School age test or procedure preparation
Preparing properly for a test or procedure may reduce your child's anxiety, encourage cooperation, and help your child develop coping skills.
Preparing school age children for test/procedure; Test/procedure preparation - school age
Know that your child will probably cry. Even if you prepare, your child may feel some discomfort or pain. Try using play to demonstrate what will happen during the test. Doing so may help reveal your child's concerns about the test.
The most important way you can help is by preparing your child ahead of time, and providing support for your child during the procedure. Explaining the procedure may help reduce your child's anxiety. Let your child participate and make as many decisions as possible.
PREPARING FOR THE PROCEDURE
Limit explanations about the procedure to 20 minutes. Use several sessions, if needed. Since school-age children have a good concept of time, it is okay to prepare your child before the procedure. The older your child, the earlier you can begin to prepare.
Here are some general guidelines for preparing your child for a test or procedure:
- Explain the procedure in language your child understands, and use real terms. Avoid abstract terms.
- Make sure your child understands the exact body part involved, and that the procedure will be done only on that area.
- Describe as best as you can how the test will feel.
- If the procedure affects a part of the body your child needs for a certain function (such as speaking, hearing, or urinating), explain what changes will occur afterward. Discuss how long these effects will last.
- Give your child permission to yell, cry, or express pain in another way using sounds or words.
- Allow your child to practice the positions or movements that will be needed for the procedure, such as the fetal position for a lumbar puncture.
- Stress the benefits of the procedure and talk about things the child may like afterwards, such as feeling better or going home. After the test you may want to take your child for ice cream or some other treat, but do not make the treat a condition of "being good" for the test.
- Suggest ways to stay calm, such as counting, deep breathing, singing, blowing bubbles, and relaxing by thinking pleasant thoughts.
- Allow your child to participate in simple tasks during the procedure, if appropriate.
- Include your child in the decision-making process, such as the time of day or the body site where the procedure is performed (this depends on the type of procedure being performed).
- Encourage the child's participation during the procedure, such as holding an instrument, if allowed.
- Let your child hold your hand or the hand of someone else who is helping with the procedure. Physical contact can help reduce pain and anxiety.
- Distract your child with books, bubbles, games, hand-held video games, or other activities.
Children often avoid responding when asked direct questions about their feelings. Some children who are happy to share their feelings withdraw as their anxiety and fear increase.
Play and third-party communication can be wonderful ways to demonstrate the procedure for your child. They can also help reveal your child's concerns.
The play technique should be tailored to your child. Most health care facilities that treat children (such as a children's hospital) will use a play technique to prepare your child. This type of communication may take some practice.
Most young children have an important object or toy they can use for a type of interaction called third-party communication. It may be less threatening for your child to communicate concerns through the toy or object than to express them directly. For example, a child may be better able to understand a blood test if you discuss how the "doll might feel" during the test.
Toys or dolls might help you explain the procedure. Once you are familiar with the procedure, demonstrate on the toy what your child will experience. For example, show positions, bandages, stethoscopes, and how the skin is cleaned.
Medical toys are available, or you can ask your child's health care provider to share some of the items used in the test for your demonstration (except for needles and other sharp items). After your demonstration, allow your child to play with some of the safe items. Watch your child for clues to concerns and fears.
For younger school-age children, the play technique is appropriate. Older school-age children might view this approach as childish. Consider your child's intellectual needs before using this type of communication.
Older children may benefit from films that show children of the same age explaining, demonstrating, and going through the same procedure. Ask your health care provider if such films are available for your child to watch.
Drawing is another way for children to express themselves. Ask your child to draw the procedure after you have explained and demonstrated it. You may be able to identify concerns through your child's art.
DURING THE PROCEDURE
If the procedure is performed at the hospital or at your child's health care provider's office, you will most likely be able to be there. Ask the provider if you are not sure. If your child does not want you to be there, it is best to honor this wish.
Out of respect for your child's growing need for privacy, do not allow peers or siblings to view the procedure unless your child allows them or asks for them to be there.
Avoid showing your anxiety. This will only make your child feel more upset. Research suggests that children are more cooperative if their parents take measures (such as acupuncture) to reduce their own anxiety. If you are feeling stressed or anxious, consider asking friends and family members for help. They can provide child care for other siblings or meals for the family so you can focus on supporting your child.
- Ask your child's health care provider to limit the number of strangers who enter and leave the room during the procedure, because this can raise anxiety.
- Ask if the provider who has spent the most time with your child can be present during the procedure.
- Ask if anesthesia can be used, if appropriate, to reduce your child's discomfort.
- Ask that painful procedures not be performed in the hospital bed or room, so the child does not link pain with these areas.
- Ask if a low sensory environment can be provided.
Alexander M. Managing patient stress in pediatric radiology. Radiol Technol. 2012;83:549-560.
Bray L, Callery P, Kirk S. A qualitative study of the pre-operative preparation of children, young people and their parents' for planned continence surgery: experiences and expectations. J Clin Nurs. 2012;21:1964-1973.
Fincher W, Shaw J, Ramelet A-S. The effectiveness of a standardized preoperative preparation in reducing child and parent anxiety: a single-blind randomised controlled trial. J Clin Nurs. 2012;21:946-955.
Khan KA, Weisman SJ. Nonpharmacologic pain management strategies in the pediatric emergency department. Clin Ped Emerg Med. 2007;8:240-247.
Stock A, Hill A, Franz BE. Practical communication guide for paediatric procedures. Emerg Med Australasia. 2012;24:641-646.
Yip P, Middleton P, Cyna AM, Carlyle AV. Non-pharmacological interventions for assessing the induction of anesthesia in children. Department of Paediatric Anaesthesia, Starship Children's Hospital, Auckland, New Zealand. Cochrane Database Syst Rev. 2009 Jul 8:(3):CD006447.
Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.