Yesterday on The PediaBlog, we took a look at a University of Michigan study that identified needle-phobia and separation anxiety as the two biggest worries children aged 2-5 have when visiting their doctor’s office. Older kids and teenagers can also have their own nerve-wracking anxieties about taking a trip to see their primary care pediatrician or pediatric specialist, and these can involve much more than just the anticipated pain from vaccines:
- Separation. Kids often fear that their parents may leave them in the exam room and wait in another room. This fear of separation during mysterious exams is most common in kids under 7 years old, but can worry older kids too.
- Pain. Kids may worry that a part of the exam or a medical procedure will hurt. Kids ages 6 to 12, for instance, often worry that they’ll need to get a shot.
- The doctor. Some kids’ concerns may be about the doctor’s manner. A kid may misinterpret qualities such as speed, efficiency, or a detached attitude and view them as sternness, dislike, or rejection.
- The unknown. Kids sometimes worry that a medical problem is much worse than their parents are telling them. Some who have simple problems worry they may need surgery or hospitalization; some who are ill worry that they may die.
Also, kids often have feelings of guilt: They may believe that their illness or condition is punishment for something they’ve done or should have done. Kids who feel guilty also might believe that exams and medical procedures are part of their punishment.
Older kids may also feel reluctant to discuss certain symptoms they are complaining about with their doctor, knowing very well those symptoms may provoke highly personal questions, probing examination procedures, or tests that may be embarrassing. Urinary frequency and enuresis (bedwetting), constipation and encopresis (involuntary soiling), rashes in private areas, or symptoms that could be explained by teen behaviors best described as inappropriate are just a few examples of situations that might allow a young person’s evolving imagination to run wild. Bringing them back down to earth before their office visit by talking things over can do a lot to relieve anxiety:
If your child goes to the doctor because of an illness or other condition, discuss the health problem in neutral language and reassure your child: “This isn’t caused by anything you did or forgot to do. Illnesses like this happen to many kids. Aren’t we lucky to have doctors who can find the causes and who know how to help us get well?”
If you, your partner, other relatives, or friends had (or have) the same condition, share this information. Knowing that others have been through the same thing can help ease fears.
If your child sees a doctor for something that led to ridicule or rejection by other kids (or even by adults), work to relieve shame and blame. Problems like head lice, embarrassing scratching caused by pinworm, and daytime wetting or bedwetting are often misunderstood by others. Stay supportive, and keep reassuring your child that the condition is not his or her fault and that many kids have had it.
If your child was injured while disregarding safety rules, point out the cause-and-effect between the action and the injury, while avoiding blame. You could say, “You probably didn’t understand the danger involved in doing that, but I’m sure you understand now, and I know you won’t do it that way again.” If your child repeatedly disobeys rules and is injured, speak to your doctor. This sort of worrisome behavior pattern needs a closer look.
In every case, though, be sure to explain, especially to young kids, that going to the doctor is not a punishment. Help your kids understand that adults go to doctors just like kids do and that the doctor’s job is to help people stay healthy and fix any problems.
You can let your child have a measure of control over the situation by giving them a voice before the visit with their doctor begins:
Gathering information for the doctor. If the situation isn’t an emergency, your child can help make a list of symptoms for the doctor. Include all symptoms you’ve seen, even if they seem unrelated to the problem. Also prepare a list of your child’s previous illnesses and medical conditions and a family history of illnesses and medical conditions among close members of the family (parents, siblings, grandparents, aunts, and uncles).
Writing down questions. Ask your child to think of questions to ask the doctor. Write them down and give them to the doctor. Or, if kids are old enough, they can write down and ask the questions themselves. If the problem has happened before, list the things that have worked and the things that haven’t worked in previous treatment. Kids will be reassured by your active role in their medical care and will learn from your example. And you’ll be prepared to give the doctor information needed for an informed diagnosis.
Above all, parents should not be afraid of talking with their children, reassuring them and soliciting their input before the visit with the doctor happens. Teamwork is a crucial aspect of pediatric care in a medical home, and it works when the team, made up of parents, children, and pediatricians (and our staff), works together for the benefit of children.