Helping Your Child Cope with Painful Medical Procedures

Helping a child through unpleasant medical procedures is a difficult task that parents of children born with EA/TEF must face. By preparing yourself, you can better prepare your child to cope with invasive medical procedures.

Improve your child's Understanding:

• Obtain information and explanations from medical staff to increase your own understanding of the expected procedure.
• In explaining the content of the procedure, relay factual information (use demonstrations, booklets, etc.)
• Suggest coping strategies. ("You can squeeze my hand until it's over.")
• Provide opportunities for active involvement rather than allowing your child to become a "passive victim". ("You can hold the band aid until we need it.")
• Give a brief explanation of why a procedure is necessary. This dispels any fantasies about medical treatments being viewed a s punishment.

In providing explanations, use vivid descriptions and simple comparisons:

1. colors ("The medicine will be thick and white.")
2. sounds ("The machine will make a loud sound like a vacuum cleaner.")
3. feelings and sensations ("It will feel cold.")
4. size and shape ("The electrodes are about the size of a dime.")

Create Positive Expectations:

• Avoid words children don't understand such as medical terms or jargon. Define a medical word the first time it is introduced to your child. ("Surgery is another word for operation." "A surgeon is a doctor who does surgery.")
• Avoid words with dual meanings such as: shot; deaden; put to sleep; stretcher; stool; dye

Avoid emotionally charged words. Say:

• "The needle will slide gently under your skin" rather than "the needle will stick to you".
• "After the surgery, your leg will feel uncomfortable " rather than "it will hurt".
• "When the IV is removed, the nurse will ease the needle out" rather than "...pull it out".
• "The surgeon will make an opening" rather than "cut".

Remember positive words act as indirect positive suggestions. Try to convey a positive, rather than a scary attitude by setting up positive expectations toward the procedure. Avoid inadvertent negative suggestions. Things that sound innocent enough such as "You look like such a brave boy. I know you're going to do such a good job" can instead convey in your child's mind, "This is going to be awful!"

It is important to always be open and honest with your child concerning their illness and treatment. Ensure that your child is free to approach you concerning any fears or questions he may have.

Reduce Anxiety

• Often children's expressed discomfort is derived more from anxiety than from the actual procedure itself.
• Offer your child emotional support by being present during the procedure. However, if you are anxious, that anxiety can be perceived by your child.
• Having a role to play, such as holding your child's hand, can counteract your own sense of helplessness.

Encourage relaxation through breathing techniques your child can practice. Relaxation takes place on the exhale phase of a breath, so promote "blowing" exercises to be used later at the time of stress. Your child can make noise through his lips or teeth; blow a pinwheel or soap bubbles; pretend to blow out birthday candles (use your fingers as candles and fold them down once he blows).

• Have your child tense then relax his muscles ("Make your arm tight and stiff; then let it loose ...Ahhh!")
• Help your child to focus attention by limiting his perception. Too many people talking all at once can be confusing and heighten anxiety. Designate only one person to talk directly to your child. If your child wants to focus on the procedure, allow it to happen rather than trying to direct his attention away from it. Otherwise, encourage your child to look at one thing, to hear one thing or to think about one thing. Relaxation comes from narrowing attention.
• Use imagery to focus your child's attention on something far away from where you are. Using your imagination, take your child to a favorite place. Stimulate his senses by asking him specific questions and guide him through the recreated experience. Don't just ask about it, visualize it in detail.
• Distraction can narrow attention and help your child focus on one thing. Use external distractions such as posters, counting holes in the ceiling tiles or petals on a flower, or internal distractions such as counting breaths or saying the alphabet.
• Positive self-talk enables a child to be in control. Remind your child when a procedure has already been experienced. Your child can then say, "I've had this before. It only lasts about five minutes."

What you as a parent do with your voice is important. Volume and pitch often increase during stressful situations, but if your goal is to relax your child, reduce the volume and level your pitch. Talk in a monotone voice. Speak lower, quieter and slower. Use words that carry a relaxed feeling: Heavy; Relaxed; Warm; Limp; Tired; Quiet

Provide your child with genuine choices that re-establish some sense of control. ("Do you want to lie down or sit up?" or "Which finger do you want your blood test in?") Refrain from giving an apparent choice when there really isn't one. )"Are you ready to have your I.V.?")
Teach coping mechanisms ahead of time to help your child feel "in charge". ("You can say 'ouch' real loud and squeeze my hand tightly.") When you are familiar with the procedure, you can coach your child through the entire treatment. Request information from the medical staff as needed.

*A very special thank you to the Child Life Department of Lutheran General Children's Hospital in Park Ridge, IL for permission to print this information which they provided. The EA/TEF Child and Family Support Connection sincerely appreciates their efforts to protect the emotional well being of the hospitalized child.