It doesn’t happen very often — perhaps once or twice every day — when an older infant or young toddler won’t stop screaming (SCREAMING!) at the top of their lungs from the moment they step into our office’s waiting area until they leave to go home. Preschoolers, in contrast, are easier to distract with books and toys and videos, so they typically wait for the doctor to enter the exam room before the hysteria begins.
This fear of going to the doctor, of course, should be completely understandable. Infants and toddlers receive an “owee” — a vaccine or a finger stick blood test — at every office well visit in the first two years. Other occasions for a visit to the doctor’s office often involve some kind of pain: an earache, an injury, an intervention such as removing ear wax, attending to a wound, or pulling out a splinter). Unforeseen emergencies requiring a trip to the emergency room, the outpatient lab or the x-ray department are even more opportunities to stoke apprehension and fear in youngsters. (Doctors and parents must keep this particular point in mind and avoid unnecessary tests, referrals, and journeys to ERs and urgent care facilities — all places with strange faces, unforgettable sights, and vivid smells that only pile on to future fears.)
Children’s fear of going to the doctor can affect their parents’ interactions with the health care provider: 22% of parents reported that it was hard to concentrate on what the doctor or nurse was saying, and 9% said they would sometimes not ask questions or bring up concerns, because their child was scared or upset during the visit. In a small proportion of families, children’s anxiety impacted the delivery of health care: 4% of parents reported they postponed getting a vaccine for their child, and 3% had canceled or delayed an appointment, because of their child’s fear of going to the doctor.
Fear of getting a shot and stranger anxiety were the two biggest reasons parents cited for their young child’s fears of going to the doctor. Parents who were polled for the study attempted a variety of strategies to help prepare for an office visit:
Many parents tried to educate their child about what would happen at the visit, by talking about it (61%), playing with a toy medical kit (26%), or reading a book or watching a show about going to the doctor (23%). Other parents tried to placate their young child, by promising to get a treat after the visit (31%) or telling the child there wouldn’t be any shots (21%). About 1 in 5 parents (22%) said they didn’t do anything special to prepare their child for health care visits.
We’ve seen before that what parents say to their kids beforehand (“Don’t worry, shots don’t hurt”) can and probably will backfire big time. Parents can amp up the anxiety without being aware of it; they can also be the biggest source of comfort:
“Parents say the biggest source of fear is ‘needle phobia,’ which can be especially tricky for younger children who require vaccinations more frequently,” Clark says. “Children’s fear of shots can be exacerbated when they pick up on their parents’ anxiety and it can often be difficult to calm children down during these services.”
Clark recommends parents ask child health providers for tips on how to decrease children’s fear of shots. Having the child be held or hugged by the parent, for example, may be calming for many children. Distracting the child with songs, a video, or even coughing briefly before the shot, has also been shown to decrease anxiety.
“Telling the child there will no shots at the visit when the child is due for a vaccination or saying ‘it won’t hurt’ may backfire and only increase anxiety ahead of future visits,” Clark says.
University of Michigan pediatrician Beata Mostafavi offers six ideas that parents can use to help ease their child’s anxiety before they come to the office:
1. Prepare them before the visit
Educating children in advance is the most effective way to alleviate fears.
Parents may prompt these conversations with age-appropriate books, a kids’ TV show about visiting the doctor or even a toy doctor’s kit for a pretend run through.
“The biggest fear is often the fear of the unknown,” Taut says. “Anything that makes the interaction feel more familiar is helpful, especially if this exposure comes at home where they’re comfortable.”
2. Don’t create fears or joke about needles
Parents polled said their child’s biggest source of fear involved getting a shot (66 percent for children 2 to 3 years old and 89 percent for children ages 4 to 5.) Be cautious, then, about inadvertently promoting needle-phobia.
“Parents might say something like, ‘Sit still or you may have to get a shot,’” Taut says. “Even if this is done playfully, it creates a negative association.”
Emphasize that shots are never a punishment — they help keep people from getting sick.
3. Don’t make empty promises
Nearly 1 in 4 parents said they would tell their child there wouldn’t be any shots to keep them calm — whether or not an immunization was due.
As a result, “children may leave without the shot they were supposed to have, delaying their vaccine, which is not ideal,” Taut says. “Or, parents break a trust with their child, which may only increase nervousness for future visits.”
Call the office in advance to know what to expect.
4. Offer distractions
There are no screen time rules when there’s a shot involved, Taut says. Letting a child watch favorite videos, listen to music or read a book during the visit can be a helpful distraction for some children.
Asking the patient to cough right before the poke is also a method that works for many patients because it often blunts the pain, Taut says.
5. Be comforting
Holding or hugging a child is preferred over having them restrained, which can only elevate a patient’s fears.
“Comfort positions allow parents to support their children during procedures,” Taut says. “This can make children feel safe and decrease anxiety.”
A parent’s anxiety can exacerbate a child’s fear, she adds, so parents should be aware of their own nerves when the needle comes out.
6. Offer a small treat afterward
The promise of an ice-cream cone, small toy or a fun shared outing after the doctor’s office may help boost positive associations with the experience.
Says Taut: “Preparing a child for a doctor’s visit ahead of time is the most important step in decreasing fears, but it can’t hurt to enjoy something fun after it’s over.”
Older kids may also harbor apprehensions about going to see the doctor. We’ll examine that drama tomorrow on The PediaBlog.