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Restraints

The Joint Commission (Joint Commission on Accreditation of Healthcare Organizations, 2001)


defies restraint as any method, physical or mechanical, which restricts a persons movement,
physical activity, or normal access to his or her body.
Purposes of restraints
1.
2.
3.

To maintain safety of the child


To facilitate physical examination and diagnostic procedures
To allow healing of a part due to immobilization

Types of restraints
The two types of restraints used with children are classified as medical -surgical and behavioral
restraints.
1. Medical surgical restraints are used for children with an artificial airway or airway
adjunct for delivery of oxygen, indwelling catheters, tubes, drains, lines, pacemaker
wires, or suture sites.
2. Behavioral restraints are limited to situations with a significant risk of patients
physically harming themselves or others because of behavioral reasons and when
nonphysical interventions are not effective.
Another classification

Physical restraints are devices that limit your child's movement. They include arm, leg,
lap, or vest restraints. Bed sheets may be used to swaddle a younger child. Caregivers
may also hold your child's arms, chest, or legs to keep him from moving during certain
tests.

Chemical restraints are medicines used to quickly sedate your child if he is violent.
These will be given as a pill or an injection.

Seclusion is placing your child in a room by himself. The room is locked and kept free of
items that could cause injury. Caregivers will watch your child at all times when he is in
seclusion.

General instructions
1. Protective devices should be used only when necessary and after all other considerations are
exhausted, never as a substitute for careful observation of the child.
2. Protective devices cannot be used on a continuous basis without an order. Continuous use
requires justification and full documentation of the type of restraint used, reason for use, and the
effectiveness of the restraint used. Ongoing monitoring, documentation, and renewal of the
order, with the length of time the restraint will be in place, are required.
3. The reason for using the protective device should be explained to the child and parents to
prevent misinterpretation and to ensure their cooperation with the procedure. Children often
interpret restraints as punishment.
4. Teach the child and family about specific devices they may be using in the hospital (ie, side
rails) and after discharge (ie, mitts, elbow restraints).
5. Any protective device should be checked frequently to make sure it is effective and is not
causing any ill side effects. It should be removed periodically to prevent skin irritation or
circulation impairment. Provide range of motion and skin care routinely.
6. Protective devices should always be applied in a manner that maintains proper body alignment
and ensures the childs comfort.
7. Any protective device that requires attachment to the childs bed should be secured to the bed
springs or frame, never the mattress or side rails. This allows the side rails to be adjusted without
removing the restraint or injuring the childs extremity.
8. Any required knots should be tied in a manner that permits their quick release. This is a safety
precaution.
9. When a child must be immobilized, an attempt should be made to replace the lost activity with
another form of motion. For example, although restrained, a child can be moved in a stroller,
wheelchair, or in bed. When arms are restrained, the child may be allowed to play kicking
games. Water play, mirrors, body games, and blowing bubbles are helpful replacements.
10. Restraints should be removed as soon as the child is no longer considered a danger to self or
others or when medical devices are no longer in place.

Restraint
Mummy restraint
The mummy device involves
securing a sheet or blanket
around the childs body in such
a way that the arms are held to
the sides and leg movements
are restricted.
This short-term type of restraint
is used on infants and small
children during treatments and
examinations involving the
head and neck

Equipment needed
Procedure

Special Precaution

Small sheet or blanket.


1. Place the blanket or sheet flat on the bed.
2. Fold over one corner of the blanket.
3. Place the child on the blanket with shoulder at the
edge
of the fold.
4. Pull the right side of the blanket firmly over the
childs
right shoulder.
5. Tuck the remainder of the right side of the blanket
under
the left side of the childs body.
6. Repeat the procedure with the left side of the blanket.
7. Separate the corners of the bottom portion of the
sheet,
and fold it up toward the childs neck.
8. Tuck both sides of the sheet under the childs body.
9. Secure by crossing one side over the other in the back
and tucking in the excess, or by pinning or taping the
blanket in place.
Make certain the childs extremities are in a comfortable
position during this procedure. Make sure that the
restraint is not
obstructing the childs airway

Jacket restraint
The jacket device is a piece of
material that fits the child like a
jacket or halter. Long tapes are
attached to the sides of the
jacket.
Jacket device restraints are used
to keep the child in a
wheelchair, high chair, or crib.

Equipment needed
Procedure

Special Precaution

Small sheet or blanket.


1. Put the jacket on the child so the opening is in the
back.
2. Tie the strings securely with a knot that can be easily
released, if necessary.
3. Position the child in wheelchair, high chair, or crib
4. Secure the long tapes appropriately:
a. Under the arm supports of a chair.
b. Around the back of the wheelchair or high chair.
c. To the springs or frame of a crib.
Children in cribs must be observed frequently to
make certain they do not become entangled in
the long tapes of the jacket device.
Release, reposition, and perform range of motion
exercises as per hospital policy.