It’s 4 p.m., and it’s standing room only in the Outpatient Blood Draw area. Some children are sitting in the waiting room with their parents, quietly playing games on their electronic devices or watching cartoons on the large TV overhead. Others seem less relaxed, either sitting in tense silence or walking all around the room.
And I am here with Kaitlyn*, a 10-year-old girl with a fear of needles and blood draws. As soon as we enter the waiting room, Kaitlyn turns to her mother and whispers, “How soon until we leave?”
Kaitlyn’s needle phobia had been a persistent problem, and it started to interfere with her medical needs, which is why she came to see me, as a child psychologist.
But many children are afraid of needles to a lesser degree, and may become anxious in the days leading up to a medical visit or take longer to get shots or blood draws because of their fear.
Here are five things parents can do to make the medical procedure go more smoothly.
Most children will be more likely to trust adults and feel in control if they know about a procedure beforehand. This gives them time to adjust to the idea and gives the family time to make a plan (see below). However, telling an anxious child weeks in advance often just gives them more time to worry. A few days to a week of advance warning usually works best.
Help the child get used to the idea and know what to expect.
For younger children, this could involve telling a story about a child going to a medical appointment or having the child be “doctor” to her stuffed animal or doll. There are some good published books that can be helpful as well, e.g. Lions Aren’t Afraid of Shots by Howard Bennett.
Make a plan for what your child will do during the visit.
Studies show children cope best when they have a job to do during a procedure. So, the child could play a video game, tell you a story out loud or even answer simple questions (e.g. arithmetic problems, for older children). This keeps the child distracted and helps her stay calm. It can also help to give a child choices where possible, to give her a sense of control. This could be a choice such as whether to sit on your lap or next to you during a blood draw or shot.
Make a plan for what you, the parent, will do.
It is important that parents stay calm and model for their children how to cope during a stressful procedure or visit. So whether you handle your own stress by taking some deep breaths, talking with other adults beforehand or keeping yourself busy, it will help your child as well.
Consider rewarding the child’s bravery.
For many kids, the promise of a small reward, such as doing a special activity with a parent or picking a favorite food for lunch/dinner after a procedure can help motivate them to follow their plan and be brave. And of course, praising a child and being positive help a lot too!
These tips can be used with children who feel anxious about other medical procedures, too.
What to do if needle phobia interferes with care
For children like Kaitlyn whose fear becomes a more significant problem, a child psychologist can help.
Kaitlyn’s fear of needles seems understandable; she was born with multiple medical issues and needed many medical procedures involving needles throughout her early life. As an older child, she started to show more fear around needles and medical visits, each one seeming to remind her of all of the other medical procedures she had been through. During the past year, Kaitlyn’s medical team put several tests on hold because Kaitlyn refused to have her blood drawn.
That’s when she was referred to me.
As part of her treatment plan she has learned facts about anxiety, and she has been taught and practiced various ways of relaxing her body and mind, such as deep breathing. She has also done practice exercises outside of the blood draw area, such as looking at pictures of needles and holding needles with their plastic caps on in my office. And perhaps most importantly, she and her parents have come up with a plan for what they will say and do to keep her distracted and calm throughout the visit.
Most recently, we visited the Outpatient Blood Draw area to do a dry run of a blood draw; she practiced using her coping skills to go through all of the steps that would lead up to the actual blood draw.
It’s part of an exercise called a graduated exposure, in which children approach a feared situation one step at a time, using coping skills and gaining confidence along the way.
Kaitlyn does well during the exposure exercise. She says she is anxious, but she is able to use breathing and distraction to get through the experience. Her mother provides encouragement, and Kaitlyn feels good about how the session went. She will be scheduled for a real blood draw in a few weeks.
* Name has been changed
About the blogger: Dr. Carolyn Snell is a pediatric psychologist in the Medical Coping Clinic at Boston Children’s Hospital and an Instructor in Psychology at Harvard Medical School. Learn more about the Boston Children’s Medical Coping Clinic.