Q: My four-year-old daughter has to go for an annual check-up at a children’s hospital in September. Getting her bloods checked is always a part of this, which of course involves them using a needle. She has become very aware in the past year about needles, from playing doctor with friends and knowing that her baby sister has been getting vaccinations, and she has often talked about “needles” and whether she will ever have to get one. ( I usually say maybe, but don’t tell her much more than that.) I am now dreading the visit (which both I and her dad will attend), as I know she will be very upset at the idea of getting her bloods done, and will very possibly act up and outright refuse to get them taken. I really don’t want to have to resort to effectively restraining her. This happened when she had to have an X-ray done earlier this year and she got very upset. Have you got any advice on how to prepare her for the visit, as well as things we can do or say on the day and when the bloods have to be taken to make things go smoother?
A: Fear of injections is common in both adults and children. In surveys, over a quarter of children report being scared of injections and about 10 per cent of the population are thought to have a specific needle phobia. So your daughter’s potential nervousness about getting her bloods taken is normal enough and not an “irrational fear”. The good news is that most children can be supported to overcome their fears and get through the process. Below are a number of suggestions.
Contact the hospital team
The children’s hospital staff should be very experienced in dealing with children who are afraid of needles and they are likely have specialist nurses or psychologists who have training in supporting children and parents in these situations. In addition, there are medical options, such as specific creams and freezing sprays to reduce the pain of needles, that can be made available if needed. Make contact with the hospital team in advance of the appointment to discuss your concerns and what they recommend in terms of preparation.
Understand your own anxiety
Children can easily pick up on their parents’ fears and anxiety. In fact, most children who have a specific needle phobia have experience of other family members who have similar fears. Be aware of the sources of your own anxiety and try to manage these. The more you can come across as positive and matter of fact about the procedure, the easier it will be for your daughter to cope. While preparing for every outcome, express a belief that it will all go well to your daughter and that no matter what happens you will be able to cope together.
Help your daughter prepare
As your daughter already brings up the subject of injections in playing doctor at home, use this as an opportunity to prepare her positively. For example, set up a game where dolly is being taken to hospital (or where you or Dad take on the roles), go through the procedure of dolly getting her bloods taken, making it factual and manageable with a light tone – “dolly gets an injection. It hurts a little but it is over soon and she is happy because they all go out for a special treat afterwards . . .”
Watching your daughter’s reaction will give you an insight into how ready she is and what the particular issues might be for her, but be careful about raising concerns or adding in worries that may not be there for her.
Help your daughter prepare on the day: At four years of age, it is probably best not to tell her too much in advance about the hospital appointment in case it preys on her mind. Instead, you might only tell her on the day and go through with her the sequence: going in the car with Mum and Dad, sitting in the waiting room reading her favourite book (or other toy brought along), meeting the nice nurse/doctor, having her bloods tested, going out for a treat, etc.
Be matter of fact and positive
During the procedure, collaborate with the medical staff and follow their lead about what is best. Do warn your daughter about what is happening (rather than taking her by surprise) so she has time to prepare herself. Be honest – “you will feel a little prick/ scrape, then it will be over” – so she is not surprised by what is happening. While it is important to be supportive and reassuring, don’t procrastinate or hesitate at this point and be matter of fact and positive.
With young children, perhaps the best technique to manage potential distress is distraction. This means you focus her attention on something else happening other than the needle. This might mean pointing out other things in the room while the needle is inserted, talking about what you are doing afterwards, counting breaths, giving her a favourite cuddly toy, taking out a noisy colourful toy or even blowing bubbles. Be creative and think of a distraction that might work with your daughter – once again, work with the nursing staff to pick the best one. Giving her some control at this point can help: “would you like to hold teddy or dolly?”
Anticipate that your daughter may get upset
Be prepared for your daughter to be upset. Remember, it is okay for her to cry and be prepared to reassure her – “ it will be over in a minute; you are doing so well” – while you hold her hand. Be careful of extensive reassurance or apology, which can make things worse and remember to also use humour and distraction as keeping it light can work best.
Be prepared also to be patient. If your daughter is very upset, it can help to take a break and then to regroup and start again. Once again, work collaboratively with the doctors and nurses about what is best.
Dr. John Sharry, Irish Times Newspaper, August 2012. John writes in The Irish Times Health+Family every Tuesday.