Ear Piercing

Dear Lisa,

I am planning on bringing my 10 year old daughter to pierce her ears. When I brought my older daughter she screamed because it hurt so much. I am dreading this. Is there anything I can do to help my daughter with the pain?

“Planning to Pierce”- N.J.

Dear “Planning to Pierce”,

There is a prescription called EMLA crème which is commonly used for painful procedures in children. It is used in children for ear piercing so the child won’t feel the pain. EMLA crème is similar to the Lidocaine that the dentist rubs on your gums before dental work. This medication numbs the area and if used correctly the child will not feel pain during the procedure. You can ask your Doctor or Nurse Practitioner if your child is a candidate for EMLA crème. This medication is typically not used on infants, especially under three months old because of the risk of side effects.(1) It is intended to be used on clean, dry intact skin. EMLA crème should not be applied to skin with an open wound or a rash. (2).

It is very important to closely follow all directions when applying EMLA crème in order to prevent side effects and to make sure that the medication works properly. When applying EMLA crème, make sure the area is clean and dry. Move all hair away from the ears by using a clip or barrette. Next, apply a small dot of crème (the size of a small pea) on both sides of each ear lobe. Instruct your daughter not to touch the area. Following this, cut 2 small rectangles (one for each ear lobe) approximately ¾ inch in length by ½ inch width of plastic wrap (i.e. Saran wrap). Apply this piece of Saran Wrap on the skin, over the dots of crème so that the plastic rectangle flaps over the ear lobe and covers the front and back. One end of the rectangle should cover the front of the ear lobe and the other end of the rectangle should cover the back side of the ear lobe. The moisture from the medication will make the plastic wrap stick.

The medication should stay under occlusion for at least 60 minutes in order for it to work properly. (1,2) The depth and duration of pain relief depends upon how long the crème remains on the skin under occlusion (2) Therefore, if the medication is wiped off by accident after 20 minutes, the analgesic effect would not be as good as crème which remained on for an hour. It is important to remember that the medication will not work if the area is not under occlusion or not wrapped with plastic.

When you are ready to have your daughter’s ears pierced, remove the wrap and wipe the excess medication off with a tissue. Discard the tissue right away and wash your hands. If you get the medication on your hands at any point wash your hands immediately. It is possible to develop a headache if you accidentally touch your head with your fingers if medication is left on them. The ear lobe should stay numb for approximately 1 hour after removing the plastic.

EMLA is also commonly used for needle sticks and blood work. (1,2) If this is the case, ask your Doctor or Nurse Practitioner where to put the medication before applying the crème to a spot. You need to apply the EMLA crème the same way, but the saran wrap should be wrapped around the area (for example around the elbow) otherwise it will fall off. In some cases the prescription will come with an occlusive dressing in the shape of a rectangle. If this is the case there is no need to use saran wrap and only use the dressing provided. It is a good idea to put the EMLA crème on two sites because sometimes the first needle stick is not successful. If both sites are not used make sure you remove the medication from the unused area. If the creme is left for a longer time than recommended the medication can be absorbed into the body and lead to side effects. (2)

It is important to explain to your child how the medication works and to support her during the painful procedure. (1,2) If a child is very anxious about a painful procedure she may still cry and scream even though she doesn't feel the pain. Studies of children under 7 years old who used EMLA crème had less overall benefit. (2) Therefore the importance of education and support should not be overlooked. A mother's loving touch and encouragement is paramount and better than any medication!

EMLA crème should not be used in children who are allergic to the ingredients or in those children with the rare condition called Congenital or Idiopathic Methemoglobinemia. Children taking drugs such as acetaminophen (Tylenol), sulfa drugs, chloroquine, dapsone, nitrates, nitroglycerin, nitrofuratonin, phenobarbital, phenytoin, are also at a greater risk for developing Methemoglobinemia. (2) If you child is taking any medication make sure you discuss this with your Doctor before using the EMLA crème.

When using EMLA creme make sure you follow the directions carefully and do not apply more than is directed. There have been reports of side effects in infants whose parents applied the medication in larger doses than recommended on a large part of their body. (2)

Good luck with your new earrings!

References:
(1) Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994: 849,866.
(2)Physician’s Desk Reference. 2004. Montville, NJ. Thomson PDR at Montville.605-608.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice for Parents