As a Child Life Therapist, much of my role has been in planning for and supporting medical procedures. Medical procedures can include any medical intervention that an infant, child, or young person is required to do during medical treatment. This can include things like blood tests, dressing changes, observations, IV insertions, plaster casting, nasal gastric tube placement, port access and a hundred things in between! For most children, having a medical procedure can be a scary event. They are often in unfamiliar environments, surrounded by unfamiliar people asking them to engage in unfamiliar tasks.
Whether it is a child’s first medical intervention or a task that they have had done many times before, one negative procedure can have a long-term impact on their perception of medical encounters.
Despite all the best planning and intentions, sometimes, procedures do not always work out as we hope. Multiple attempts may be required to complete the procedure, or the child may have pain, discomfort or fear during the experience. The procedure may need to be aborted due to the distress of the child or an inability to complete it safely.
In these situations, both children and parents are often left with a feeling of ‘dread’ for further medical procedures and reflecting on how horrible the experience was. It is never easy to watch a child in discomfort and distress; and exponentially difficult when it is your own. So how do we progress from these experiences and set up young people for a more positive experience moving forward? If your child needs to have repeated procedures, it is important to debrief with your medical team and talk through ways that the experience can be improved for the next time. It is perfectly ok to advocate for your child!
· Are there sedation options that may provide a smoother and more positive experience for your child next time?
· Can comfort positioning be used to help them manage the procedure better?
· Do we need to reduce the number of people present for the procedure?
· What opportunities are there to provide choice and control for your child?
· What can help prepare your child better for the procedure and their understanding of what needs to happen?
All these questions are positive to reflect on if you can debrief with your medical team.
But what about the experience for your child? How can we help them process the negative experience to provide a more positive outlook for future medical procedures.
Reframing is a psychological term used to describe a different way of viewing an experience. It allows us to recognise and appreciate the positive aspects of a situation. Reframing is not a denial that the challenge that we have experienced was a difficult one, but rather a search for positives to focus on. Reframing techniques can actually change your physical response to stress; as your body’s stress response is triggered by perceived stress, as much as it is by actual stressful events. We often see this as the fight or response kicks in as soon as your child is reminded about a particularly difficult event.
So how do we shift the focus to the positive aspects of the experience?
Was there something during the procedure that went well?
Maybe they transitioned well to the treatment room, or they were able to put their arm out for the nurse or doctor to have a look. Maybe they were very upset at the time, but recovered quickly once they were out of the room? Praising your child for these seemingly small achievements can help them reflect on the situation in a more optimistic light.
We often talk about ‘book ending’ difficult procedures. This means trying to provide a positive experience prior to and immediately after the procedure. This way, you begin the encounter on a positive and finish on a positive. You can ask your child what they may like to do when they have finished the procedure. Would they like to have an ice-cream or go for a play at the park? As you are waiting for the procedure, you may read a favourite book together or watch something on your phone. You can focus on the chosen fun activity during the procedure and remind them of what they get to do when they have finished. This doesn’t mean that the procedure won’t be challenging, and it is still important to acknowledge their anxieties and fears around it; but it is a way of supporting the brain to move perceptions onto more positive trains of thought.
Encourage your child to be part of the process moving forward. How would they like things to be done differently next time? Would they like to choose something to watch during the procedure? Would they like to pick out a special Band-Aid from home to bring in and use after the blood test? Offering opportunities for choice will help them feel more in control and gain a sense of autonomy over the encounter.
Sometimes as parents, this means that we also need to shift our focus and reflect on the positives. There is no denying that it is extremely challenging to bear witness to a difficult procedure, but by modelling these positive thought patterns, we can help our child see that there are different ways of viewing negative experiences.
Kate Strickland is a community-based Child Life Therapist with a background in Occupational Therapy and Education. She works with infants, children, and young people along with their families in managing the stresses associated with health care encounters, procedures, hospitalisation and medical trauma. Visit healingheartsbeyond.com.au for more information.