"I want to do it myself!" Interferon self-injection for children with chronic viral hepatitis

As part of protocols for the treatment of chronic viral hepatitis B or C, children were scheduled to receive subcutaneous injections of interferon three times weekly for a period of 6 to 12 months. Both the children and their parents perceived the injections as painful and technically difficult. In response, a program was developed to provide an educational approach that supported the active participation of 34 children (20 male, 14 female), ages 1.5 to 16.5 years of age (mean, 9.4 years). Interferon was reconstituted as 10 mu/1 ml and administered with a 29-gauge needle and a 0.5- or 1.0-mL insulin syringe. These children were asked what they feared most about treatment and what would help them be less fearful. A developmentally based teaching plan emphasizing safety, trust, initiative, and mastery was created by each family with the help of the pediatric nurse practitioner. Flexibility and development of rituals were supported. Participants were asked what they learned and what advice they had for others; this feedback was shared with new families entering the protocol. This article describes the implementation of a new approach incorporating self-injection by children.