Helping Children Cope With Medical Tests and Interventions

Abstract

Medical procedures and tests become a challenge when anxiety and pain make it difficult for the patient to cooperate or remain still when needed. Fortunately a short intervention with hypnoidal language at the onset of a procedure induces a positive and sustained change in the way pain and anxiety are processed. While anesthesia may appear to be a simple solution to eliminate pain, the adverse effects of pre-anesthesia anxiety on postoperative behavior and recovery are often not fully appreciated. This paper discusses options for self-hypnotic relaxation that are applicable to interactions with children. The high suggestibility of children makes it relatively easy to engage them in make-believe scenarios. Avoidance of negative suggestions is key in avoiding nocebo effects that may be difficult to overcome later. Once a child is immersed in his or her preferred scenario or hobby/activity of choice, environmental and procedural stimuli can be easily integrated in the imagery. Ego-strengthening metaphors that tie in features of strength, confidence, or resilience are particularly empowering. Even when children are fully under general anesthesia they may still have recall of what is said in the room and therefore caution in word choice should be maintained.

Using a Respectful Approach to Child-centred Healthcare (ReACH) in a paediatric clinical trial: A feasibility study

“…We believe that the compliance figures we obtained for our Milky Way Study participant blood draws without any such restraint show that a child-centred approach can form part of a medical phlebotomy protocol and achieve acceptable rates of success. Our ReACH approach included promotion of active coping behaviours in the children [ 45 , 49 , 57 ], with parents commenting favourably on researcher-led controlled breathing before the blood test ( Box 4 ).…”

“…A variety of practical and psychological approaches have been used to help manage pain and/or associated anxiety in paediatric clinical procedures, such as psycho-education, play therapy, medical play, deep breathing and/or relaxation, comforting language, music, hypnosis and/or hypnotic suggestions of make-believe scenarios, filmed modelling of behaviours, cognitive behavioural rehearsal and therapy, and classical operant techniques such as positive and/or negative reinforcement [ 45 , 49 , 51 , 57 , 61 ]. To date, cognitive behavioural therapy and hypnosis alone have been considered to provide validated efficacy in pain management [ 49 ].…”

“…Psychological approaches used with children should promote self-control and encourage active participation in their own care [ 49 ]. However, care is recommended in dealing with accompanying parents, as parental emotions and attachment may affect the child’s coping mechanisms [ 57 ].…”

“…The ReACH researcher attempted to build a comfortable relationship with each child, using authentic explanations at eye level with the child to enhance trust. Crouching or kneeling to match position and establish eye contact, rather than towering over small children, has been recommended as critical in establishing trust ahead of medical procedures [ 57 ]. However well-intended, parents—possibly reacting instinctively and emotionally to a medical-type setting—could displace their child’s considered assent and trust in the healthcare professional or researcher with a distraction, by effectively removing their attention from the procedure.…”

“…However well-intended, parents—possibly reacting instinctively and emotionally to a medical-type setting—could displace their child’s considered assent and trust in the healthcare professional or researcher with a distraction, by effectively removing their attention from the procedure. This could disrupt activation and enhancement of the child’s innate coping mechanisms [ 57 ], while negating both prior parental consent and child assent.…”