Coping with Painful Procedures
Be responsive to the child’s needs for information.
- Try and give your child the amount of information he/she needs rather than what you think your child should have – they will generally let you know. Children may have misconceptions or distortions about how or why procedures are done. It is important to acknowledge and discuss these concerns. An atmosphere of openness can allow a child to feel more comfortable.
- Keep yourself informed so you can be a resource for your child. Most children prefer to be warned about upcoming procedures. They can often cope more successfully with something painful if they have had time to mentally prepare for it. When to give the warning depends on the child. Some children want to know plans days or weeks in advance while for others, it may be more appropriate to wait until the last minute. In addition to some warning a procedure will occur, some children will benefit from a step by step description as the procedure is performed. Others just prefer to know when it is over.
Be aware of and supportive of the child's feelings during and after procedures
Perhaps the most important thing a parent can do for a child to help them cope with painful procedures is to give them support. How this support is given varies from child to child and from parent to parent.
- Some children do better with their parent in the room with them during the procedure; others do better with the parent waiting outside. One point to remember is not to make promises you cannot keep. Occasionally, a parent may say to the child: "Don't worry, I'll always be with you during procedures". Then, at some point to the future, the parent may not be able to be with the child. The child may then feel betrayed and let down.
- It appears the most important types of support are love, empathy, hugs, a hand to squeeze, distractions and occasionally, treats afterwards.
- A good attitude helps. A positive approach does not require everything be accepted with a smile, but recognition that no procedure lasts forever seems helpful.
Be aware of the child's feelings of helplessness and loss of control
- Having no control over the situation tends to heighten fear of painful procedures. Parents cannot, of course, give full control to their child, but there are things to keep in mind which may enhance a sense of control for them. Examples of such choices can be:
- The time of day to go to the clinic.
- Which door of the Hospital to use.
- Which brief story to tell the doctors or nurses.
- Which hand to use for a finger-prick.
- What special treat to be given after the procedure.
- People feel more in control of a situation when they understand the reasons for it. They also feel more in control of a situation if they are able to anticipate the behaviour of the people around them. If a child knows that the parents, doctors and nurses are going to be supportive and accepting of his needs and feelings, the child can better predict what will happen and feel a bit more in control. When there is a lack of understanding or communication between the parents and medical staff, feelings of upheaval and disharmony result which can make the parent and child feel more out of control.
- Children want respect for, and acknowledgment of, their feelings whether expressed directly or indirectly. Fearfulness and anxiety are associated with all procedures. You and your child need to work out acceptable ways to express these feelings.
Help the child develop inner strengths and self-control
- Children under stress sometimes exhibit resistant, disruptive, or inappropriate behaviour due to anger and frustration about the disease and its treatment. Acceptance of the child's feelings is important, but accepting inappropriate behaviour promotes confusion and anxiety in the child. Being clear and consistent about what you as the parent expect the child to do, can improve their behaviour.
- Encourage and reward courageous behaviour whether it be enduring a simple physical examination or a painful procedure. Often parents and staff get so upset by the child who exhibits disruptive behaviour they neglect to pay attention to the child when he is doing well. Children like to be complimented. By suggesting appropriate and acceptable behaviour and by using positive reinforcement, a child's coping skills will improve.
- At times it can be perfectly acceptable to ignore a child who is displaying resistant, inappropriate behaviours. Ignoring the behaviour can make it disappear. Paying attention to the behaviour, even in a negative way, can encourage that behaviour. Of course, some behaviours that are destructive or violent cannot be ignored because of their consequences.
- Children may find it helpful to think or talk about other more pleasant things to keep their minds off the procedure.
Be aware of and encourage the child’s play
Play is the language of children and is the major form of communication up until the age of 9 or 10. For this reason, Play Therapy can be extremely beneficial, as it involves the provision of creative and therapeutic experiences which aim to ensure life remains as normal as possible for children and young people during hospitalisation. This occurs through medical play, procedure preparation, distraction and developmental/therapeutic play opportunities. Play Therapy sessions may take place one on one or in groups, and may also extend to include siblings and other family members.
For example, a child may be given a syringe, an IV pole, and a doll and be encouraged to give the doll injections. For a child about to have surgery, the child may be encouraged to do "pretend surgery" on a doll beforehand in order to teach them about the process of their own surgery and, thereby, help them to cope with their feelings. This acting out of feelings can relieve tension and decrease anxiety. Even though the child may appear violent when poking at the dolls, they may be reviewing the frustration and pain they felt from the procedures they’ve received.
In their play children may regain their sense of control over the situation. With repetition of the activity, the child is experimenting with alternate ways of coping. This type of play can be encouraged by parents. Medical kits can be purchased or made with materials obtained through the hospital, clinic, or physician's office. Toy hospitals and books related to hospital or medical experiences may be purchased. Parents can often learn about their child's feelings and anxieties by watching, listening and sometimes even participating in their child's play.
Children can also learn to relax. Sometimes relaxation techniques can be used during a procedure to help a child become less anxious. Decreased anxiety can enhance tolerance of pain.
The opportunity to work with Play Therapy to develop coping strategies ensures children and their families are well supported throughout their time with the Kids Cancer Centre.