Needles and Doctors

Soothing your child's fears -- and maybe your own, too

Two-year-old Dante Young is just moments from being rolled into the operating room, but there's no time, or need, for tears. Dante is too busy watching Mickey Mouse Clubhouse and playing with his doctor's kit. When mom has to walk away and let the doctors and nurses take him, mom seems to be the only one worried.

Sound like your child? Well, if not, it could be, said Sandra Morecroft, a certified child life specialist at Holtz Children's Hospital at the University of Miami/Jackson Memorial Medical Center. Her job is to make kids smile and make sure their trips into surgery are as easy as possible. Not always an easy mission.

"You'd be surprised to hear how many kids think they are here to go on a field trip -- with no idea that they are about to have major surgery. It makes for a very difficult morning," Morecroft said.

Morecroft has seen it all, from kids and parents who are panicked even before they set foot in the hospital to the families who manage to laugh and play almost throughout their entire experience with major surgery.

Morecroft's days are a constant rush between the beds in the pre-op area and its playroom, which is stocked with all sorts of toys, books, crafts, movies and video games. Morecroft does whatever it takes to make pre-op children laugh. She is half-comedian, half-psychologist. Her arsenal is her goofy faces, silly jokes, talent at peek-a-boo and, of course, a treasure chest full of fun distractions. Toddlers get blocks and cool cars. Preschoolers are busy with doctor kits that contain some real medical items such as mini-oxygen masks. And teens are trying to figure out how to beat their high score on PlayStation 2 or Nintendo DS.

You can find child life specialists at most major pediatric hospitals. They are experts in the emotional, physical and psychological development of children. They're also an excellent asset to parents and families dealing with a hospital stay because one of their other main functions is to help kids understand what is happening to them.
It's hard enough for mom and dad make sense of it all, much less a 4-year-old. The techniques and strategies used by these child life specialists can help kids deal with everything from a major illness to a routine dental visit.

So, the next time your child has a checkup and you know it's going to be a doozy, whether it's because of shots or another unpleasant experience, make sure you do your homework. Preparation and communication prior to a tough appointment or any difficult event can make it easier for you and your child.

Preparation and Communication Are Key

Leslie Hutchins, also a certified child life specialist at Holtz Children's Hospital, said you should talk to your child before the upcoming appointment. Just make sure you don't do it too early. For instance, a toddler probably won't remember what you told him a week ago. Usually a day or two in advance works best.

Be sure to explain that this doctor's visit will be different from other ones. For example, try an explanation similar to this: "This time the doctor needs to give you a shot. All children have to go see a doctor. Children need to do this to be able to go to school. We can't go to school until we get this done."

Also make sure you give enough information to help your child understand without overdoing the details. Every child is different, so the amount of details they need depends on their age, developmental stage and temperament. Trust your instinct. Playing doctor is a great tool for little ones. Use a syringe and Band-Aid on a favorite stuffed animal or baby doll to reassure preschoolers that the process is fast and simple. Ask older kids to write a story or draw a picture about what they expect to happen. Discuss their work so they'll be encouraged to vocalize their concerns. Events can seem less traumatic when we talk about them.

Hutchins, who works with kids dealing with chronic illnesses such as kidney failure, said it's best not to use words like "pain" or "hurt."

"What may be painful to one child may not be to another," she said. "But if a child asks if a shot will hurt, say, 'Needles don't always hurt, but it might be uncomfortable.'"

Give Your Child Some Control

One of the most difficult aspects of a medical encounter for a child is the loss of control.
"Think about it," Hutchins said. "We tell our children not to talk to strangers, but now we're asking them to let a total stranger have complete access to their body and do something that scares them."

The best way to ease that anxiety is to help children feel they have some control over their situation. For instance, have your child decide which arm will get the shot or which finger will be pricked. Maybe your child wants to watch the vials of blood filling up -- let him look if he wants to.

"Never grab your child's head and force it away. If they want to watch the nurse prepare for an injection, let them. It may even make a child feel better to smell the alcohol pads," Hutchins said.

Six-year-old Alfredo Lopez, awaiting surgery on his feet, actually watched the IV going into the back of his hand. His mom, Carmen Lopez, said, "I was the one shaking. I couldn't believe how he watched it all."

Help Your Child Deal With His or Her Fear

Another key part of being prepared is working with your child to find methods and tools that will help him or her deal with fear and discomfort. Say, "Let's make a plan because everybody gets nervous. How about squeezing my hand and giving mommy the bad feelings?" Or try squeezing a handful of Play-Doh or a Nerf ball. You could even try singing a favorite song or reciting a bedtime prayer. Teens may find comfort in an iPod or a DVD player.

Explain to your child that it is important to be still and ask if she prefers that you hold her arm still or if she prefers a nurse do it. And don't let a "staller" take control and turn it into a long, drawn-out process. Explain that no one can slow down what needs to be done.

But remain calm even if your child starts to scream, run, kick and wiggle when you were hoping they'd cooperate. That's the "fight or flight" instinct at work, and it's absolutely normal. After all, who wouldn't be upset about a root canal or an appendectomy?

Encourage your child to talk to their doctor and dentist about their concerns. This also empowers children early on to take charge of their health care needs. Tell the nurse or physician about your child's uneasiness and that your child might benefit greatly from an explanation of what will happen. Don't be intimidated to step in and explain things that your health care provider doesn't.
Judith McCullough knows how important it is for moms to stay cool even if the medical staff isn't doing all they can to help. When her 4-year-old needed to swallow a cup full of special liquid for a diagnostic exam of her digestive system, McCullough, who is a child psychologist from Holtz Children's Hospital, thought she had done everything right.
"I had prepared her," McCullough said. "She was pretty calm, and then the tech walks in and starts talking about how this is a really tough exam for kids, and if she wasn't able to drink the drink, they would have to take a syringe and stick it down her throat."
Needless to say, McCullough's daughter was no longer eager to chug down the concoction in front of her. So McCullough dismissed the tech's comments and acted as if the task at hand was no big deal. She reminded her daughter that this was the same chalky drink they had talked about at home and that it would help her doctors figure out how to fix her tummy troubles.
"Without a doubt, kids take their emotional cues from mom and dad," McCullough said. "If they see a parent isn't worried, they won't be either. You're definitely more important than the nurse and doctor. In the end, my daughter did great."

While child life specialists, doctors and parents wish they could wave a magic wand to relieve every bit of anxiety and discomfort, they know they can't. But they can work together to make the event a little less scary and uncomfortable. And when it's all over, the child may even feel a little braver and tougher in the process.

Some Tips From the Experts

The child life specialists at Holtz Children's Hospital at the University of Miami/Jackson Memorial Medical Center in Miami have many tips and tricks to help ease a visit to the doctor or the hospital. Here are a few that work for adults too!

  • During the difficult moments, remind your child to practice relaxation breathing. That means holding his or her breath for three to five seconds and then slowly blowing it out -- just like blowing out birthday candles or blowing bubbles.
  • Make sure your child's environment is as calming as possible. Too many people talking at the same time or giving and demanding instructions just adds to the tension. Only one person should talk at a time.
  • Remember to plan a reward in anticipation of your child's brave behavior. The bigger the challenge, the bigger the reward. Your child primarily needs your loving reassurance and calming presence. As a wise man once said, "You don't have to be in control of it all; the key is just making people think that you are."

Sandra Fiedler Esquivel is a media-relations specialist with Jackson Health System and a freelance journalist. She lives in Pembroke Pines with her husband and two children.

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