Guide for Parents and Caregivers of Children with IV Lines

When your child needs a vascular access device — whether for days, weeks, or months — the experience is different from adult IV care in important ways. Children process fear and pain differently at different ages, their bodies are smaller, they are less able to protect the device from accidental dislodgement, and you as a parent or caregiver carry significant emotional weight alongside the practical responsibilities.

This guide is written for you — the parent, guardian, or primary caregiver — to help you support your child effectively while also taking care of yourself.

Understanding Your Child’s Vascular Access Device

The same types of devices used in adults are used in children, though sizes are different (pediatric catheters are smaller) and insertion sites may vary by age and size. For children, the most common devices are:

Peripheral IV (PIV): Short-term, placed in hand, wrist, forearm, foot (in infants), or scalp (in neonates/infants)
PICC line: Common for children receiving extended IV antibiotics, chemotherapy, TPN, or other long-term therapy
Implanted port: Common in children with cancer receiving prolonged chemotherapy; allows greater freedom between treatment sessions
Broviac catheter: A tunneled catheter used for very long-term central access in children, particularly smaller children; similar to Hickman in adults

The care principles are the same as for adults, with modifications for the child’s age, size, and developmental level. See our specific device care guides for detailed care instructions, and ask your child’s care team about any pediatric-specific differences that apply.

Talking to Your Child About Their IV

How you talk about vascular access depends enormously on your child’s age and developmental stage. The overarching principles at all ages:

Be honest — at an age-appropriate level. Do not promise “this won’t hurt at all” if it will. Children who are told a procedure will not hurt and then experience discomfort lose trust in caregivers, which makes subsequent procedures much harder.

Give information before events, not surprises. Children who know what is coming — even difficult things — cope better than children who are blindsided.

Use simple, accurate language. “The nurse is going to put a small tube in your arm so the medicine can go in” is better than complex explanations or oversimplifications that later confuse.

Normalize the situation. “Lots of kids have this kind of tube when they need important medicine” reduces the sense of uniqueness and isolation.

Infants and toddlers (0–3 years)

Infants and young toddlers do not understand explanations, but they respond strongly to your emotional state and presence. Your calm presence is the single most important factor.

Stay calm and confident — your child reads your anxiety
Comfort through voice, touch, and eye contact
Swaddling helps calm infants during procedures
Pacifiers, breastfeeding (if applicable), or sweet solutions (sucrose) can reduce pain perception during brief procedures — ask the nursing team about these comfort measures
Immediate comforting after a procedure helps regulation

Preschoolers (3–6 years)

Preschoolers have vivid imaginations and misconceptions about medical procedures. Their fears are often more about loss of control and abandonment than about pain.

Use simple, concrete terms: “tube,” “medicine going in,” “tiny pinch”
Give choices where genuinely possible: “Which arm?” “Do you want to watch or look away?” “Do you want to hold Teddy?”
Play therapy and medical play (playing doctor/nurse with toy equipment) helps this age group process experiences
Do not say “I’ll be right back” if you are actually leaving — separation anxiety is intense at this age

School-age children (6–12 years)

School-age children can understand basic explanations and benefit from preparation.

Explain what will happen step by step, in simple terms
Answer questions honestly: “Will it hurt?” → “The numbing shot will sting for a few seconds. After that, you might feel pressure but not the sharp kind of hurt.”
Give age-appropriate control: “Would you like the light on or off?” “Do you want me to talk to you during it or stay quiet?”
Teach and practice coping strategies in advance: deep breathing, counting, squeezing a stress ball
Validate feelings: “It makes sense that you’re nervous. This is new and strange.”

Adolescents (12+ years)

Teenagers need autonomy and respect for their developing identity.

Speak to them directly (not just to you as the parent) and include them in information-sharing
Respect privacy; ask if they want a parent present for procedures
Be honest about side effects and limitations — teenagers who feel deceived become very difficult to engage
Acknowledge that having an IV device is disruptive to peer relationships, appearance, and daily life — this is a real loss
Support their participation in decision-making about their care when appropriate

Managing Needle Fear and Procedure Anxiety in Children

Needle fear is extremely common in children and is one of the most significant challenges in pediatric IV care. Fortunately, there are highly effective interventions.

Topical anesthetic cream (EMLA / LMX4)

A numbing cream applied to the skin at least 45–60 minutes before a needle procedure significantly reduces or eliminates the pain of the needle. This is the single most impactful intervention for children with needle fear.

Apply proactively. If you know your child will need a blood draw, port access, or IV placement, apply the cream ahead of time.
Ask your care team or pharmacy about EMLA cream (available by prescription) or LMX4 cream (available over the counter in the US). Follow application instructions carefully, including the wrap/covering to keep the cream in place.
Some centers apply the cream routinely for all pediatric procedures; others require you to request it.

Distraction

Distraction is highly effective for children across all ages during brief procedures:

Tablet or phone with a favorite video or game — particularly effective for children 3+
Blowing a pinwheel or blowing bubbles — activates deep breathing and focuses attention
Pop-up or lift-the-flap books (for younger children, held by parent during procedure)
Counting down together
Listening to music with earbuds

The key to distraction is starting it before the procedure begins — do not wait until the needle is going in.

Guided breathing

Coach your child through slow, deep breathing. Use child-friendly language:

“Breathe in and smell the flowers… breathe out and blow out the candles”
“Breathe in for 1-2-3-4, hold for 1-2, breathe out for 1-2-3-4-5-6”

Child life specialists

Most children’s hospitals and many pediatric units have certified child life specialists — healthcare professionals specifically trained to support children and families through medical experiences. They can:

Prepare your child for procedures with age-appropriate explanations and medical play
Provide distraction and coaching during procedures
Help your child process difficult experiences afterward
Provide resources and coping tools

Ask your care team: “Is there a child life specialist available to help prepare my child for this procedure?”

Positioning matters

For most children, being held in an upright lap-hold position (a parent or child life specialist sitting behind the child, arms gently around them) is less distressing than lying flat on a table. Ask if this positioning is possible.

Cold spray / vibration devices

Brief cold spray (vapocoolant) applied to the skin just before a needle provides a few seconds of numbing. Vibrating devices that use competing sensation (e.g., Buzzy — a bee-shaped cold/vibration device placed near the injection site) can reduce needle pain perception. Ask your care team whether these are available.

After the procedure: acknowledge and celebrate

Whatever the child’s response during the procedure — crying, screaming, being brave — validate it afterward: “You did it. That was hard and you got through it.” Do not criticize crying (“big kids don’t cry”) or over-praise in a way that trivializes (“That was nothing!”). Acknowledge the reality and the accomplishment.

Protecting the Catheter in Children

Children are not naturally careful with their catheters, and that is developmentally expected. Your job is to create an environment that protects the device without making it the center of constant anxiety.

Securing and covering PICCs in active children

PICC sleeves: Specially designed protective sleeves fit over the arm over the PICC dressing, providing a layer of protection and making the dressing less accessible (and less interesting) to small fingers. Various styles are available commercially.
Compression stocking or snug sock with the toe cut off can serve a similar purpose for a forearm PICC.
Avoid tight wrapping that restricts circulation.
Secure the external PICC connector/hub so it cannot dangle and get caught on clothing.

Tunneled catheters in children (Broviac)

The external catheter must be tucked in or secured snugly against the body at all times
Avoid loose, dangling catheters during play
Older children (school-age+) can wear special catheter management vests or belts
Teach the child not to pull on the tube — in age-appropriate terms, “The tube is like a bridge for your medicine. We have to keep the bridge safe.”

Sleep and rest

For young children with PICCs, a loose onesie over the PICC arm (for infants) or a soft catheter sleeve helps prevent self-dislodgement during sleep. Avoid restraining the arm in a way that disrupts sleep.

School and Activities with a PICC or Port

Returning to school

Many children can return to school with a PICC line or port in place, depending on their overall health. Before returning:

Notify the school nurse of the child’s device, medications, and any restrictions
Provide the school nurse with your emergency contact and the home infusion nurse’s number
Provide written documentation from the physician if required for medications administered at school
Discuss PE class accommodations with the teacher — typically, full-contact activities and activities where the PICC could be hit or pulled are restricted

Physical education and sports

For PICCs: no swimming, no contact sports, no activities with significant arm impact or heavy lifting on the PICC side. Light PE activities (walking, modified games) are usually fine.
For ports (not accessed): very few restrictions. Swimming is permitted. Most sports are permitted with the exception of full-contact sports where the port chest area could be directly impacted. Ask the physician.
For ports (accessed): no PE on infusion days.

Children may feel self-conscious about visible devices, particularly PICCs. Support age-appropriate disclosure — “You can tell your friends you have a tube that helps give you medicine” — and validate that it can feel awkward. For older children and teens, rehearsing how to answer questions from peers can help.

Managing Infusions at Home

For children receiving home IV antibiotics or TPN through a PICC:

Establish a consistent routine — same time each day, same setup
Make the infusion time as neutral or positive as possible (special shows, family time, audiobooks)
For OPAT courses, a 30-minute infusion before bedtime is often feasible and minimally disruptive
Older children (typically 10+, depending on maturity) can begin to learn to participate in or eventually manage their own flushes and connections with supervision

Taking Care of Yourself as a Caregiver

Managing a child’s vascular access device and IV therapy is a significant physical and emotional responsibility. Many parents and caregivers experience:

Caregiver anxiety — worry about doing something wrong with the catheter, fear of infection, fear of something happening during the night
Fatigue — interrupted sleep, the cognitive load of managing a medical regimen
Emotional exhaustion — grief about your child’s illness, helplessness, and the ongoing disruption to family life
Secondary trauma — some parents experience distress related to witnessing their child’s fear and pain during procedures

These responses are completely normal. You are not failing if you feel overwhelmed.

What helps:

Divide responsibilities with a partner or co-caregiver when possible
Accept help from family and friends with practical tasks (meals, transportation, sibling care)
Talk to your child’s social worker — pediatric social work is available at most children’s hospitals and is specifically equipped to support families in this situation
Connect with parent support groups, either through the hospital or online communities for parents of children with specific conditions
Give yourself permission to step away from the caregiving role periodically — you can only give what you have
If anxiety or depression is significantly affecting your function, speak with your own physician or a mental health professional; this is treatable and you deserve support

This guide is for educational purposes. Pediatric vascular access care is highly individualized. Always follow the specific guidance of your child’s care team, including their nurses, physicians, and child life specialists.