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WHEN SHOTS LOOM: HELPING KIDS COPE

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by Howard J. Bennett, M.D.

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Despite the friendly atmosphere, doctors' visits can be unsettling for children. Kids may not understand why they are being examined, and they typically have little say in the matter. To top this off, the visit often ends with blood tests or shots.



How you can help
Children are sensitive to their parents' emotional state, so a calm and reassuring tone on your part helps tremendously. Before you leave for the appointment, let your child know she will be seeing the doctor. This will give her a chance to ask questions about what to expect. If your child appears anxious, discuss a previous visit, emphasizing what she liked about the doctor or the office.

At a doctor's visit, tell your child the truth. Above all, avoid the temptation to say a procedure won't hurt. Even though throat cultures don't bother most adults, they can be distressing to children, for instance. It's better to say a procedure may hurt, but add that it will be over quickly and you'll be there to help.

Plan your trip
Getting through a doctor's appointment can be trying, so it's helpful if you plan your day carefully.
--If possible, don't schedule a visit during your child's naptime.
--Bring a bottle or snack to the office in case your child gets hungry.
--Take a favorite book or toy for your child to play with.
--Bring as few children to the office as possible.
--Don't plan another activity right after the appointment, in case it lasts longer than expected.

Help your child interact with the doctor
Although pediatricians love children, the opposite is not always true. That said, there are a number of strategies to make the visit go more smoothly:
--If you are new to an area, make a brief "get acquainted" visit with the doctor. This allows your child to meet the doctor in an informal way that does not involve an examination.
--If your child is nervous before the appointment, read a book about doctor's visits.
--Bring a treasured stuffed animal to the appointment. They are not only comforting, they foster communication between doctor and child.
--Bring a toy doctor's kit so your child can "examine" the doctor.

What to say about shots
Parents often ask if they should tell children about shots before the visit. If your child has a specific appointment for a shot, you should tell him before you leave home. Although this may make your child anxious, it gives him a chance to prepare for the procedure. If your child is having a routine checkup, the best approach is to say you don't know if he's getting a shot. Immunization schedules change and doctors sometimes run out of vaccines that are given at certain ages.

Techniques to use before and during the shot
A calm, direct approach works best. It also helps to give children some choices. Your child can pick which arm gets the shot, which bandage to use, and whether you should rub the arm fast or slowly when the injection is over.

Here are some additional tips you can use to help reduce shot stress:
--Young infants: Maintain eye contact, smile and talk to the baby, sing songs
--Older infants and toddlers: Distract the child with toys, songs, a story, car keys, blowing bubbles, or looking at interesting objects in the room
--Preschoolers and school-aged children: Look at family pictures, use electronic devices like a cell phone or Game Boy, talk to the child, watch a video on a portable DVD player

Techniques to use after the shot
Some children will cry despite your attempts to ease their pain. I always tell children that it's OK to cry, but that we need them to try and hold still. Once the shot is over, you can tell your child that he did a good job getting through the procedure. Give hugs and kisses, rub the child's arm, give her stickers. Finally, it may help if your child knows he can do something special after the visit -- a trip to the park, extra TV or computer time, or even going out for a treat.


DR. BENNETT is a pediatrician in Washington, DC. He is the author of two picture books for children, "Lions Aren't Scared of Shots" and "It Hurts When I Poop".


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