Wednesday, March 12, 2014

Helping your school age child at the doctors

Today I was talking to my cousin about a pending doctor appointment for her school aged daughter.  She mentioned that because her daughter doesn't want to be sick she will leave out important details or down-play symptoms to make the illness seem less concerning.  This is a typical reaction for children, but one that can be detrimental in the healing process.  It's not easy, but as a parent, support person or child life specialist there are things that can be done to alleviate some of the stress and stereotypes surrounding illness.  My top five recommendations that I have personally used or have seen to be effective include:

1.  Prepare
Before the appointment, remind your child that a check-up is scheduled and go over the plan for that day.  If your child is in kindergarten through second grade it is wise to remind them the morning of the appointment where an older child may benefit from a day or two advanced notice.  Regardless of the age, it is important for the child to know the plan for the day (i.e. will he be getting out of school early, who will accompany him to the appointment and what should he expect from the medical staff while he is there).  This preparation will give your child the opportunity to work out stressors in their mind, express concerns or fears that can then be addressed and ask questions to clarify any misconceptions.  Without this time to prepare, children can be overcome by fear and stress, but be unable to have the time needed to work through it in their own way.

2.  Empower
Children need to know they have some control and can be responsible for their own body.  When a child is impacted by their own illness, it can be a great opportunity for that child to learn about their own body.  If a child understands that no one knows what's going on in his body better than he does, he can be responsible for sharing symptoms and being a part of the medical team in a new way.  This creates feelings of people doing things for him instead of to him.  Another way to empower a child is to consider whether or not painful stimuli will be used during the appointment.  If a child must experience a painful procedure, he can be empowered by receiving "break cards".  Three cards for a 30 second, 1 minute and 3 minute break can be given to the child to provide him with control and attempt to alleviate some of the stress surrounding the painful procedure.  Please speak with the medical care provider before discussing these cards with your child.  Most providers will be happy to provide this type of control to the child, however, some procedures do not allow for a break.

3.  Support
Anytime a child is experiencing a stressful situation, having the support of a trusted adult will make all the difference.  A child will feel more able to complete the task at hand when he feels supported and believed in.  This support can come through holding hands, encouraging words or even allowing a safe space for tears.

4.  Partner
In a typical medical experience where the patient is an adult, providers will speak directly to the patient.  However, when that patient is a child, the providers may bypass the patient and speak directly to the adult in the room, regardless of whether or not that adult is the parent.  If this occurs, the child may feel more like a specimen than a part of the team.  To change these feelings, it is essential that the adults in the room include the child in conversation, allow him to answer questions about his body and make direct eye contact to keep the child engaged and included.  When a question is asked that the child could answer, it is extremely important to allow the child to have the space and time to answer the question.  Often, adults will allow only 3-5 seconds of silence before answering the question.  This tells the child he does not need to pay attention and his words have little value. 

5.  Communicate
And last, but definitely not least, it is essential that communication be thorough and remain at the child's level.  When adults talk over the child or use big words that the child does not understand, he is left to create meaning and imagine the worst case scenario.  Even when a poor prognosis is being discussed, children should feel included and given the opportunity to communicate in a developmentally appropriate way.  This shows love and respect while clarifying misconceptions and alleviating fear.  A poor prognosis is often not as bad as the ideas a powerful imagination can create in the mind of a child.

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