RESTRAINTS
INTRODUCTION
Children may need to be restrained for
some diagnostic procedures, therapeutic
procedures or during the physical examination
and sometimes to protect from an injury
An appropriate safe and comfortable restraint
should be selected. The restraint may be
provided manually with help of some device
PURPOSE
To carry out the physical examination
To provide the safety to child
To protect the child from injury
To complete the diagnostic and therapeutic
procedures
To maintain the child in prescribed position
To reduce the discomfort of child during some
tests and procedures like specimen collection
ARTICLES NEEDED
Baby blanket or draw sheet
4” bandages for clove hitch knot
Cotton pads
Restraint cloths with pocket
Wooden plastic sticks (spatula) to keep
in for elbow restraint
Scissors to cut the bandage
Jacket for jacket restraint
Adhesive tape to fix the bandage
POINTS
TO
REMEMBER
WHILE
RESTRAINING
Always select the safe and appropriate restraint
Restraint should not be too tight; it should not
interfere with the normal circulation
Use appropriate cotton pads for maintaining the
comfort of child
Restraint should demonstrate to the child, on the
child doll to gain the cooperation and reduce the
anxiety
Explain the restraint and it to comportment that
the child should be able to understand
Always maintain comfort to the child and
maintain body alignment
Open the restraint knot, when the side rails
are eased to prevent traction
Observe the restraint every 20-30 minutes to
prevent any complications
Change the side of child to prevent pressure
sore
Do not give too much tight knot. It should
be easily releasable
Do not provide purposeless restraining
Do the recording and reporting properly
TYPES
OF
RESTRAINING
Mummy restraint
Mummy restraint is used for the children to
restrict the moment of limbs
It is used to the children for examination,
procedure and treatment of head, neck and
face is required
For example like scalp vein puncture, ear
examination, and eye irrigation, gastric and
gastric lavage
PROCEDURE
Take blanket or draw sheet and spread it our the bed
or table
One corner of a small blanket is folded over
The infant is paced on the blanket with the neck at
the edge of the fold
Keep one hand of baby near the body and wrap the
baby,s body by holding the corner of the sheet and
tuck it under the body in opposite side
Now place another hand near the body and wrap
the childs body by holding another corner of sheet
and tuck it
Now take the rounded sheet at bottom near the
leg and fold it towards the chest and tuck it upper
level of sheet or we can pin it at lower of sheet
It restrict all extremities
ELBOW AND KNEE RESTRAINT
Elbow and knee restraint is used to
control the flexion of elbow and knee
In this a readymade cloth with 6-10
pockets is used
Place the cotton on sides of elbow and
knee and the knee the wooden or plastic
strips on pocket cloth. These pockets are
vertical
Place the cloth on elbow and knee and
adjust it with central location and tie the
both side strips properly
This elbow restraint is used in case of face
and head surgeries
Cleft lip and cleft palate, scalp vein
infusion, heart injuries and sutures are
good examples of using this elbow
restraint
ABDOMINAL RESTRAINT
This restraint is used to hold the infant in a supine position
on the bed
Abdominal restraint should not be too light, so that it
cannot interfere with respiration and bowel movement
For this restraint, use wide size wooden strips
Place the cotton pad appropriately to provide the proper
comfort
Extremity Restraint (Ankle & Wrist restraint)
This involve the extremity (one or more)
restraint to complete some procedures
It is used to immobilize the extremities
These are various method uses for ankle and
wrist restraint
CLOVE HITCH KNOT RESTRAINT
It used to immobilize the leg or arm
The material for clove hitch can be soft cloth,
crepe bandage and inch wide gauze bandage
First apply the cotton pad over the wrist,
ankle to provide comfort
Prepare a figure of “eight” by the bandage and
place it on the wrist or in the ankle and tie the
bandage by knot
Knot should not be too tight, or too loose
Child can remove the knot, if it is too loose
To tight knot can interfere on blood circulation
The fingers and toes should be checked for
discoloration or any skin rashes
Finger Restraint
It can be completed by making a mitten
The mitten course the all fingers of a hand and restrict
the movement of the fingers
The hand can be wrapped by gauze or hand can be put in
a bag like pouch and tie it properly at the wrist of child
Finger restraint is used in case of facial surgeries, burns,
intravenous infusion, any eczema of face and body parts
Keep the mitten soft and it should not interfere
circulation
Crib-net restraint
In this a net is used to cover the child cot
Net is attached to the cot frame
This net restraint is used to prevent the children climbing
over the side rails of cot
Inside the crib net, the child is totally free to move, no
movement is restricted
It mainly prevents the child to climb and fall from the
side rails cot
Jacket Restraint
In this method, a jacket made up of soft cloth and leather is
used
This jacket has laces at the back and two long strips
The laces are tied at back and long strips tie at the side
below the rails under the mattress
Child can sit and sleep in supine position while wearing
jacket
It can use on chair also
This restraint is used to avoid the child from climbing
over the side rails, climbing out from chair, bed, cot, etc.
It prevent the child from fall and injury
Some other types eg. Chest restraints are also used for
children who are sitting on a chair or wheel chair to
maintain their position and to prevent them from fall
and injury
Safety Belts
These are made up of electrically non-conductive
material
These belts are used on stricter and operation
labels to prevent the children from falling
The belts go around the childs waist and tied to the
frame of bed under the mattress
Side Rails
The rails are made up of iron or steel
These can be raised when ever need arises
and can be decreased as per convenience
The main purpose of side rails are to
prevent from fall and can be used for other
restraints.
These are used for children with convulsive
disorders also
Splints
These are prepared devices which are used to
restraint the movements of extremities
These are made up of plastic, card board, hard
paper, and cotton and gauze pieces
These can be applied where ever needed
COMPLICATIONS
OF
RESTRAINTS
If restraints are not used properly, it can cause various
complications or hazards
It can interfere the child muscular development due to lack
movement
If restraint is too tight, it cause obstruction in blood
circulation tissue damage, redness, scar formation,
discoloration of the skin etc
Dislocation of the shoulder joint may occur if the child
struggles during application of arm restraints
Development of pressure sore, if the child is kept restricted
for longer period of time and does not have frequent change
of position and skin care
Hypostatic pneumonia due to immobility
Ischemia or nerve damage due to constrictive restrains
Psychic injury to the child, the child feels that, he/she is punished,
attention is self body image
Disturbance in psychosocial development
To avoid from these hazards, the care giver or nurse should follow the
safety precautions
Use proper amount of cotton pads, and do not use too tight restraint
Always follow continuous observation on child
If any application occurs release the restraint and consult with doctor
Maintain proper recording and reporting