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C.O.R.E. Promise

 
 

At St. Jude, the safety of your child is our top priority. We have created a program called the Safe and Sound: CORE Promise. This program aims to ensure the safety of all children in our care.

As part of CORE Promise, we offer comfort measures to all patients during medical events. This helps patients cope better with day-to-day medical experiences.

Experts across the hospital created the CORE Promise based on programs from other hospitals and feedback given by members of our Patient Family Advisory Council. 

There are several ways we work to make your child more comfortable and ease their pain and anxiety.

 

 
 
CORE Promise graphic

C.O.R.E. stands for: 

Comfort Positioning: We will help change the way your child sits or stands based on ways that have been shown to help children feel safe and secure during needle sticks and other medical experiences.

One Primary Voice: We will limit extra medical talk. This reduces confusion for your child and helps create a calm environment.

Reduce Pain: We will try to reduce your child’s pain when possible.

Every Child, Every Time: We will offer clinically appropriate comfort measures for needle sticks and other medical experiences. We will also ask you about your child’s coping needs that we are able to help with during medical experiences.

Below you will find suggestions on how to help reduce a patient's distress

Please ask about using these strategies during medical experiences. 

 
 

C.O.R.E.  Promise recommendations by age group

  1. Comfort Positioning

    • Being held by a caregiver
    • Swaddling for infants 0–6 months old or as is helpful for your infant
    • Patting or rocking

    One Primary Voice

    • Create a calm environment.
      • Hushed tone of voice
      • 1 main voice speaking to the child.
    • Shushing
    • Soothing music or sound machine
    • Singing or humming

    Reduce Pain

    • Sucrose or breastfeeding for pain management.
    • Sucking on pacifier
    • Buzzy® ( device that uses vibration and cold to distract from pain)
    • LMX (numbing cream)

    Every Child, Every Time
    Each child has unique ways of coping. St. Jude staff will ask what works best for your child during medical experiences. Infants feel safest in your arms but may become upset when going through something painful. Distraction, the presence of a caregiver, and soothing techniques may help reduce the perception of pain and help the child return to their “normal” state. Here are a few distraction and soothing techniques that may help your infant:

    • Mobile
    • Visual distractions
    • Peek-a-boo
    • Sound or sensory books
    • Comfort provided by caregiver
  2. Comfort Positioning

    • Sitting in a caregiver’s lap
    • Chest-to-chest hugging
    • We do not suggest lying flat or being held down, with some exceptions.

    One Primary Voice

    • Create a calm environment.
      • Hushed tone of voice
      • 1 main voice speaking to the child.
    • Soothing music or sound machine

    Reduce Pain

    • Numbing cream
    • Buzzy (device that uses vibration and cold to distract from pain)
    • J-tip (needle-free device that gives numbing medicine)
      • Note:  This needle-free device makes a sound when activated. If using this method, we suggest that you let your toddler know what to expect and use noise-canceling headphones and distraction to support coping.

    Every Child, Every Time
    Each child has unique ways of coping. St. Jude staff will ask what works best for your child during medical experiences. A toddler’s favorite word is often “No!” Going through an unwanted medical experience may be distressing. Distraction, preparation, the presence of a caregiver, and play may help reduce the perception of pain and help the child return to their “normal” state. Here are a few distraction techniques that may help your toddler:

    • Interactive music or songs
    • Visual distractions
    • Peek-a-boo
    • Sound or sensory books
    • Interactive toys
    • Fun or educational videos
    • Comfort provided by a caregiver. 
  3. Comfort Positioning

    • Sit alone, in a caregiver’s lap, next to a caregiver on the bed, or in a chest-to-chest hugging position with a caregiver.
    • Offer to hold hands (the child may prefer to hold the caregiver's hand)
    • We do not suggest lying flat or being held down, with some exceptions.

    One Primary Voice

    • Create a calm environment.
      • Hushed tone of voice
      • 1 main voice speaking to the child.
    • Soothing music or sound machine

    Reduce Pain

    • Numbing cream
    • Cold spray
      • *Note: Cold spray is not recommended for children under the age of 4.
    • Buzzy® (device that uses vibration and cold to distract from pain)
    • Needle-free lidocaine injection*
      • *Note: This needle-free device makes a sound when activated. If using this method, we suggest that you let your child know what to expect and use noise-cancelling headphones and distraction to support coping.

    Every Child, Every Time
    Each child has unique ways of coping. St. Jude staff will ask what works best for your child during medical experiences. Preschoolers have big imaginations, which can make the medical setting unpredictable or scary. Distraction, preparation, the presence of a caregiver, and play may help reduce the perception of pain and help the child return to their “normal” state. Here are a few distraction techniques that may help your preschooler:

    • Stress ball or squishy toy
    • Deep breaths
    • Fun or educational video or iPad games
    • Interactive toys
    • Books
    • Validating the child’s feelings
  4. Comfort Positioning

    • Sit in a caregiver’s lap or alone in a preferred position.
    • Offer to hold hands (the child may prefer to hold the caregiver's hand)
    • Respect modesty by offering privacy.
    • We do not suggest lying flat or being held down, with some exceptions.

    One Primary Voice

    • Create a calm environment.
      • Hushed tone of voice
      • 1 main voice speaking to the child.

    Reduce Pain

    • Numbing cream
    • Cold spray
    • Buzzy® (device that uses vibration and cold to distract from pain)
    • Needle-free lidocaine injection*
      • *Note: This needle-free device makes a sound when activated. If using this method, we suggest that you let your child know what to expect and use noise-canceling headphones and distraction to support coping.

    Every Child, Every Time
    Each child has unique ways of coping. St. Jude staff will ask what works best for your child during medical experiences. School-age children want to know what to expect. Distraction, preparation, the presence of a caregiver, and play may help reduce the perception of pain and help the child return to their “normal” state. Here are a few distraction techniques that may help your school-age child:

    • Deep breaths
    • Stress ball or squishy toy or fidgets
    • Books
    • “I Spy” game
    • Virtual Reality
    • Fun or educational videos or iPad games
  5. Comfort Positioning

    • Choice to sit in the child’s preferred position (with caregiver present if preferred)
    • Respect modesty by offering privacy.
    • Offer to hold hands.
    • We do not suggest lying flat or being held down, with some exceptions.

    One Primary Voice

    • 1 main voice speaking to the preteen.
    • Careful choice of music
    • Relaxing sounds and meditation

    Reduce Pain

    • Numbing cream
    • Cold spray
    • Buzzy® (device that uses vibration and cold to distract from pain)
    • Needle-free lidocaine injection*
      • *Note: This needle-free device makes a sound when activated. If using this method, we suggest that you let your preteen know what to expect.

    Every Child, Every Time
    Each preteen has unique ways of coping. St. Jude staff will ask what works best for your preteen during medical experiences. Preteens can tell us what they think can help. Distraction, preparation, and social support may help reduce the perception of pain and promote coping. Here are a few age-appropriate distraction techniques that may help your preteen:

    • Simple explanation of what to expect.
    • Diversional video or iPad games
    • Virtual reality
    • Engaging conversation
    • Deep breaths
    • Stress ball or fidgets
  6. Comfort Positioning

    • Choice to sit in the teen’s preferred position (with caregiver present if preferred)
    • Respect modesty by offering privacy.
    • Offer to hold hands.
    • We do not suggest lying flat or being held down, with some exceptions.

    One Primary Voice

    • 1 main voice speaking to the teen
    • Careful choice of music
    • Relaxing sounds and meditation

    Reduce Pain

    • Numbing cream
    • Cold spray
    • Buzzy® (device that uses vibration and cold to distract from pain)
    • Needle-free lidocaine injection*
      • *Note: This needle-free device makes a sound when activated. If using this method, we suggest that you let your teen know what to expect.

    Every Child, Every Time
    Each teen has unique ways of coping. St. Jude staff will ask what works best for you and your teen during medical experiences. Teens can tell us what they think can help. Distraction, preparation, and social support may help reduce the perception of pain and promote coping. Here are a few distraction techniques that may help your teen:

    • Deep breaths
    • Simple explanation of what to expect.
    • Diversional video or iPad games
    • Virtual reality
    • Engaging conversation
    • Stress ball or fidgets
 
 

About pain management

Pain management during needle sticks

  •  Numbing cream requires at least 30–45 minutes to take effect. If your child needs labs to be drawn quickly, we suggest using another method to manage pain. Ask your nurse about strategies that work more quickly to reduce pain.
  • Cold spray* is available to help reduce pain to the skin.
    • *Note: Not recommended for children under the age of 4.
  • We suggest sucrose, breastfeeding, or sucking on a pacifier for infants ages 0–12 months to reduce pain during needle sticks or other painful events. Sucrose can be given under the tongue or with a pacifier to encourage a sucking motion. Please ask your health care provider if you are interested in trying pain management strategies for your infant.
  • Some pain management agents cannot be used in certain circumstances. Please ask your health care provider for more details.

Pain management tips in Diagnostic Imaging

  • Your Diagnostic Imaging technologist can offer sucrose, a pacifier, or encourage breastfeeding for infants along with Buzzy® for pain management during needle sticks.
  • Diagnostic Imaging technologists cannot give lidocaine (numbing medicine). So, they cannot give numbing cream or needle-free lidocaine injections.
  • If your child prefers numbing cream or a needle-free lidocaine injection, please plan to apply numbing cream before your appointment or arrange to have the IV placed or port accessed before you arrive in Diagnostic Imaging.

Support for children struggling with needle sticks

  • It’s common for children to become fearful of needle sticks. Child life specialists and psychologists are trained to prepare and support a child as they cope with medical experiences. Please contact Child Life or ask your care team for a referral. 

Reducing stress during all types of care

  • You and your child can apply the principles of the Safe and Sound C.O.R.E. Promise to reduce distress during all types of medical care.
  • Child life specialists and psychologists are trained in to prepare and support a child in coping with medical experiences. Please contact Child Life or ask your care team for a referral. 

Distress reduction strategies available at most care facilities

  • Many other hospitals also make formal or informal commitments to reduce distress during medical experiences. We always encourage you and your child to ask for distress-reducing strategies wherever you get care. 
 
 
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