Information

Preparation can effectively reduce distress in children who are undergoing medical tests, minimizing crying and resistance to the procedure. Research finds that lowering anxiety can actually decrease the sensation of pain felt by people during uncomfortable procedures.

Before the test, understand that your child probably will cry. Preparation may not change the fact that your child will feel some discomfort or pain. You can try demonstrating what will happen during the test in advance to learn about your child's particular fears and concerns. Using a doll or other object to act out the test may help reveal worries that the child may not be willing to discuss directly.

This may help reduce your child's anxiety. Most people are more frightened of the unknown. It helps if the child knows what to expect. If a child's fears are unrealistic, you may want to explain what will actually happen. If the child is worried about an unavoidable part of the test, do not minimize this concern. Reassure the child that you will be there to help as much as you can.

Make sure your child understands that the procedure is not a punishment. Children at this age may believe that the pain they feel is a punishment for something they did.

The most important way you can help your child is with proper preparation, and with your support and comfort around the time of the procedure.

PREPARING BEFORE THE PROCEDURE:

Keep your explanations about the procedure to 10 or 15 minutes, because preschoolers have a limited attention span. Preparation should take place directly before the test or procedure so that the child doesn't worry about it for days or weeks in advance.

Here are some general guidelines for preparing your child for a test or procedure:

• Explain the procedure in language your child understands, using plain words and avoiding abstract terms.
• Play preparation can be a wonderful way of demonstrating the procedure to your child and identifying concerns.
• Make sure your child understands the body part involved, and that the procedure will be limited to that area.
• To the best of your ability, describe how the test will feel.
• Be honest with your child about discomfort that may be felt.
• If the procedure affects part of the body that serves a noticeable function (such as speech, hearing, or urination), explain what changes will occur afterwards.
• Give your child permission to yell, cry, or otherwise express any pain verbally.
• Ask if your child has not understood something you have explained.
• Allow your child to practice the positions or movements that will be required for the particular procedure, such as the fetal position for a lumbar puncture.
• Stress the benefits of the procedure and talk about things that the child may find pleasurable after the test, such as feeling better or going home. You may want to take your child for ice cream or some other treat afterwards, but do not make this conditional on "being good" for the test.
• Practice deep breathing and other comforting activities with your child. If possible, have your child hold your hand and squeeze it when feeling pain.
• Ask the provider if the child can make some decisions, when appropriate, such as which arm should have the IV or what color bandage they would like to have.
• Distract the child during and or after the procedure with books, songs, counting, deep breathing, or even blowing bubbles.

PLAY PREPARATION

Play can be a wonderful way of demonstrating the procedure for your child and identifying any anxiety. Tailor this technique to your child. Most health care facilities for children use similar techniques to prepare children for procedures.

Many young children have a favorite toy or other important object that can be a tool for a process called third-party communication. It may be less threatening for your child to express concerns through the toy or object instead of directly. For example, a child who is about to have blood drawn may be better able to understand if you discuss how her doll might "feel" during the test.

Toys or dolls can help you explain the procedure to your preschooler. Once you are familiar with the procedure, briefly demonstrate on the toy what your child will experience. Using the toy, show your child:

• Bandages
• How injections are given
• How IV's are inserted
• How surgical cuts are made
• Stethoscopes
• What positions the child will hold

After your demonstration, allow your child to play with some of the items (except for needles and other sharp items). Watch your child for clues about concerns or fears.

No matter what test is performed, your child will probably cry. This is a normal response to a strange environment, unfamiliar people, and separation from you. Knowing this from the beginning may help relieve some of your anxiety about what to expect.

WHY RESTRAINTS?

Your child may be restrained by hand or with physical devices. Young children lack the physical control, coordination, and ability to follow commands that older children and adults usually have. Most tests and procedures require limited or no movement to ensure accuracy.

Restraints may be used during a procedure or other situation to ensure your child's safety. For example, to get clear results with x-rays there must not be any movement. Radiological and nuclear studies require that all staff temporarily leave the room. In these situations, restraints may be used for your child's safety.

If a puncture is done to get a blood sample or start an IV, restraints may be used to protect your child. If the child moves, the needle could cause an injury.

Your health care provider will use every method to ensure your child's safety and comfort. Besides restraints, other measures include medications, monitors, and observation.

Your job as a parent is to comfort your child.

DURING THE PROCEDURE:

Your presence may help your child during the procedure, especially if the procedure allows you to maintain physical contact. If the procedure is performed at the hospital or your health care provider's office, you may be given the opportunity to be present. If you are not sure whether you are allowed to be present, ask.

If you think you may become ill or anxious, consider keeping your distance but remaining in your child's line of vision. If you are not able to be present, leaving a familiar object with your child may be comforting.

Avoid showing your anxiety. This will only make your child feel more upset. Research has suggested that children are more cooperative if their parents have taken measures (such as anxiety reducing acupuncture) to reduce their own anxiety.

Other considerations:

• Ask your provider to limit the number of strangers entering and leaving the room during the procedure, because this can raise anxiety.
• Ask that the provider who has spent the most time with your child be present during the procedure.
• Ask that anesthesia be used where appropriate to reduce the level of discomfort your child will feel.
• Ask that painful procedures not be performed in the hospital bed, so that the child does not associate pain with the hospital room.
• If you are in your child's line of sight, imitate the behavior the child needs to do, such as opening the mouth.
• Ask if a low sensory environment can be created.

Alternative Names

Preparing preschoolers for test/procedure; Test/procedure preparation - preschooler

References

Khan KA, Weisman SJ. Nonpharmacologic pain management strategies in the pediatric emergency department. Clin Ped Emerg Med. 2007;8(4):240-247.

Yip P, Middleton P, Cyna AM, Carlyle Av. Non-pharmacological interventions for assisting the induction of anesthesia in children. Department of Paediatric Anaesthesia, Starship Children's Hospital, Auckland, New Zealand. Cochrane Database Syst Rev. 2009 Jul 8;(3):CD006447.

Update Date: 4/19/2012

Reviewed by: Jennifer K. Mannheim, ARNP, Medical Staff, Department of Psychiatry and Behavioral Health, Seattle Children's Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.