Background
Methods
Data collection
Online discussion forums (F) or Blogs (B) | Number of forum or blog threads | No. of unique names identified | Range of dates of posts | Extraction date |
---|---|---|---|---|
F1 | 2 | 9 | 7 years ago | 12-01-2015 |
8 | 5 years ago | |||
F2 | 10 | 10 | 07-06-2014 to 08-06-2014 | 07-01-2015 |
5 | 03-04-2014 | |||
6 | 04-12-2012 | |||
5 | 14-11-2011 to 15-11-2011 | |||
9 | 30-11-2014 to 02-12-2014 | |||
7 | 22-01-2013 to 23-01-2013 | |||
5 | 15-02-2012 to 16-02-2012 | |||
6 | 14-09-2011 | |||
6 | 02-11-2011 | |||
9 | 23-01-2013 to 25-01-2013 | |||
F3 | 7 | 9 | 31-12-2012 | 07-01-2015 |
5 | 07-06-2010 | |||
8 | 07-07-2014 | |||
8 | 30-03-2013 | |||
5 | 11-01-2012 to 15-01-2012 | |||
8 | 26-02-2011 | |||
7 | 22-03-2010 to 22-04-2010 | |||
F4 | 2 | 5 | 22-03-2009 | 12-01-2015 |
12 | 11-01-2015 to 13-01-2015 | |||
F5 | 1 | 11 | 24-07-2010 | 09-01-2015 |
F6 | 1 | 7 | No dates recorded | 12-01-2015 |
B1 | 1 | 1 | No dates recorded | 12-01-2015 |
F7 | 1 | 9 | No dates recorded | 12-01-2015 |
B2 | 1 | 1 | No dates recorded | 12-01-2015 |
F8 | 9 | 4 | 08-05-2007 | 07-01-2015 |
10 | 29-07-2011 to 30-07-2011 | |||
7 | 03-09-2012 to 05-09-2012 | |||
4 | 30-09-2006 to 01-10-2006 | |||
5 | 09-09-2005 to 11-09-2005 | |||
6 | 06-01-2005 to 09-01-2005 | |||
12 | 19-09-2006 to 20-09-2006 | |||
4 | 10-08-2009 to 11-08-2009 | |||
9 | 26-09-2008 to 27-09-2008 | |||
F9 | 1 | 4 | 11-05-2007 | 12-01-2015 |
F10 | 1 | 7 | 08-10-2012 | 12-01-2015 |
F11 | 1 | 8 | No dates recorded | 12-01-2015 |
F12 | 1 | 2 | 19-04-2011 | 12-01-2015 |
F13 | 1 | 4 | 26-03-2009 | 12-01-2015 |
F14 | 6 | 6 | 23-04-2007 to 25-04-2007 | 12-01-2015 & 15-01-2015 |
18 | 23-10-2008 to 24-10-2008 | |||
19 | 05-01-2010 to 08-01-2010 | |||
7 | 15-05-2006 to 17-05-2006 |
Data analysis
Ethical considerations
Results
Themes | Subthemes | Descriptions |
---|---|---|
1. Administration Experience | Child’s resistance to administration | Fight, scream & cry |
Shut their eyes tight | ||
Distress and fear | ||
Drops sting eyes and taste bad | ||
Parents’ reluctance to administer | Horrible and cruel | |
Upset child | ||
2. Administration Methods | Using force and restraint | One person pin & drop |
Two persons pin & drop | ||
‘Leg-over-child’s arms’ method | ||
Burrito-method | ||
“Show and tell” | Demonstration & Role-play | |
Talk child through | ||
Praise & reward | ||
Minimize child’s distress & awareness | Distraction – Game or play | |
Manage eye drop on closed eyes | ||
While sleeping | ||
Other management strategies | Give up eye drop administration | |
Alternative ways to treatment | ||
3. Role of healthcare professionals | Diagnosticians & prescribers | |
Guidance on eye medication administration methods |
Administration challenges
Child’s resistance to administration
The physical responses were focused on escape (for example ‘wriggling’, ‘thrashing’, ‘fighting’) and resistance, such as shutting their eyes tight to prevent the eye drops being inserted. The‘Every time it's her screaming and crying murder! I bet someone walking by would think we are beating her!!! For eye drops!!!!’ (F2, C)
Parents often reported how the immediate discomfort of the eye drops contributed to the child’s reluctance.‘It is such a nightmare to get her to take them she fights us and scrunches her eye so tight there is no way the drops go in.’ (F8, A)
‘The drops burn and hurt, so he will instinctively fight those drops. Plus, they take a while to work which means a prolonged battle.’ (F14, AZ)
Parents’ reluctance to administer
Parents similarly expressed fear that they might hurt their child, for example:‘I’m having to employ the pin-her-down and use ‘prise eyes open’ tactic now. It's horrible, I hate having to do it!’ (F3, M)
‘We feel terrible about that and worry that she might get hurt thrashing about as she does. It is just horrible, and we still have some more days to go.’ (F15, E)
Administration methods
Using force and restraint
There were other, more sophisticated, methods of restraint described, including the ‘burrito method’ to swaddle the child so that their arms are trapped. One parent said,‘With great bloody difficulty I sit on the floor ….., lay him back with my legs over his shoulders, holding his eye open with one hand and doing the drops with the other. Walah! Worst experience ever. *Bows*. I have tried every other way and it’s not as effective, so I’m stuck with the mean mummy way.’ (F5, LS)
‘I started wrapping him up in a bath towel like a giant baby burrito. Then, I lean over him, slide my arm under his head, and put the drops in the corner of his eye.’ (F15, AZ)
Show and tell
For a child at the age of understanding parents might try to explain why the eye drops were needed. One parent wrote,‘So far the demonstration has fascinated him but doesn't stop his panicking when we put the drops in him. He even “gives” Daddy, Mommy, and Elmo the drops. Oh well, even if not all of the medicine gets in there it seems to be working.’ (F7, AY)
Other parents recommended praise or reward when the child cooperated.‘I'm finding more and more that [Child] understands what I'm saying even if she can't communicate back very well and if I explain exactly what is going to happen in advance … then she usually has no problem at all.’ (F3, FY)
‘Try giving him a lollypop as a reward and to distract him from the pain and taste. … Or let him pick a treat after he does the drops.’ (F3, JM)
Minimize child’s distress and awareness
Alternatively, parents waited until their child was asleep then lifted the eyelids and inserted the drops.‘Did you try letting him lie down with his eyes closed? Incline his chin back a bit and put the eyedrops in the corners of his eyes...then tell him to open his eyes … It helped that they couldn't see the drop coming!’ (F14, JH)
Other management strategies
Other parents adopted alternative treatments, for example cleaning with ‘breast milk’, or bathing the child’s eyes with ‘salt water’, ‘warm water’, or ‘cold tea’.‘We gave up. [Child] had pink eye with his last ear infection and the urgent care doc prescribed eye drops that we were supposed to give every 4 hours. I called my regular doctor and asked if it was really necessary. And pink eye with drops will, on average, clear up in 3.4 days and without will clear up in 4.5 days.’ (F2, SK)
Others recommended asking for ointment rather than drops, or keeping the eye drops warm to reduce stinging.‘I expressed breastmilk into a clean bowl, dipped in cotton wool and then wiped over each eye several times a day. Cleared up in around 3 days if I remember rightly.’ (F4, FT)
‘It did help to use warm drops. I kept the bottle in my pocket or bra, so it was body temperature.’ (F15, BT)
Role of healthcare professionals
Diagnosticians and prescribers
Only occasionally was re-consultation with a health care professional suggested to achieve a different formulation that is easier to administer and requires fewer doses:‘[Child] has mild conjunctivitis in his eyes. The doctor gave him some eye drops to use 2 times a day for 5 days.’ (F8, FF)
‘Go back to the doctor, say it is impossible and ask for Fucithalmic, it is more of a cream than an eye drop, so easier to apply but also only needs to be applied a few times a day.’ (F16, A)
Guidance on eye medication administration methods
Unlike accounts of advice from other health professionals, the advice from nurses combined advice on administration with tips on restraint, perhaps reflecting their greater professional involvement in giving eyedrops.‘A recent advice from an eye specialist for giving eye drops to my toddler - if you put enough drops onto the eyelashes of a close eye, when the eye is opened, the drops will wash in …’ (F16, NE)
‘The nurses in the NICU showed us how to do it. You have to kind of pin the baby's head so they can't move, hold the eye drops in one hand ready to use them, use your thumb and index finger of the other hand to open their eye lid and hold it open while you squeeze the eye drops into the inside corner of their eye.’ (F2, TJ)