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Frightening and Painful Medical Tests Traumatic for Kids?

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My two year old grandson has had 2 recent hospitalizations requiring frequent blood work and insertion of IVs. He was extremely resistant and as fearful as I have ever seen a child. During his last night at the hospital he had a full blown night terror for the first time. I realize that his lack of sleep and the residual effect of his illnesses made it more likely to have a night terror, I can't help but think the actual cause is the extreme trauma of his medical tests. I also wonder if the trauma was worsened by his dad and me helping to hold him down during the tests, How awful it is for him to know that the two people whom he loves and depends upon would aid in what for him was torture and not responding to his cries and pleading. Have any studies been done to determine if it is better for a friendly nurse or aid to help restrain him and not have the parents present? A child must learn that a parent can not always be there to protect him but why should he ever have to learn his parents helped hurt him? One could explain to an older child but you can't to a toddler. Have studies been done on this specific subject or on health care trauma in children?
-- Jackie


This is such a tough question.

Extensive research shows that anxiety dramatically increases pain. That means that if a child is less anxious during a medical procedure, he will perceive it as less painful and will be less traumatized afterwards.

Therefore, during a minor procedure, such as receiving a shot, a parent's presence is comforting to a child, reduces his fear and anxiety, makes it less painful, makes it less likely that medical personnel will have to traumatize him by holding him down, and helps him to recover more quickly. Although the parent is obviously collaborating with the medical personnel, the child does not generally blame the parent, and definitely finds the experience less traumatic than if he were simply taken by a nurse away from the parent to have the shot.

With uncomfortable but not painful procedures, the parent can often distract the child better than a stranger can (by singing to him, blowing bubbles, making animal noises together, reading a favorite book, etc.), and this can make the procedure tolerable rather than terrifying.

But if the procedure is more traumatic and the child is too young to understand any explanations, as you describe, is it a different situation? One research study by Bauchner, Vinci & May that addressed this question found that even with preverbal children, the parents' presence (voice and stroking) was helpful in lessening the child's distress.

These researchers, though, expressly warned parents against restraining their child. They also found that parents need support and a little training so they know how to be most helpful to their kids. For instance, numerous studies show that parents are most helpful to their children when they encourage, praise, and distract them, rather than just being helplessly apologetic.

So the answer to this question seems to hinge on whether the parent is perceived as part of the "torture." My view is that the parent should never restrain the child for a medical procedure, but should stay nearby, speaking in a soothing tone and attempting to comfort, reassure, and distract the child. Often the child can wear headphones and listen to a favorite story or music, or watch a video, which offers distraction from the scary noises and discomfort. 

By the way, a great deal can be done in advance to prepare kids for medical procedures and help them to relax and reduce distress during them. If possible, be sure to give tylenol in advance of any procedure to reduce discomfort. One good article to read on preparing kids for medical procedures is on the University of Michigan Medical Center's website. In addition to carefully explaining what will happen and answering kids' questions, I highly recommend hypnosis, which can be used with children as young as three or four years old. Many hospitals can refer you to a hypnotist who is experienced in working with children to prepare them for medical procedures.

After suffering through a medical procedure, children will often need to process the trauma by telling the story over and over and crying. If the child does not do this spontaneously, it often helps to act the story out with him, using a dollhouse or stuffed animals as the characters. EFT (Emotional Freedom Technique) is also a useful tool to help kids let go of the feelings and move on.

In closing, I want to express my sympathy that your grandson -- and you -- had to go through this trauma. I agree with you that it is not ideal if he perceived his trusted adults as participants in the medical trauma, and I suspect you are correct that his night terrors were related to the stress of his hospitalization. I want to reassure you, though, that this is one incident in a much larger life, and you can repair your relationship with him. He's lucky to have a grandparent who has such empathy for his experience.

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