if your child is afraid of — or refusing — a medical procedure, here’s how to help

the coronavirus pandemic has brought medical procedures, like covid-19 testing and covid-19 vaccinations, into our day-to-day lives like never before. these experiences  aren’t easy for everyone , especially for children.

but even outside a pandemic, medical procedures such as vaccinations and blood draws are common throughout childhood. when asked, children reliably say that their biggest concerns about medical procedures are needles and pain. they are also worried that their comfort won’t be taken into account. and  evidence says they’re right .

research is also clear that when children’s pain and fear aren’t well managed during medical procedures, there are both  short- and long-term consequences . procedures can take longer and have an increased risk of adverse events (such as fainting or being physically restrained), and children are likely to need more medications for pain and to develop negative or traumatic memories.

we have prepared  tips to make covid testing  and  needles comfortable , and those recommendations are really important. but here’s the thing: what helps for pain and low-to-moderate fear isn’t enough when children are very afraid.

with repeated negative experiences, a child’s distress and fear can become so high that it can produce a true adrenaline fight-or-flight response, similar to if they were face-to-face with a lion. traumatic stress from medical procedures is in the eye of the beholder: a child’s own experience of the procedure, and fear response to it, are  more important than the “objective” severity  or how painful or scary it may seem to others.

coping with fear and distress

we have heard from parents that they want to know more about what to do when their child is refusing a procedure because of high levels of fear, often resulting from a previous negative or traumatic experience. sometimes when children become highly distressed,  adults will restrain them  in an effort to “just get the procedure over with.”

a child’s fear must be taken seriously and addressed before they can benefit from efforts to  manage pain  and  low-to-moderate fear . if your child is very afraid of a medical procedure (for example, covid testing, vaccinations, blood draws, dental treatment), the following science-backed steps are needed.

exposure-based therapy

in  exposure-based therapy , someone gradually faces their fear head on, starting with easier situations and working their way up to more difficult ones. in this case, it involves educating your child about what is going to happen and why, and enabling them to practise gradually facing each step of the medical procedure before the actual procedure itself.

• validate your child’s concern: acknowledge their feelings and why they make sense (even if you don’t agree or can’t relate).

• take an open, non-judgmental and curious approach to understand what scares them about the medical procedure.
• don’t assume. ask. make sure your child understands what they are being asked to do as part of the medical procedure, why they are being asked to do it, what will happen, what it will feel like, how long it will last and who will be there. answer any questions that they have and correct any misperceptions. you might need to get some information from a health-care professional so that you have all the answers.
• what is the focus of their fear? older children and youth can often tell you what they are worried about regarding the procedure. for younger children, you may have to offer suggestions or alternatives and make your best guess.

practise facing the fear

for fears that are out of proportion to the danger posed, children will need to practise  facing their fear head on . you need to generate a list of fear-inducing situations related to the procedure, such as:

• talking about the procedure;
• seeing pictures or videos of it (tip: make sure these are positive videos where minimal or no distress is shown);
• playing with related toys/equipment;
• driving past the health centre or site where the procedure will take place; and
• the micro-steps leading up to the procedure itself (such as sitting in a chair, having a tourniquet applied or their arm cleaned with an alcohol swab, etc.).

tip: for children ages five to seven, you can use the  children’s fear scale ; for seven-year-olds and older, a zero-to-10 scale ranging from no fear at all to most fear possible; for younger children, you could order the situations by asking them to make choices in head to head comparisons in which the child picks which one is easier out of two, or if all else fails, your best guess.

trouble-shooting

don’t forget that  strategies to manage pain from medical procedures  are also important! for more help,  anxiety canada  has fantastic resources.