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Preschooler test or procedure preparation

Definition

Preparing properly for a test or procedure reduces your child's anxiety, encourages cooperation, and helps your child develop coping skills.

Alternative Names

Preparing preschoolers for test/procedure; Test/procedure preparation - preschooler

Information

Preparing children for medical tests can reduce their distress. It can also make them less likely to cry and resist the procedure. Research shows that lowering anxiety can decrease the sensation of pain people feel during uncomfortable procedures. Even so, being prepared may not change the fact that your child will feel some discomfort or pain.

Before the test, understand that your child will probably cry. Demonstrate in advance what will happen during the test to learn about your child's fears and concerns. Using a doll or other object to act out the test may reveal worries your child may not be able to talk about, and may reduce your child's anxiety.

Most people are frightened of the unknown. It helps if your child knows what to expect. If your child's fears are not realistic, explaining what will actually happen can help. If your child is worried about a part of the test, do not minimize this concern. Reassure your child that you will be there to help as much as you can.

Make sure your child understands that the procedure is not a punishment. Preschool-age children may believe that the pain they feel is a punishment for something they did.

The most important way you can help your child is to prepare properly, and provide support and comfort around the time of the procedure. Ask if the hospital has a child life specialist who can help you before and after the procedure.

PREPARING BEFORE THE PROCEDURE:

Keep your explanations about the procedure to 10 or 15 minutes. Preschoolers have a limited attention span. Explain the test or procedure right before it takes place so that your child doesn't worry about it for days or weeks in advance.

Here are some general guidelines for preparing your child for a test or procedure:

  • Explain the procedure in language your child understands, using plain words and avoiding abstract terms.
  • Use play preparation to demonstrate the procedure to your child and identify concerns (see the next section).
  • Make sure your child understands the body part involved in the test, and that the procedure will be limited to that area.
  • Describe as best as you can how the test will feel.
  • Be honest with your child about any discomfort or pain the test may cause.
  • If the procedure affects a part of the body that your child needs for a certain function (such as speaking, hearing, or urinating), explain what changes will occur afterwards.
  • Give your child permission to yell, cry, or express pain in another way using sounds or words.
  • Ask if your child has questions about something you have explained.
  • Allow your child to practice the positions or movements that will be required for the particular procedure, such as the fetal position for a lumbar puncture.
  • Stress the benefits of the procedure and talk about things the child may enjoy after the test, such as feeling better or going home. You may want to take your child for ice cream or some other treat afterwards, but do not make the treat a condition of "being good" for the test.
  • Practice deep breathing and other comforting activities with your child. If possible, have your child hold your hand and squeeze it when feeling pain.
  • Ask the health care provider if your child can make some decisions, when appropriate, such as which arm should have the IV or what color bandage to use.
  • Distract your child during and after the procedure with books, songs, counting, deep breathing, or blowing bubbles.

PLAY PREPARATION

Play can be a wonderful way to demonstrate the procedure for your child and identify any anxiety your child may have. Tailor this technique to your child. Most health care facilities for children use play to prepare children for procedures.

Many young children have a favorite toy or other important object that can be a tool for a process called third-party communication. It may be less threatening for your child to express concerns through the toy or object instead of directly. For example, a child who is about to have blood drawn may be better able to understand if you discuss how the "doll might feel" during the test.

Toys or dolls can help you explain the procedure to your preschooler. Once you are familiar with the procedure, briefly demonstrate on the toy what your child will experience. Using the toy, show your child:

  • Bandages
  • How injections are given
  • How IVs are inserted
  • How surgical cuts are made
  • Stethoscopes
  • What positions your child will be in

After your demonstration, allow your child to play with some of the items (except for needles and other sharp items). Watch your child for clues about concerns or fears.

No matter what test is performed, your child will probably cry. This is a normal response to a strange environment, unfamiliar people, and separation from you. Knowing this from the beginning may help relieve some of your anxiety about what to expect.

WHY RESTRAINTS?

Your child may be restrained by hand or with physical devices. Young children lack the physical control, coordination, and ability to follow commands that older children and adults usually have. Most tests and procedures require limited or no movement to ensure their accuracy. For example, to get clear results with x-rays there must not be any movement.

Restraints may also be used during a procedure or other situation to ensure your child's safety. Restraints may be used to keep your child safe when staff temporarily have to leave the room during x-ray and nuclear studies. They may also be used when a puncture is done to get a blood sample or start an IV. If your child moves, the needle could cause an injury.

Your child's health care provider will use every method to make sure your child is safe and comfortable. Besides restraints, other measures include medications, monitors, and observation.

Your job as a parent is to comfort your child.

DURING THE PROCEDURE:

Your presence may help your child during the procedure, especially if the procedure allows you to maintain physical contact. If the procedure is performed at the hospital or at your child's health care provider's office, you may be able to be there. If you are not sure, ask if you can be there.

If you think you may become ill or anxious, consider keeping your distance, but stay were your child can see you. If you cannot be present, leave a familiar object with your child for comfort.

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 and 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.

Other considerations:

  • Ask your child's health care provider to limit the number of strangers entering and leaving 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, so that the child does not link pain with the hospital room.
  • If your child can see you during the procedure, do what your child is told to do, such as opening your mouth.
  • Ask if a low sensory environment can be created.

References

Alexander M. Managing patient stress in pediatric radiology. Radiol Technol. 2012;83:549-560.

Fincher W, Shaw J, Ramelet A-S. The effectiveness of a standardized preoperative preparation in reducing child and parent anxiety: a single-blind randomized 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 assisting 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.


Review Date: 5/14/2014
Reviewed By: 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.
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