Suturing on children

I feel pretty comfortable at this point suturing a superficial laceration. I've even sutured some lacerations in sensitive areas such as the face and hands. But, man, it's a completely different beast suturing on a screaming squirming child! I didn't try this, thankfully, but I saw several of them during my first week on pediatrics. With one kid, even a hit of Versed wasn't enough to calm him down!

One attending's advice: Immobilization. If you keep them completely immobile, they'll eventually stop trying to move; but if you let them move just a little bit, they'll squirm throughout the entire procedure. Just holding down their arms isn't enough. We used blankets to wrap these kids into burritos to immobilize their arms, legs, and torso all at once.

Another attending's advice: Patience. Make any sensitive movements while the kid is actually crying since they tend to be more still during exhalation. One attending spent what felt like 5 minutes trying to take out a single suture, his hand braced against the child's face steadying the scissors to be ready to snip the suture during the briefest window of calm.

To do a good job suturing on children takes a level of patience and steely nerves that I certainly admire.