When your child or young person has a condition or injury that requires regular trips to hospital, it’s likely they (and you) are going to have to become comfortable with medical and diagnostic procedures.
Whether it’s an X-ray or MRI, a dressing change, a blood test or vaccination, procedures can be scary for children, especially when they are new and unfamiliar.
But there are ways to reduce anxiety as much as possible, for everyone.
Try these tips for managing expectations before, during and after procedures to help your child or young person stay calm and reassured as they get through the procedures they need.
Before the procedure
Anticipation and anxiety can often peak before a procedure, so it can be useful to take time to prepare beforehand. Communicating clearly, setting up expectations, and planning a list of coping strategies are valuable tools that can help bring anxiety down.
Clear communication helps children develop a sense of trust and predictability. Talk to your child or young person about what is going to happen, who is going to be there and why the procedure needs to happen. When you might choose to discuss the procedure with your child or young person is also important and depends on the age of your child or young person. This is just a guide and will vary according to each child or young person:
- 0–3 years—immediately before procedure (minutes before)
- 3–6 years—morning of the procedure
- 7+ years—a week in advance (or more)
Once you make time to discuss, allow them to discuss their feelings and concerns and encourage any questions they may have. Let them know that others may be feeling the same way and that their feelings are normal and expected.
Set clear expectations
Children will usually be less worried about something if they know what to expect and what is expected of them. While there can be some pain and discomfort involved with medical procedures, being honest without scaring them is possible. For example, you can tell them that while some children think it hurts, it doesn’t bother other children.
Another way to set up clear expectations is to practice what might happen on a doll or teddy bear. Using descriptive language like ‘we wipe teddy’s arm with the alcohol wipe, it feels cold’ or ‘the strap around the arm feels a bit tight, but teddy is just going to take some deep breaths’ can to help normalise the experience.
Planning a list of coping strategies with your child or young person in advance, and packing the necessary items can take the pressure off on the day. Some effective coping tools include:
- reading a book
- playing a game on a phone or tablet
- hugging a favourite toy
- calm breathing
- squeezing a hand or stress ball
- imagining a favourite place or memory.
During the procedure
You may feel like there is not much that you can control within a hospital setting, but there are ways to tailor a better experience for all involved. Allowing your child or young person to make small choices, modelling calm behaviour and being ready to provide active distraction are all things you can do.
Give them some choice (where possible)
Providing small choices wherever possible encourages your child or young person to feel involved. Some examples of choices that your child or young person can make include:
- ‘Are you going to have your needle in your right arm or your left arm?’
- ‘What toy are you going to bring with you to the room?’
- ‘After we do our blood test, what are we going to do to celebrate you being so brave?’
Be aware that children may try to prolong the procedure using these choices. Don’t encourage your child or young person to stall, as this can sometimes increase anxiety. Although we’re providing choices, the procedure is non-negotiable. It’s okay to talk with staff involved and let them know what your child or young person prefers.
Find a comfortable position
As children are not required to lie down for most procedures, you can chat with nursing staff about different positioning options before starting a procedure. Sitting up is less distressing as children can feel more secure and in control and allows parents or carers to distract children more easily.
Holding a child or young person down may increase their anxiety and increase behaviours, which could result in future difficulties. However, for some ages and children, restriction may be required to either keep them still or to complete the procedure as quickly as possible. If this is the case, it’s a good idea to use a comforting, rather than confronting, position (e.g. a bear hug on your lap).
The best way to assist your child or young person is to model calm and relaxed behaviour yourself! If you respond to their procedures with distress or anxiety, children may learn to do the same, so try to remain calm and have a ‘we can handle this’ attitude. If you have difficulty with supporting your child or young person with procedures, just do the best you can or get support by asking a family member or friend to come along to help.
The power of distraction
Distraction includes anything that will help them look away from what is happening. Distractions are also effective before entering the treatment room as waiting can sometimes be the most worrying part.
The best distraction is any activity that keeps your child or young person’s mind busy, and active activities are often more engaging, i.e. playing a game on an iPad is more ‘active’ than watching a video. Examples include:
- blowing bubbles
- looking at a pop-up book or hidden images book (‘can you find the …’)
- singing along to music or play a game on an iPad
- using a toy that vibrates—this can help distract from the sensation of procedures
- talking about everyday topics or making jokes.
Throughout the procedure, you can redirect your child or young person’s attention to their distraction activity by asking questions or using humour.
After the procedure
While it’s a relief to finish a procedure, it’s useful to take some time to set up your child or young person for success next time by comforting them, providing praise and making a plan for next time.
Immediately after a procedure has finished, your child or young person may still feel uneasy and it could be helpful to re-engage them in a distraction activity to help move their focus away from the procedure. Many children also benefit from comforting hugs to help them calm down after procedures and feel okay again.
Whether the procedure went well or not, ask yourself ‘What has my child/young person done well?’ Children respond well to encouragement, so praise them for things they did well, no matter how big or small. If a child or young person is distressed, they may not look like they are responding to your praise, but it is important to acknowledge a job well done.
Providing rewards go hand-in-hand with praise after procedures to reinforce positive behaviours. Rewards do not need to be anything big—a kiss, a sticker, or a favourite drink can be motivating for children after a procedure. Be specific so your child or young person knows exactly what they are being rewarded for. For example, ‘You held your arms so still during that blood test so you get a sticker!’
Make a plan for next time
After providing comfort, praise and rewards, discuss with your child or young person what did and didn’t go well during the procedure. Based on this, make a plan for the next time (e.g. ‘You did a great job using your deep breathing! We’ll make sure we use deep breathing again next time.’). You may need to consider trying out different distraction, relaxation or positioning options if the procedure didn’t go so well. When you get home, your child or young person might be clingy or behave a bit differently, and that’s okay. Keep to your normal routines and give them some time and patience, and they will soon readjust.