Table 2.

Steps in a Sample Plan for Preparation and Management of Pain during the First Administration of Passive Stretching with a 5-Year-Old Patient

1.	In advance, choose some distraction materials. These could be items in the room such as a poster on the wall, or music, or a toy brought by the child.
2.	Demonstrate the stretch on teddy bear. Narrate the procedure: “First the teddy bear lies down, then the bear takes a deep breath, then …”
3.	Say how it might feel: “Some kids say this feels like pressing, other kids say it feels like pushing, and others say they can hardly feel it.”
4.	Position the child in contact with or close to the parent.
5.	Request self-report: “Please tell me how it feels as we go along.”
6.	Watch the child's facial expression, eyes, breathing, for signs of pain. If signs are noticed, slow down a bit.
7.	Draw the child's attention to the distraction chosen at Step 1.
8.	Compliment the child's coping efforts. Even if the child cries, there are moments when efforts to regain control can be seen and complimented.
9.	When finished, narrate the procedure that was just completed in a way that emphasizes positive aspects, to set up good expectations for the next time.