Smart Solutions for Painful Situations
By Suzanne Flint
It's time for another blood draw or procedure and you're not sure who
dreads it more... you or your child. Here are some ideas to help you get
through the tough stuff.
Positive Feedback
Children should be praised for doing their best. Cooperative behavior
should be encouraged. Statements like: "I was pleased to see you trying to
stay still" or "It was good you told the nurse exactly how you were
feeling" can be helpful. Minor misbehavior should be ignored, although, at
times, a no-nonsense approach may help your child to cooperate.
Setting Limits
Even children with serious illnesses need limit setting and expectations
of "good" behavior. Setting limits is an essential part of parenting a
child through any difficult situation. It also conveys a great deal about
how you view your child's capabilities. Good limit setting is impersonal
and understandable to the child. It is supportive not punitive, and
planned not arbitrary. Being too lenient or inconsistent in setting limits
can convey a lack of confidence in your child's ability to cope. Whereas,
being overly authoritative prevents a child from getting the chance to
learn about his or her own capacity for self-regulation. Good limit
setting, on the other hand, creates a nurturing environment in which your
child's own developing sense of self can emerge and flourish.
Giving Control
Offering children some control about their treatments can help reduce
feelings of helplessness and uncertainty. This, in and of itself, can
often help to reduce a child's experience of pain. Even very young
children can be allowed to decide some parts of their treatment, for
example: whether to sit on your lap or in a chair, which finger to have
pricked, and/or whether to have a Band-Aid. Even how much preparatory
information they receive should be up to the individual child's choice.
Rewards
It is okay to give a child a small treat for cooperating with a procedure
but it should be given based on a skill or behaviors exhibited and not
just for enduring the procedure itself. It should also be negotiated
beforehand with the reward contingent upon an agreed upon specific
behavior. If feasible it is best when the child can select the behavior
and the reward. The reward and behavior should be both specific and simple
to understand. A good rule of thumb is to make sure the child always wins
something for trying and something extra for succeeding. Avoid negotiating
or changing the rules after the fact. If you make the target behavior too
easy, your child may feel you lack faith in his or her abilities.
Physical restraint
Be prepared for the possibility that the procedure could become just too
scary or difficult for your child.
If physical restraint is needed, learn how to provide it in a non-punitive
way. For example, "This shot is just too hard for you to hold still for,
even though you are trying your very best. I know how much you've tried,
and I can see that you don't think you can hold still any longer without
my helping you a bit." In this example the use of physical restraint is
introduced as support, not punishment and the child is held in a
comforting and non-combative way.
Positioning for Comfort
Non-aggressive holding positions can be very useful in helping a child
through a painful procedure without forced physical restraint. Forcibly
restraining a child often in-creases their pain experience, compromises
their sense of dignity, and can even traumatically damage their
self-esteem. On the other hand, positioning for comfort can provide:
Thought-Stopping and Self Talk
Thought stopping teaches children to catch themselves as they begin to
exaggerate or catastrophize the unpleasant aspects of pain and to
deliberately substitute a positive, self-calming thought. The positive and
reassuring aspects of the situation are condensed into key points. From
these points, children make up a positive statement, which they then
memorize and repeat to themselves. For example, during a feared blood
draw, a child might say, "This will be over quickly. I have
good veins. The nurse who is doing it is nice." Another such statement
might be, "I can handle this. I know how to breathe out any discomfort. My
mom is here and I'm not alone." Or, "It's tough but I'm doing well. This
will help me in the long run." Children above about six years of age can
be coached during a procedure to utilize this technique. After about 10
years of age, children can learn to do this independently, even when no
"coach" is there to assist them.
Suzanne Flint is a Child Life Specialist, Health Educator, Interactive
Imagery Guide, and Program Director of "Reach Out and Read" at Lucile
Packard Children's Hospital in Palo Alto, California.
