropriate distraction techniques and/or hypnosis should be readily available. NPS are useful for all types of medical and dental procedures and should always precede and accompany procedural sedation. NPS should be embedded into a family-centered, care-directed policy as it has been shown that family-centered care can lead to safer, more personalized, and effective care, improved healthcare experiences and patient outcomes, and more responsive organizations.
authors.affiliation: aDepartment of Pediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands bFaculty of Dentistry, Universidade Federal de Goiás, Goiânia, Brazil cDepartment of Pediatric Dentistry Dental School, University of Athens, Athens, Greece dFaculty of Industrial Design, University of Technology, Eindhoven, The Netherlands eDepartment of Family Healthcare Nursing, University of California, San Francisco, USA.
authors.forename: Piet L
authors.initials: PL
authors.lastname: Leroy
authors.forename: Luciane R
authors.initials: LR
authors.lastname: Costa
authors.forename: Dimitris
authors.initials: D
authors.lastname: Emmanouil
authors.forename: Alice
authors.initials: A
authors.lastname: van Beukering
authors.forename: Linda S
authors.initials: LS
authors.lastname: Franck
mesh_terms: D002648:Child; D002662:Child Health Services; D022143:Family Nursing; D006801:Humans; D000070659:Patient Comfort; D056888:Patient Positioning; D012149:Restraint, Physical; D013315:Stress, Psychological / Q000517:prevention & control