Preparing for Medical Visits

Preparing children for medical visits. A new study in the Journal of Clinical Nursing (August, 2011) revealed some interesting information about how children feel about hospital stays and how they are being prepared for medical procedures.

stuffed toy image via Shutterstock

Researchers interviewed 55 children and teens (age 7-18) in three different hospitals and found that children want to be more involved in discussions about their health care and have their views taken seriously.  Most kids reported that health care workers began procedures and treatments with little to no explanation of what was happening, and many kids felt that they couldn’t even ask questions.  The result?  Children are feeling scared and angry in the face of medical procedures.

My daughter has been to many doctors for many reasons.  Although she’s generally a healthy child, there have been a couple of visits to specialists during the past 4 ½ years.  What I have found over and over again is that, while they all tag “pediatric” onto their titles, they are not all prepared to interact with pediatric patients on an emotional level (the Pediatric Allergist was by far the most aloof.  I’m not sure he’s even right for an adult).  In fact, some caused me to wonder how they even earned any sort of pediatrics degree in the first place.

Our most recent experience involved “pediatric” dentistry.  As it turns out, my daughter comes from a long line of people with “sensitive teeth” (I’m not sure what that means, but my husband seems to think it’s valid).  Translation:  She has cavities.

On the day of the x-ray I was told not to prepare her for the next visit at all.  The assistant looked me in the eye and said, “we are very good with children here; you will just make her nervous if you talk to her about it”.  They don’t know that I’m a Child & Adolescent Psychotherapist.  They don’t know that I’m a Parenting Expert and parents look to me to help them with situations just like this one.  They also don’t know my daughter very well.  They don’t know that she’s a worrier, that she doesn’t transition well, and that she doesn’t like surprises.  They had only met her twice, after all.

So I did what I do best.  I combined my training with my mommy instincts and I prepared my daughter for her next visit to the dentist, to have her cavities filled.

I’m glad I did.

She was given no preparation as they put the mask over her nose to give her the laughing gas.  No preparation by them, that is (with the exception of letting her choose the scent.  She chose strawberries).  I held her hand and gently reminded her that this was the air that she would breathe through her nose to help her relax.

She was given no explanation about the medicine used to numb her gums (except, “we’re making your tooth sleepy now”).  She looked at me with panic in her eyes and tears streaming down her face as the Dentist said, “don’t cry, it’s almost done”.  I stepped in.  I stopped the Dentist, ran my fingers through her hair, and reminded her of her Dora book about the Dentist.  I reminded her that the Dentist had to numb Dora’s tooth so that they could fix the small hole.  I also told her that it’s ok to feel sad and scared and that she can always tell me how she feels.

This time, they followed my lead.  They gave her a mirror (which they originally said they would do but then forgot) so that she could see that her mouth still looked the same.  They slowed down.  They gave more specific descriptions (“I’m cleaning out your tooth now”, “I’m putting the ‘stars’ on your tooth to make it all better”, etc).

In the end, she calmed down and got through the rest of the procedure with fewer tears.  But I left feeling a bit frustrated.  I was told that they would handle the preparation.  That they would make her feel calm during the procedure.  If I hadn’t prepared her, it would have been much worse.

So how do you prepare a child for a medical procedure?

• Ignorance is not bliss:  There are some scary tools used by doctors and dentists.  Kids can panic just at the site of them.  Play doctor kits are great for giving kids a chance to explore these tools and practice in a safe environment.  Provide brief but specific explanations.  I’m not talking about describing the size of the needle, but if shots are (or might be) involved, tell him.  Don’t leave it up to his imagination.
• Bring comfort items:  Even older children can become very anxious when it comes to visiting the dentist or having a medical procedure.  Bring a favorite lovey, stuffed animal, blanket, or book.  Your child will feel most comfortable when surrounded by his favorite belongings.
• Describe feelings:  Tell your child what to expect regarding how he might feel emotionally both before and during the procedure.  Remind him that it’s ok to feel scared and it’s certainly ok to cry.  Tell him to signal you for help if he’s having trouble saying his feelings (or has a mouth full of dental equipment).
• Check in:  I saw my daughter’s eyes starting to panic and look different and I stood up and looked her in the eyes and asked how she was feeling.  I asked if her tummy felt ok and if she was feeling scared.  Check in with your child regularly using a calm voice to let him know that you are still right there.
• Be an advocate:  It can be difficult for kids to verbalize their needs under anxiety producing circumstances.  Speak for child and don’t sit back and watch if something doesn’t seem right.  You might not be a doctor, but you do know the most about your child’s emotional state right now.  Advocate for his needs.
• If you are not allowed in the room:  Make sure you prepare your child for a separation if anesthesia is involved and you are not allowed to be present.  Visit the facility in advance so that he can see what it looks like.  Ask questions- Will you be allowed to escort him to the surgery room?  Some facilities actually will let you sit with a child under five while they administer the anesthesia, but you might have to search them out.  At what point do you have to say goodbye?  How long is the procedure expected to last?
• Bring a DVD Player, iPad, etc:  There is generally a lot of waiting involved, even for very minor procedures.  Bring things to distract your child; don’t count on the waiting room being fully stocked (or interesting to your child).  Coloring books, Play Doh, books, DVD’s, and some fun iPad/iPhone games are always good distractions.
• Be Positive:  Your child is likely feeling scared; he needs you to appear calm and positive.  Even when I felt like things weren’t going so well, I smiled and used a very calm voice to interact with my daughter.  We need to be strong for our children when they feel scared.  When they see that we are calm but assertive, they see that we are taking good care of them.  They also learn how to cope with similar situations in the future.
• Use Books:  Many wonderful children’s books have tackled visiting the dentist, the doctor, or even a hospital.  Always preview a book before reading it to your child, as you know what he is capable of processing.  Dora, Franklin, and Little Critter have all chronicled their trips to the doctor and the dentist in a fun but realistic way.  Read them a few times in preparation for the visit, and then use them as a reference when your child starts to feel scared.

How do you help your child prepare for medical or dental procedures?

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