Our six-year-old fell and broke his wrist while pretending to be a stuntman – jumping from a barstool to a mini trampoline – and needed surgery to align broken and displaced bones.
His pain and fear heightened his intolerance for medical procedures during his treatment course. Certain phrases used by the medical staff brought on extreme anxiety, and calming him back down was agonizing for us as parents. Having a history as a pediatric nurse helped me in this situation but going through medical procedures with my own fearful child brought new challenges.
Overcoming a child’s fear about an impending medical procedure can be an exhausting road for parents. There are several approaches that can help ease this fear.
The initial pain after his fall was extreme and, as parents, we knew we had to put our own anxiety aside to act quickly and rationally. Our pediatrician suggested we go straight to a clinic with an orthopedist. Our son’s wrist did not swell, but it was crooked so we knew it was broken. We knew we needed to go in.
As we waited for his x-ray results, our son's incessant shrieking fueled our anxiety because we were helpless to relieve his pain. When the staff came in to tell us the news that surgery would be needed later that day, the already shaky floor fell out from under us. Our situation went from bad to worse, a cast wasn’t going to be enough.
Our son’s fear came roaring at us as the staff set up to splint his arm amidst his tear filled eyes and yelling protests. We pleaded with him, insisting the splint would make it hurt less but he was panicked. I knew holding his hand during the procedure would help reduce his anxiety and make me feel like I was doing something to help. I told him to squeeze my fingers with his other hand while they applied the splint. His screams brought tears to my eyes, and to my husband's as well.
When it was done, he said, “Squeezing your hand helped, Mom." Whenever possible, be in physical contact with your child – if you can't hug, hold a hand.
Surgery was scheduled for the next morning. We were amazed how well our son did all evening with the pain medication in his system. But sleeping that night became impossible for him, as the medication wore off and anxiety about the impending surgery kicked into high gear. He continued to sleep for twenty to thirty minutes at a time, then he would yell out. Sometimes he was awake when I went in, and sometimes he was yelling in his sleep.
At 2:30 a.m., when he said he couldn’t sleep anymore, we got up and watched TV. He amazed me. He understood he couldn’t have anything to eat or drink, and he accepted it. Around 4:30, we headed out into the cold, dark morning to drive to the hospital. As we drove, he had many questions about what would happen once we got to the hospital. I knew less specific information would be better for him as a six-year-old so I focused on the fact that the doctor would fix his arm rather than stating specifics of how they would fix his arm.
Since the developmental age of a child impacts fear, explanations of the procedure should vary based on the age of the child. Older children may understand more detailed explanations than younger kids, and preparing a child with books about what to expect can help reduce anxiety (KidsHealth).
Certain phrases can trigger anxiety and increase surgery fears (Verywell.com). Once admitted to the hospital our son’s anxiety exploded when the staff began to use the phrase, "go to sleep" over and over again. I tried to catch the staff and ask them not to use the phrase, as it sent our son into hysterics every time. To counter the anxiety triggered by that particular phrase, I repeated a sentence that calmed him: The doctors would use medicine so that he wouldn't feel them fixing his arm. My sentence took the focus off the word "sleep" which triggered his fear. Some children have negative associations with sleep –they can be fearful about going to sleep and not waking up, so they should be assured that they will sleep during surgery and wake when it’s done. Or they could be thinking about pets – when pets are put to sleep, they die. So, it's important to assure children that sleep is temporary in surgery.
Each child is an individual and what works for one may not work for another. Offering a choice helped our son. After discussing it privately together, the anesthesiologist presented my son with an empowering choice: he could pick which way the medicine would be administered. Breathing into a mask was one option for anesthesia, and receiving it in the arm was another. He opted for the arm method, which required an IV. A numbing medication was used to ease the pain of the needle used for IV insertion.
What I didn’t anticipate was my own inability to control my emotions when I considered that something could go wrong, creating a complication or even the rare, but real, potential for death. Before he went into surgery I cried in front of him and that scared him, exacerbating his anxiety. I covered it up stating I was sad he got hurt rather than spilling my real fears for his safety. He understood and believed my reason for crying, but stepping out of the room if possible for a minute is also an option when overcome by tears. Staying calm and using calm non-verbal cues can help a child be less fearful.
Accompanying your child into the operating room to ease separation fears associated with impending surgery, is another effective measure for reducing anxiety. Walking alongside his bed as he was wheeled into the OR also helped calm my anxiety. I was allowed to stay with him until he was given the anesthetic – the most dreaded phase for him – and it comforted me to see him fall asleep, as he was no longer crying or in pain.
Even with a short half hour surgery, sitting in the waiting room was torture. As a nurse, I know anesthesia procedures are quite safe today, but the parent in me felt gripped by the potential for complications. When they called to say he was awake and well, and that I could see him in the recovery room, I was elated.
In the recovery room he was sipping apple juice with his arm propped up on two pillows. He smiled and said, “Now there is just one thing left, they need to fix my arm.” I laughed with relief as I told him it was done and they'd fixed him already. He was amazed that he didn’t even remember any of it. Telling a child that they will not remember what occurred during surgery once they wake up is also an important piece to include when preparing for surgery.
A week later the hard cast was applied and the staff told him he was indestructible, which is what every 6-year old wants to hear. He picked out a royal blue color and brought markers to school so his classmates could sign it.
When it was time for the second surgery to remove the pins, he understood more about what to expect. That said, it's important to accommodate for new and changing fears. Because we went to a different medical center for the second surgery, I found what worked last time didn’t work as well for him this time. The IV hurt more the second time, and the staff had to use the mask as well, but my son was less fearful because of his previous experience. Again, as his guide, I used wording that was less likely to trigger fear, such as “they will remove your cast” vs. "they'll use a saw to cut your cast off." As parents, we have to adapt our approach as our children's fears change.
Discussion and education are key in easing and overcoming fear and anxiety triggered by medical procedures. Being prepared to guide your child through the steps and phases of surgery fears is an important factor in keeping them calm.
Sources:
http://www.med.umich.edu/yourchild/topics/medproc.htm
http://kidshealth.org/en/parents/anesthesia-prepare.html
https://www.verywell.com/ten-common-questions-before-surgery-3156987
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