CHOC Children’s ED Strives to be ‘Ouchless’

Stitches, shots and sutures can be scary for Emergency Department patients of any age, which is why the Julia and George Argyros Emergency Department (ED) at CHOC Children’s Hospital strives to make visits as ouchless as possible.

Staff members take a holistic approach for pain management at CHOC: Not only do they focus on minimizing physical pain, but they also focus on alleviating mental discomfort. Staff members are versed in age-appropriate techniques, and also call on Child Life specialists to help or relieve fear and anxiety in patients. In line with CHOC’s mission to provide family-centered care, ED staffers also rely on the simple presence of a parent or guardian to help calm patients.

Distraction also plays a strong role in comforting patients. Here’s a short list of distraction methods or tools used in the ED:
• books
• iPad
• games
• movies
• stickers
• coloring books
• video games
• bubbles
• beads

ED staff members also have a variety of medical tools at their disposal to help ease pain and minimize discomfort during procedures. Here’s a short list:

Ultrasound-assisted blood draws

CHOC Children’s ED has a one-poke goal, meaning staff members work to ensure that a needle is injected just once during a procedure. If a patient’s veins are difficult to find, perhaps because they are dehydrated, staff may rely on an ultrasound machine to help identify the location of a vein. This increases the chances that one poke will be sufficient to achieve the procedure’s goal.

J-Tip Needle-Free Injection System

The J-Tip allows CHOC Children’s ED staff to administer numbing medication, such as lidocaine, transdermally and without needles. The device uses pressurized gas to propel medicine into the subcutaneous portion of the skin in less than a second. Once activated, the J-Tip emits a “pop” and “hiss” noise, similar to what’s heard when opening a soda can. The J-Tip is easy to use for staff and virtually painless for patients.

Toot Sweet

Efforts to minimize discomfort are made for even the smallest of patients at CHOC Children’s ED. Staff members offer babies pacifiers dipped in Toot Sweet, a 24-percent water and sucrose solution. Absorbed through the mucous membranes in the mouth, the solution has proven to calm and soothe infants. The solution can be administered just minutes before a procedure, or during as necessary.


Patients receiving stitches at CHOC Children’s ED hardly feel a thing thanks to LET, a topical anesthesia mixture containing lidocaine, epinephrine and tetracaine. A staff member will apply the numbing gel to the affected area before administering stitches. The affected area will feel numb and weak, which usually wears off after 20 minutes or so.


CHOC ED patients who will undergo a lumbar puncture or who have ports that must be accessed will first be numbed with LMX, a topical liposomal lidocaine cream. It takes between 20 and 30 minutes to take effect, and wears off between 40 and 60 minutes after application.

The Julia and George Argyros Emergency Department at CHOC Children’s is located at 1201 W. La Veta Ave., Orange, CA 92868, in the Bill Holmes Tower. 

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