Challenge
Outpatient dermatology clinics provide an ideal setting for short, minimally invasive procedures. However, without general anesthesia, procedures can be obstructed by infants’ and toddlers’ difficulty to remain still throughout the perceived stressful event(s) in clinic.1 Assistance from parents, caregivers, or medical assistants is not always available or reliable. Thus, immobilization can be achieved in procedural settings with the blanket/sheet wrapping technique for children less than 4 years of age. This technique is similar to swaddling that IS often used to soothe infants but will be described in detail for trainees and clinicians who may not be familiar with or feel comfortable using this method in a medical setting.
Blanket/sheet wrapping is not required for all procedures in pediatric dermatology. Ideal examples of procedures amenable to this technique in dermatology include laser therapy for vascular lesions and biopsies. Liquid nitrogen, candida injections, cantharidin, and bacterial/fungal swabs do not typically require immobilization.
Solution
In this video tutorial (Video 1, available on www.jaad.org), we demonstrate immobilizing a young child, around the age of 2 years, with a cloth sheet to perform a clinic-based procedure without general anesthesia. This technique can be used for children up to the age of 4 years. Equipment is limited to a procedure table and 1 to 2 cloth sheets. Sheet size may vary based on the child’s age and size.
Setup
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1.
Lay sheet #1 horizontally across the procedure table.
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2.
Place the child on sheet #1 with their neck aligned with the edge of the sheet.
Wrap∗
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3.
Pull one side of sheet #1 across the patient’s body, ensuring that you cross the patient’s shoulder on the same side∗∗.
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4.
Keep both arms close to the body and tuck sheet #1 over the patient’s opposite arm and underneath their body.
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5.
Repeat step 3 on the opposite shoulder.
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6.
Tuck sheet #1 underneath body.
Optional
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7.
For additional comfort, a second sheet can be added.
Conflicts of interest
None declared.
Funding sources: None.
IRB approval status: Not required.
Prior presentations: None.
If the procedure will be performed on the patient’s left extremity, then step 3 would be started on the patient’s right extremity and vice versa if the procedure will be performed on the patient’s right extremity.
Including the shoulder in the wrap limits the child’s range of motion.
Supplementary data
Reference
- 1.Lyon V.B., Palmer C.M., Wagner A.M., Cunningham B.B. Toddler wrap for abdominal biopsy or excision. Pediatr Dermatol. 2008;25(1):109–111. doi: 10.1111/j.1525-1470.2007.00595.x. [DOI] [PubMed] [Google Scholar]
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