April 17, 2019

Preparing your child for a doctor's visit

If only every child's visit to the doctor was easy and hassle-free, ending with a sticker and a smile. But that's not always the case, especially for anxiety-prone kids who dread shots or other medical procedures.

"Anxiety about being in a medical office is very normal," says a UW Health pediatrician.

Creating feel-good interactions at the doctor's office early in childhood can help set the stage for positive health care experiences later on and ensure that a reluctant young patient doesn't grow up to be a doctor-dodging adult. Stockhausen shares these tips for managing medical anxiety in children of all ages:

Don't assume your child is scared of the doctor

That's especially true for infants and toddlers going through a stranger anxiety phase. When kids are in those normal developmental stages where they're anxious because we're not their family, some parents interpret that as fear of the doctor: "Oh, she's afraid to be there,' and that sometimes builds on that anxiety," Stockhausen says. "I encourage parents not to worry when your kids are young and crying about being at the doctor. Don't make it a big deal, don't label it."

As they get a little older, usually between 2 and 3 years old, many children become more comfortable in the office with people other than their parents talking to them and working with them.

Prep them in advance but don't overdo it

"When kids are 3 or 4 or older, tell them a few days before: "We're going to go to the doctor, and she's going to give you a checkup. She's going to listen to your heart and look at your ears.' A little preparation goes a long way to helping a child feel more comfortable" she notes. "But you can overdo it if you talk about it every day for a month. So you have to find that balance between helping them prepare but not making it a big deal"

Younger children might find it helpful to read a book about going to the doctor or watch a related TV show, like Doc McStuffins or Daniel Tiger's "Daniel Visits the Doctor" episode.

Be honest

"If your 4-year-old asks, 'Am I going to get a shot?' tell them 'yes.' If you don't know, say 'I don't know.' If you say no, and you show up and they need a shot, then they're going to be even more upset," Stockhausen notes. "You could say, 'It's going to hurt a little bit, but it'll be fast, and then we'll go to the library or do something else fun.' Being honest and upfront but brief and age-appropriate is a really important part of preparing kids"

Whatever you do, don't lie. "If you say it won't hurt, and then it does, they're always going to question whether you're really being honest. That feeling of, 'It didn't go the way mom said it would' is way more anxiety-producing than, 'Mom said it might hurt a little,'" she explains.

Check your own emotions

Kids pick up on your reactions, even if unspoken.

"We can feed into our children's anxiety if we're worried about them getting a shot or how they're going to do with the doctor" she says. "When kids are looking to us to see how to react, if mom has a smile on her face and looks very calm and comfortable, then it seems more OK."

Emphasize the positive

Remind kids that shots keep us healthy and are a good thing. And don't blame the people who give the shots. Stockhausen often hears parents refer to doctors as "nice" and the nurses who give shots as "mean."

"Labeling those nurses as mean not only makes the kids more anxious, but it makes the nurses feel bad," she says. "The message should be, 'Yes, it's going to hurt a little bit, but these wonderful people are doing it to help you.' That's an entirely different message."

Prepare for more advanced procedures

If your child needs a blood draw, CT scan, MRI or other procedure, talk them through what to expect in age-appropriate language. "With an X-ray, I tell young kids, "It's a camera and it won't hurt, and it makes a sound like this, and I'll make the sound with my mouth so they know and are waiting for the sound," Stockhausen says.

UW Health also uses a device called Buzzy Bee during blood draws, which vibrates to confuse pain nerves so it doesn't hurt. For hospital procedures, child life specialists can offer other distraction techniques to help soothe a child's nerves.

Offer choices

"Choices are power," she notes. "I'll ask, 'Do you want your blood pressure taken on your left arm or your right arm? Do you want to do it before we talk or after?' If we have an older child who is so stressed about the shots that they can't even focus on what I'm saying, I'll ask, 'Do you want to do it first to get it over?' and they'll often say yes. That little sense of control, even if it's illusionary, can help."

Of course, you have to be careful which choices you offer. Stockhausen frequently hears parents ask young children whether they want a flu shot, and of course, the choice is almost always "no." "Then if we go against their wishes they're really upset," she says.

Remember that you are in charge and make the decisions about procedures like this, and your child can choose the location, timing, etc., within reasonable boundaries.

Take a favorite object from home

"Always remember to bring a security object or something that's calming or comforting, like a stuffed animal, or for older kids, an iPod or tablet for listening to music or watching a movie to help calm their nerves," she suggests.

Remember that comfort doesn't need to be edible.

"We see parents who give their child a snack immediately after the shot's over, and we don't want to encourage the frequent use of food as a feel-better technique," she says. "That being said, it's perfectly OK to take your kindergartener out for ice cream after shots or another stressful or scary procedure."

Help babies stay calm

Obviously you can't reason with an infant the way you can with an older child, but there are still ways to ease their anxiety and pain. "Babies do feel pain, for sure, and as a parent, keeping your own reaction to painful procedures as calm and matter of fact as possible is important," Stockhausen says. "They will look to you for how to react."

After a vaccine, offer hugs and kisses, and maybe breastfeeding or a bottle if that's a favorite calming technique. If your baby seems uncomfortable after a shot, you can give pain medication. Doctors may also give young babies sucrose solution, which has been shown to help alleviate pain, before a circumcision or other minor procedure.

Teach older kids anxiety-calming techniques

Music, deep breathing or distracting conversation can help older children manage their anxiety.

"If you get to age 11, 12, 13, and if you still have debilitating anxiety in the doctor's office, we need to get that figured out before kids are old enough to make their own medical decisions," she says. "We don't like to hold kids down for shots. It's not good for them, it's not good for us, and it's technically difficult. At that age, anticipation is always worse than the actual event."

If your older child consistently shows serious anxiety about going to the doctor or having procedures performed, talk to your doctor about whether a visit to a health psychologist may be helpful to learn coping mechanisms and to learn about managing stress and anxiety.

Give it time

"More often than not, the kids outgrow it," Stockhausen says. "The more experiences they have that are pleasant, the better it gets."