Imagine you are taken to into an unfamiliar environment. You don’t know any of the people around you and then they ask you to do something you’ve never done before. You don’t have any trust in these people and what they are asking you to do seems scary. They tell you that it is all going to be ok, but you don’t believe them. How would you react?
Maybe your fight or flight response would kick in? Your heart rate might increase, or you might start getting sweaty. You may want to do a runner and get out of there as quickly as possible. Perhaps, as an adult, you could relate it to a more familiar experience that you’ve had previously and talk yourself into doing it.
But imagine you are a child... You’ve never had anything like this happen before or maybe you have, and it was a negative experience. The same fight or flight responses may kick in, but you don’t have the language to explain this or even understand why your body is reacting like this. To the outside observer, you are just being ‘difficult’, ‘non-compliant’ or ‘sooky’. You are told to be brave, but you don’t understand how to do that when all your body signs are telling you the exact opposite.
In medical encounters, children are often exposed to exactly these types of scenarios. We expect them to be able to rationalise what’s happening and behave accordingly. However, children often don’t have prior experiences that they can draw on or haven’t developed the coping strategies to manage the physiological responses associated with stress.
So, what can we do to help young people manage in these situations? A growing body of research indicates that predictability in childhood help parts of the brain that support regulating emotion. Our little ones thrive in an environment where they feel safe and secure. Predicable routines make their world less chaotic, creating a blanket of comfort and security.
When a child develops an understanding of what to expect, and we can orientate them in terms of their senses, it provides a platform for increasing predictability. If there is a medical procedure that a child needs to complete, we can support them by describing what is going to happen with short, manageable explanations that also provide reassurance. It is also a good opportunity to provide choice and control so that they feel part of the process. The following is an example of having a blood test. You don’t need to provide all the information at once and you may break this up into the day prior, morning of or just before the procedure.
For example:
Today we need to go and have a blood test. We are going to drive to the hospital and I will be with you all the time. When we get there, we might have to wait for a little while until it is your turn to go. What would you like to do while we are waiting? Should we bring in your favourite toy or activity?
The nurses are going to put some cream on your arm to help it go numb while you have the blood test. Numb means that the area will have a little sleep while you have the test done and then wake up when it is all over.
When it is your turn, you can choose to sit with me and have a cuddle or you can sit by yourself and I can hold your hand. We can choose to read a book or watch something on the iPad or on my phone.
The nurse will clean the area and it might feel a little bit cold and wet. They will then use a special seat belt on your arm which feels like it is giving your arm a big squeezy cuddle. This helps them know the best place to do the test. When they find the best place, they will use something called a butterfly needle to help get the blood they need. They won’t take a lot, just enough for the test. You might like to keep watching the iPad or reading with me while they do the test, or we could sing a song. The nurse will do all the work and your only job is to stay nice and still while we watch something together. Once it is finished, you will get a special Band-Aid to put on your arm for a little while. I will be with you all the time and we can get a special treat after.
As mentioned, this information can be spread out, but you can see that it provides explanations that include what the child might see, hear and feel. We are providing an opportunity for them to understand the steps and taking out the unpredictability of the situation. It is also good to ask the child if they have any questions! Often, they might be worried about something that we haven’t even anticipated! Addressing misconceptions or worries beforehand also provides a sense of empowerment.
In these environments, you are often the only person that your child knows and trusts. It is important to provide reassurance that you will be there with them at all times. This will increase their confidence to manage the situation knowing that you are there to support and help them.
Your child may still feel anxious about having the medical procedure done, and it is important to also normalise these emotions. In doing this, you are recognising and validating their experience and can provide additional reassurance. You might even use it as an opportunity to revise some coping strategies such as: belly breathing, focusing on distraction, toe wiggling or counting.
Providing predictability, developmentally-appropriate explanations (including sensory expectations), choice and control, as well as reassurance, can all help in providing a much more positive and smoother medical experience for young people.
Kate Strickland is a community-based Child Life Therapist with a background in Occupational Therapy and Education. She works with infants, children, and young people along with their families in managing the stresses associated with health care encounters, procedures, hospitalisation and medical trauma. Visit healingheartsbeyond.com.au for more information.
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