Needles & Blood: Preparing your Child for Medical Procedures
Updated: Oct 27, 2020
It’s that time again, the time all of us with small children dread: shots. When my kids were babies, they were easily distractible; however, since around the age of 3, vaccinations and bloodwork have been increasingly difficulty times met with much anticipated fear. For my son, years 4, 5, and 6 were met with increasingly more resistance. The climax was felt at his last scheduled vaccination which, after a bit of chasing around the office, reassurance and then pulling away, and bribery (lollipops!!), ended in his hiding underneath the doctor’s desk and both the doctor and I agreeing that it would be best to delay the vaccination and bloodwork until his next scheduled appointment.
I decided that this year I needed to be more prepared.
As a mental health professional working with parents and adult survivors of childhood trauma, I should have been more prepared last year. Yet, the birth of my daughter about three and a half years ago threw our family into a state of disequilibrium, and recovery has been slow process which seemed to plateau last year (her 2nd year). So, in short, it was a tough year and I fell short of adequately meeting some of my child’s emotional needs – this being a case, in point.
As many of you know, unrealistic fears start to set in dramatically around the age of 3. You may notice your children finding some content scary – content that never bothered them before. My son (almost 7) started fearing skeletons around the age of 3, and is still not able to watch silly cartoons featuring skeletons; on the other hand, my daughter (almost 4) never feared them. Kids may also start to have nightmares, a manifestation of your child’s attempt to process phenomena which he or she cannot or does not adequately understand. Their separation anxiety may set in again, as their dark room or your absence becomes more fear-provoking. Specific fears may also set in, among these the fear of blood and needles. Most children are able to work through these fears through maturity, increased understanding of the stressor, and having an adequate number of experiences which counter the perceived “truth” of the fear itself. (A phobia which lingers into adulthood may result if there is a traumatic event, the child’s own coping skills are not adequate, and he or she is not given the support to process the experience, but these cases are rare). It is important to understand that many children share these fears, and that the majority work through them given both time and support.
Here, I would like to share ways that you can prepare your little ones for their yearly vaccinations, bloodwork, or related medical interventions. This advice is intended to be used with young children, approximately 3-6 years in age (give or take, on both sides); however, it can be generalized to school aged children as well with a bit of developmental alterations to language and content. Please note that some of these tips can also be integrated for use into your daily life and become routine ways of managing difficult situations.
1. Educate your children. This means providing them with information in a developmentally appropriate way by using language that your children understand, and concepts that their concrete-thinking minds can comprehend. For many parents, this can be challenging, so I recommend using books to help you do this. In our home, we have several books that teach children about the role of microbes and illness, how the body works, and ways to protect your body from illness. Since these individual topics are interrelated, I make a plan to read all our “health and body” books before visiting the doctor or dentist and discuss any questions the children may have. In our library, we have the following books: Usbourne Inside your Body, Do Not Lick this Book, and Usbourne Book of Germs. We also have a puzzle of the body and openly discuss body processes and ways that we can support the health of our bodies. I discuss these topics matter-of-factly at other points throughout the day as well, such as in relationship to COVID19 preventative practices of mask usage and hand washing/hand sanitizer. (As COVID19 can also cause anxiety among some, it is extremely important to consider your own emotional state when choosing to discuss these things.) Videos and other programs (such as educational content on Youtube or “Magic School Bus” on Netflix) can also be useful for providing education on the body, illness, health, and safety.
2. Validate fears and reassure safety. This item is so important, since one of the most damaging practices we can do as parents is to dismiss our children’s fears. Children build up defenses when they don’t feel validated, but the emotions are still expressed in other ways: in aggressive or defensive behaviors toward parents, siblings, or other children, or harm to the self. For these reasons, we need to communicate to our children that their fears are valid, that other people share these fears, answer any other questions they may have that contradict the “truth” of their fears, and be there for them, thus reassuring them of their safety. For younger children, you will need to be prioritize being present at the time of the vaccination or bloodwork (or other procedure); if this is not possible, ensuring that another trusted caregiver is present that understands the child’s fear and how best to meet it.
3. Empower your children. Research on the effect of nonverbal expressions has shown that "power poses" can serve to instill confidence in anxiety-provoking situations (see more info here). We often use the topic of superheroes in our conversations; when I describe the vaccination to the children, I compare it to a "superpower" that trains the body to fight off an illness. The kids respond well to this, as its language and a concept that they can relate to. Since my daughter was born three years ago, I attempted to counteract feelings of inferiority and invisibility by accentuating the positive aspects of his new role and highlighting his strengths: this transformed my son from "Oliver" to "Super Oliver," a persona he readily embraced. We oftentimes discuss the amazing things that he can do that make him "super" which serves to build his confidence by reminding him of his innate characteristics and abilities. During this most recent doctor's visit, I reminded him of his bravery in past situations, and asked if it would help to become "Super Oliver" for his vaccination. He agreed to take the costume, but did not feel the need to wear it during the actual procedure.
4. Play out the fear. Children can benefit from play as a tool to work through their fears, either on their own (child-directed play) or initiated by you (adult-directed play). One example is a role-reversal game based on the vaccination scenario: use the shot from a play medical bag or anything else a child can transform into a “pretend shot” and play the role of the patient while your child is the doctor/nurse administering the shot or other procedure. Exaggerate your response to the shot to draw out laughter, as laughter releases tension. (See more info here.) Children may also engage in play that involves their fear; if this occurs, understand that it is a healthy process and allow it to continue.
5. Discuss ways to manage fear “in the moment.” If you haven’t begun building emotional literacy with your children, there is no better time to start than the present (see here). While you help your child learn to communicate their emotions through language, you can offer healthy coping strategies and even create a space to engage in calming activities, such as the Quiet Room in our home (see more info here). As your child ages, begin to ask him or her directly and offer your own observations about what has worked in the past. While I remind my children of changes in their (and my own) emotional state throughout the day, and offer them (and myself) options for defusing their (our) emotional crises, I have found that mantras or songs work wonders. For our last doctor’s visit, I used a clip from the Daniel Tiger episode “Daniel gets a Shot” (available on youtube) to guide our discussion for healthy coping for this scary moment. In the clip, Daniel’s mother encourages him to “close your eyes, and think of something happy!” My kids both love the cartoon and the song, and the mantra was used to prepare for the scary moment at the doctor’s office. I also offered the option of bringing favorite stuffed animals or dolls which neither ended up using at the time of the shot.
6. Model confidence and emotion-management. Lastly, we can be mindful of the nonverbal messages we are sending our children. Our emotions affect our body language, behaviors, and way of speaking; for some children, this can cause or elevate preexisting anxiety. Our emotions also translate into the language we use, so if we are mindful of our emotional states we can also be mindful of the language we use when discussing fear-provoking topics.
I hope that these tips prove useful on your child’s next visit to the doctor. In my experience, the more we prepare our children (and ourselves) for difficult situations, the smoother it goes! Please feel free to explore my Facebook and Instagram pages for more tips and inspiration in the world of parenting and child development.