Preparing Your Child for a Medical Procedure
When a child undergoes a medical procedure, both the emotional and educational preparations are important. The following guidelines are presented from an integrated interpretation of published guidelines developed by various psychological theorists. Thank you to Linda Bensing, Child Life Specialist at Lutheran General Children’s Hospital in Park Ridge, Illinois, for submitting this helpful information.
Guidelines for preparing the 2 to 4 year old:
- Verbal skills are limited and cognitive skills are not yet developed. Therefore, nonverbal communication is strong. Body language becomes the strongest source of communication for both the nurse and parents. Watch your expressions and what your hands are doing.
- Even though the child is developing a sense of autonomy, the 2 to 4 year old has not yet become independent of his or her parents. Therefore, the child’s level of understanding simple preparation is correlated to the parents’ level of anxiety.
- Fantasy and reality are closely related. Concrete explanations just prior to the procedure are best. Since the element of time is not well understood, explanation should be done “here and now,” not a week before the procedure.
- This age group has a limited amount of previous experience, so try to use words that will be the most familiar to your child (i.e., terms your family uses to name body parts, stool, etc.).
- Stress may result in a regression to more baby like behavior. This should be accepted and supported. Don’t allow an I.V. to be started on a thumb-sucking hand, request that your child stay on your lap, etc.
- Transitional objects are extremely important in providing comfort (e.g. security blanket, stuffed animal, binky, etc.).
- Anxiety and fantasy are aroused by each experience a child has. Parents should allow these feelings to be “played out” after the procedure.
Guidelines for preparing the 4 to 7 year old:
- The child’s thinking is based on immediate perceptions and experiences. Discuss previous medical experiences and explain how this procedure will be the same or different.
- These children are concrete learners. They focus on what is seen, felt, and heard. They are also very literal, so language choice is very important. For example, if you say, “The nurse is going to start an I.V. in your hand now,” your child may picture the nurse trying to stick an ivy plant in his/her hand.
- Fantasy is still closely linked to reality, so a child’s perception can be distorted. Be truthful and selective in what is said and seen. Ask your child about a previous “hurt” and correlate it to the amount of discomfort he/she will feel during the procedure. This will also give your child confidence.
- It is common for a child this age to view medical procedures as punishment. Explain what will be done and how you will help your child accomplish this. Refrain from using words that can increase the child’s guilt or sense of failure. (e.g., “You’re a good girl” If your child is not able to cooperate, it does not mean the child is no longer “good.”
Guidelines for preparing the 7 to 11 year old:
- The child now has the ability to think and reason logically. He/she still does not have very abstract thinking, so the same concrete details of look, feel, and sound are understood best.
- Children now have greater attention spans and greater imaginations. Therefore, information should be given ahead of time (clinic, home) including pictures, models, simple anatomy demonstrations, a procedure doll, educational play. Detail is well accepted and understood. Since their imaginations are so vivid, be truthful and complete. Simple analogies help to clarify information (e.g., scopes are used for looking closely at things, like microscopes, telescopes, and endoscopes).
- Again try to relate a similar pain experience to your child.
- A school-age child can be encouraged to write a story or draw pictures. This can reinforce the difficult experience that your child has endured.
Guidelines for preparing the adolescent:
- The maturity level of adolescents varies widely, especially under a stressful situation in which regression may occur. Be accepting and supportive of all behaviors.
- Again, information should be given ahead of time with as much detail as questioned. Brochures typically given to parents can be helpful.
- Most adolescents are concerned with embarrassment and privacy. Address these issues and explain how you will respect them.
Preparation in all age groups should include truthful information and responses to questions. All children and parents experience increased anxiety when they feel out of control. Therefore children of all ages should be given the opportunity to make a choice whenever possible. Simple choices, such as sitting in mom’s lap or on the bed, starting the I.V. in the right or left hand, or putting the oximeter on which finger can all make a big difference in the child’s perception of control and will lessen the child’s level of anxiety.
This article is reprinted with permission from EA/TEF Child & Family Support Group, which also offers a brochure entitled “Helping Your Child Cope with Painful Medical Procedures.” The brochure outlines specific examples of ways to reduce your child’s level of anxiety when undergoing an invasive medical procedure and is available at www.eatef.org.