Helping Children Cope During Medical Exams and Procedures

Transcription:

Scott Webb (Host): Welcome to UK HealthCast, the podcast from UK HealthCare. I'm Scott Webb. And despite how awesome pediatricians are, visits to the doctor for our kids can sometimes be stressful, and it's good to have my guest today, Emily Bollinger. She's a certified child life specialist and she's got some great tips and suggestions for how we can help our kids cope with medical exams and procedures.

Host: Emily, thanks so much for your time today. I have a couple of kids, so I have been to the doctor's office many times with my children over the years for acute sort of things and regular visits and broken bones, you name it. What are some of the issues children might face when going for a medical exam or doctor's visit? I know what I experienced, but what should folks in general be expecting?

Emily Bollinger: Many kids, just like adults when they go to a doctor's office or any type of medical procedure, there's going to be some uncertainty. There's going to be some questions. There's going to be concerns about if something is going to hurt, what are they going to do, what's going to happen during this visit. What that looks like for kids and what those concerns tend to be focused on really varies based on their developmental levels. So, what's stressful about going to see the hospital for a one-year-old is going to be very different than what is stressful for a 15-year-old going to the doctor. But that general uncertainty and kind of wariness and memories of possible, you know, pain or discomfort, anything like that are likely to be at the forefront of their minds.

Host: Yeah. Definitely in my experience for sure. And when we think about preparing for a medical visit, you know, how soon before that visit should we begin to prepare? Whether that's just putting some notes together, preparing the child for the visit and so on?

Emily Bollinger: Right. That's a really good question, and it really, again, depends on the age of the child. Our general rule of thumb that we tell people is the younger the child, the closer to the event itself, you want to start talking about it. So if you are taking your two-year-old, then you don't want to blindside them and just suddenly show up at the doctor when they thought they were going out for ice cream. But it is appropriate if you go to a playground or something that morning and then let them know, "Okay. We could go on the swings, then we're going to go for a checkup at your doctor's office." For a teenager, they understand time a little bit better, they can think about it. And so, letting them know when it's scheduled or, you know, days to weeks in advance is appropriate. If it's a child that has a lot of anxiety or concerns or may have a more unique reaction to it, then that's kind of a parent's judgment call. Some kids really need time to get used to the idea and ask their questions, and some kids don't want to know as much. But in general, a younger kid you can do day of or night before. Whereas an older kid or an adolescent, it's appropriate to talk about it days or weeks in advance.

Host: Yeah. And of course, all kids are different. Wondering, Emily, what else can we do in terms of, you know, coping on the day or during the commute? Can we listen to their favorite music? What else can we do to help them?

Emily Bollinger: So, we always encourage everyone to be honest with kids. A lot of times adults try to sneak something in or sugarcoat something or downplay it because of our own anxiety or our own discomfort talking about things. Kids tend to do much better than adults in general at handling unfamiliar situations and circumstances if they have accurate information. And so, we do tell kids, "We're going to a doctor's office and they're going to check your body from head to toe" or "Today, we will need to get your flu shot," you know, things like that. If it's going to be part of the experience, then we do let kids know rather than trying to trick them or sneak something in.

Also, giving them control over the situation, so saying, "We're going to the doctor and we're expecting to be there for about as long as it takes to watch an episode of Daniel the Tiger. What do you think would be fun to do after we leave?" And letting the child kind of have some control over their day and what things look like. During an uncomfortable part or even the drive there, then again giving that control, like you said, "Do you want to choose our music to listen to on the way there? Is there a stuffed animal that you would like to bring with you?" For teenagers, also giving them the option, "Do you want me to be in the room with you or would you rather have that privacy?" So, letting the child have the information and work with you to decide what they want to do and what feels good and comfortable and familiar for them is going to be helpful regardless of what that appointment itself includes.

Host: Yeah, definitely. And I used to like to take pictures when my kids would have, you know, the little smocks on. You know, what do they call those?

Emily Bollinger: Hospital pajamas.

Host: The hospital pajamas. You know, I used to like to take pictures and sort of document, "Hey, this was this time at the doctor and another time at the doctor." At some point, I had to start listening to them more and just know that they didn't enjoy that. They didn't ever want to see those pictures again or anyone else to see them. And so, I started listening to the kids more. And, you know, whether it was, as you say, being in the room, not being in the room, sitting near them, sitting across the room, letting them do more of the talking, I guess what I'm getting at, Emily, is when we're there in the room or just outside the room, like what can we do? Is it really just being a good listener to our kids?

Emily Bollinger: Some of it is. It's also being willing to share the expertise on our child with their care providers. I think many parents kind of shut down a little bit or decide, you know, the doctors and the nurses are going to make these medical decisions, which they are. But the doctors and the nurses aren't going to know our own children and what works well for them to the extent that we do, even if it's a pediatrician who they see regularly. So, really communicating things that have worked well for our children in the past, things that were really detrimental to our kids that we would like for them to avoid this time can also be really helpful information and just having that kind of ongoing dialogue and partnership.

And then, for the child, like you said, a lot of it is knowing them and things that are stressful for one are different than what's stressful, you know, for another child or kind of their baseline information. But giving them the choice of where they sit for the procedure. They may want to sit with the parent. They may want to sit, you know, on the exam table or in a chair. Sometimes the child can choose what order they do some things. And some kids like to get the more intimidating thing over with first, some would like that to be the last thing before they go. If they want to watch, I've had a lot of parents who are kind of forcefully trying to shield the child's eyes, you know, from an immunization or a lab draw, and the child is kind of fighting the parent because they want to watch. And many children actually cope much better when they are able to see it. If an adult is nervous about something and we say, "Oh, here's how I'll help. Let me blindfold you," that tends not to decrease our anxiety. That tends to make it seem even scarier that something so bad is coming at me that I can't even look at it and kind of puts you on higher alerts.

So, demystifying what's happening. Many especially pediatric providers will give the child a chance to kind of look at and hold and explore different medical equipment that's safe for them to do so. So, the child can deal with what the stethoscope looks like and, you know, kind of use the different things. Maybe show them on the parent or on a stuffed animal so that it becomes more familiar and is less intimidating before it's being used on the child. So, those types of things, giving the child the opportunity for, or even asking, "Hey, you know, my daughter is kind of nervous about this. Would it be okay if she used the stethoscope on her teddy bear before you did her exam?" and kind of asking for that. Most pediatric providers want to help kids. They want to support kids. They would like for this to go as well as possible for everyone involved. And so, kind of giving them that information of how best to support your child is going to be beneficial.

Host: Yeah. What's your best advice when we try to help them cope with, you know, preparing for a surgery, knowing what to expect, and try to keep the anxiety levels as low as possible?

Emily Bollinger: Obviously, there's a wide range of what surgery entails and what that's going to look like. So, the same will span as far as how far in advance you talk to your child about it, starting sooner to the event itself with a younger child; giving older kids and adolescents more time to get comfortable with the idea; listening to their questions and helping them find the answers. Within the children's hospital, then child life specialists like myself and my colleagues do a lot of that preparation and that education for kids, and so we understand what they're likely to be thinking about. We know how this tends to go within the hospital setting. And so, we meet with kids and their caregivers and help them gain that understanding.

But if a child is having surgery somewhere where child life is not available, then supporting them and asking the providers questions or the parent asking it and just saying, "You know, they're concerned about what their scar might look like afterwards. Are you able to give them more information about that so that they get their questions answered?" And then, being really intentional in what information we share. A lot of kids are going to be focused on the sensory component, so they're less interested in exactly what's entailed in removing my appendix than they are in how long will it be before I get to eat again and what snack will be waiting for me when I wake up, and, you know, "Is this going to hurt? Do I still get to go to my friend's birthday on Saturday?" So, trying to think through, you know, listening to what are they asking, what are their priorities in this, and focusing on those more sensory-driven or impactful pieces for the child is going to be the best support.

Host: Emily, this is great advice today. As we wrap up, you mentioned sensory. Let's talk about that. If a child has unique sensory needs, how can we help them cope with their medical visits?

Emily Bollinger: So, this really needs to be a collaboration between the medical team and the parent and caregiver. These are patients that child life specialists spend a lot of time with because they do need more support in order to handle the experience that is being presented to them and that they need to be actively involved with.

Having an established coping plan is really helpful. And so going in, some parents can type this out, they can send it, you know, electronically to providers in advance or just communicating it, but letting them know if there are numbing agents that are helpful for their child, if there is a position that is more physically comfortable for them to be positioned in. If they hate Band-Aids or tape, you know, those types of things we default to, but some of them are not absolutely necessary. And so if we know that this child really doesn't like Band-Aids, then that's fine. Let's, you know, find another way. We can do a cloth wrap-around gauze. There are other options for that.

Giving the child time to process, we tend to kind of get in a hurry in general in healthcare settings. And then, if we're nervous or think something's going to go bad, many of us default to, "Well, let's just hurry up and, you know, kind of get it done and over with," and then start trying to calm down. But it is much harder to undo a negative experience than it is to take the time to build a more positive experience from the start. And so, listening to what is calming and comforting and reassuring for that child, giving them those extra minutes that it may take to get comfortable, letting them choose if they want to listen to music, if there's a show that they want to watch on their parents' phone, if there are questions that we can, you know, help address for them, if there are comfort items.

Many of these kids are very uncomfortable having additional strangers and unfamiliar people coming in, so trying to limit the interruptions and how many staff are involved with the child's care. And for the parent to know that they are empowered to say, "This is getting overwhelming and my child needs a break." And that's a very valid thing for a parent to advocate for or to say, "You know, my child would do a lot better if they could sit next to me on the chair instead of being on the exam table. Does that work for this exam?" And so, figuring out those things that are going to be comfortable and familiar.

We also work with some kids and we'll help them write and put pictures together of a social story before they're coming into the hospital or clinic, if it's going to be something that they need to do frequently and they have a lot of questions and it's going to contribute to the anxiety, then we can work with other providers and put together kind of a photo story book explaining what this looks like and the steps of that visit or that procedure that they're likely to have. Some facilities will have this available on their websites as well. Or if a parent does have a child that's going likely to be more anxious, pulling up some of those pictures or even videos and tours, even just driving by the building when you're not going for the procedure and saying, "This is where we'll come on Thursday and this is where we're going to park. And that blue door is where we'll walk in," and kind of demystifying some of those unknowns in advance. And then once they're there, using the things that you know work for your child and communicating that to the providers and advocating for what your child needs. And just acknowledging how hard it is, even if the child doesn't sit perfectly still or whatever it is, you know that they're trying and you know that this is stressful, so telling your child things like, "This is tough and I can see how hard you're working. Thank you for helping us take care of you. I know it's a hard job," and just really validating how much effort is being put in, even if it doesn't, you know, end up as perfect and seamless as you would hope for it to be.

Host: Yeah. Perfect and seamless is the goal. But, you know, kids and medicine and those moments. You know, one time when my son was like two, he was sick and he needed shots in his legs and I had to sort of hold him down and it was all very traumatic for both of us. So, you know the range of things, but we do our best, our kids do their best and you've done your best today. Great advice. Lovely to have your expertise today. So, thanks so much. You stay well.

Emily Bollinger: Thank you. It was nice talking with you.

Host: And for more information, visit our website at ukhealthcare.com. And that wraps up another episode of UK HealthCast from UK HealthCare. Please remember to subscribe, rate and review this podcast and all the other UK HealthCare podcasts. I'm Scott Webb. Stay well.