‘I was so scared I thought I was going to die. I needed my mom….’
Every year, tens of thousands of children end up in medical situations that are painful, scary and potentially traumatizing. Many of these are planned procedures, and others are due to injury or sudden onset of symptoms. Thus, some events are completely out of your control while others can be greatly affected by your parental choices, which impact the degree of stress, anxiety, and fear that children experience.
Research suggests that pediatric traumatic stress is a significant factor for children and adolescents, where procedures are invasive, painful or scary. Even relatively trivial procedures hold some potential for trauma, if handled poorly, as children can become intensely fearful if they feel alone, abandoned or have deeply disturbing thoughts during a procedure.
What is pediatric medical traumatic stress? This is a set of psychological and physiological responses of children and their families to pain, injury, serious illness, medical procedures, and invasive or frightening treatment experiences. In this article, we will focus on parental strategies to help avoid such stress, with careful planning and thoughtful execution.
Practical stress prevention for medical procedures:
1. Be accurately informed: In our modern world, it is relatively easy to become well-informed about any medical procedure. However, physicians vary in how they may approach patients, what their message may be and the degree to which they concern themselves with managing patient comfort. In addition, knowing what the post-procedure experience will be is equally important. It is worth a few extra questions to know what your child will see and hear, as well as what they will likely feel—before, during and after. All of this will help you.
2. Manage your child’s expectations: As children become more cognitive, it is important to manage expectations. Walk them through the process, answering questions as you go along. If possible, take them through the actual physical setting and have them meet the professionals in advance. With all procedures, let them know where you will be, and exactly when and where they will see familiar faces and hear a predictable, “There you are. I love you.” If there is going to be discomfort, don’t lie. Be truthful, but don’t belabor a point. Just don’t avoid it. You want to avoid having your child experience surprises that are scary or painful. They should be prepared for these. In addition, pay attention to your own emotional state because:
3. You must model calm confidence: This is not just about what you say, but how you say it. If the procedure is scary, painful or risky, it is likely that you have some internal fears and anxieties. This is natural, but do not share these with your child. It is essential to manage this in the adult world, with other adults. The energy you bring to these conversations is more important than the words you offer, so do what you must to keep these fears at bay. Exercise, meditate, practice deep breathing, and seek professional help if needed. But diligently strive to avoid bringing your fears and worries into your child’s world, as this speaks louder than any words you offer. This component helps with abating the onset of deep fears and worries that can spiral into traumatic stress. Internally you must remain calm and confident, so you can share this energy with your child. When you do so, also express it with certainty:
4. “You will get through this, sweetheart. You will be OK.” While always important, this message is critically important if the procedure is scary or painful. Explaining that all the discomfort is temporary and installing a sense that truly “this too shall pass” is vital. It is easy for a child’s brain to focus on the pain of the moment, thinking it will never end only because the pain has captured their immediate attention. This is where the mind can be overrun with fears and worries, and the risk of more serious psychological trauma emerges. However, we can help mitigate the risk of this with cognitive strategies that focus the mind elsewhere. One such strategy is to know that the pain is temporary and that it will end. A corollary to this strategy is to:
5. Teach your child to vividly imagine beyond the pain or procedure: In addition to instilling with certainty that this will pass, have your child vividly imagine the hours and days when the pain and scariness are gone. Practice beforehand vividly rehearsing the events that will follow the procedure and what the child will enjoy with mom or dad. The more serious the procedure, the more time spent on such cognitive strategies. Keep at this, practicing filling in the spaces (as the child imagines it) with moments of lightness, love and a sense of safety. You do this by walking them through the future in this imagined rehearsal, including where you will be, what you will be doing, while repeatedly emphasizing a focus on your closeness to them and the reminder that “you did get through this—you are OK.” If you don’t feel confident in doing this, enlist the help of a professional who can work with you and your child. But do not underestimate the power of visualization and make this essential when there is likely more intense pain or fear involved. Some children will get stuck on:
6. “Why me, mom?” This type of question often arises. Regardless of the facts, the ultimate answer often is “I don’t know, sweetheart.” At other times, there are some historical reasons why. If answering with fact-based information doesn’t resolve the repeated whys, then it is time to move on. In other words, the mind can easily get stuck on asking why in situations where the “why” doesn’t serve us. You must be able to discern when this is happening. You will know after you have repeatedly answered the question, yet your son or daughter keeps asking. At that point, you inevitably reach the point where you say, “I don’t know, sweetheart” and move on. What do you move on to? You simply add, “I do know that this procedure can make you stronger, healthier and better. I do know we can all grow and learn from this. And I do know that I love you more than you can know.” Transition the conversation to growth, improvement and a sense of certainty in the future. It won’t serve anyone to stay stuck in the “why” questions.
These are some basic guidelines, all easier said than done! However, with a bit of practice, you will master these. And again, if you want more details, seek professional psychological help.
Dr. Randy Cale offers practical guidance for a host of parenting concerns. For more information visit www.TerrificParenting.com.