Helping your young child prepare for a medical test or procedure can reduce anxiety, increase cooperation, and help the child develop coping skills.

Proper preparation for a test or procedure can minimize anxiety and help a child cope.

Before the test, know that your child probably will cry, and that preparation may not change the fact that your child will feel some discomfort or pain. Try using play to demonstrate what will happen during the test. You may be able to uncover your child's concerns. The most important way you can help your child is by preparing them and by providing support at the time of the procedure.

PREPARING BEFORE THE PROCEDURE:

Limit your explanations about the procedure to 5 or 10 minutes, because toddlers have a short attention span. Any preparation should take place directly before the test or procedure.

Some general guidelines for preparing your child for a test or procedure include the following:

• Explain the procedure in language your child understands, using plain words, and avoiding abstract terminology.
• Make sure your child understands the exact body part involved and that the procedure will be limited to that area.
• To the best of your ability, describe how the test will feel.
• If the procedure affects part of the body that serves a noticeable function (such as speech, hearing, or urination), explain what changes will occur afterwards.
• Give your child permission to yell, cry, or otherwise express any pain verbally. Tell them to tell you where they feel pain.
• 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 that the child may find pleasurable 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 this conditional on "being good" for the test.
• Allow the child to make simple choices such as what color bandage they want after the procedure.
• Distract the child with books, songs, or a simple activity such as blowing bubbles.

PLAY PREPARATION:

Play and third-person communication can be wonderful and revealing ways of demonstrating the procedure for your child and identifying any anxiety. This technique should be tailored to your child. Most health care facilities that are oriented toward children use similar techniques to prepare children for procedures.

Many young children have a favorite toy or object of importance that can be a tool for a type of interaction called third-party communication. It may be less threatening for your child to express concerns through the object rather than directly. For example, imagine a frightened 2-year-old girl -- about to have her blood drawn -- holding her well-loved doll. Such a child may be able to understand if you discuss how the doll might "feel" during the test.

Toys or dolls might help you explain the procedure to your toddler. Children of this age are very concrete thinkers -- they take everything literally, without making deductions or generalizations. For younger children with limited vocabulary, visual examples and experimentation may be helpful.

Once you are familiar with the procedure, briefly demonstrate on the toy what your child will experience. Show positions the child will hold, bandages, stethoscopes, how incisions are made, how injections are given and IVs are inserted. After your demonstration, allow your child to play with some of the noninvasive items. Watch your child for clues to concerns and fears.

Regardless of the test 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 possess. Most tests and procedures require limited or no movement to ensure accuracy.

Restraints may be used during a procedure or other situation to ensure your child's safety. For example, with x-rays, clear test results require that there be no movement. Furthermore, radiological and nuclear studies require all staff to temporarily leave the room. In these situations, restraints may be used for your child's safety.

If a venipuncture is performed to obtain a blood sample or start an IV, restraints may be used to protect your child. If the child moves, the needle could cause an injury.

Your provider will use every means to ensure the safety and comfort of your child. Besides restraints, other measures include medications, monitors, and observation.

Your job as a parent is to comfort your child.

DURING THE PROCEDURE:

Your presence helps your child during the procedure, especially if the procedure allows you to maintain physical contact. If the procedure is performed at the hospital or your health care provider's office, you will most likely be given the opportunity to be present. If this is unclear, ask if it is possible for you to be present.

If you think you may become ill or anxious, consider keeping your distance while remaining in your child's line of vision. If you are not able to be present, leaving a familiar object with your child may be comforting.

Avoid showing your anxiety. This will only make your child more nervous.

Other considerations:

• Your child will probably resist the procedure and may even try to run away. A firm, direct approach from you and the health care staff may be helpful.
• Give one direction at a time during the procedure using 1- or 2-word commands.
• Avoid covering their face.
• Ask your health care provider to limit the number of strangers entering and leaving the room during the procedure, since their presence can raise anxiety.
• Ask that the provider who has spent the most time with your child be present during the procedure.
• Ask that anesthesia be used where appropriate to reduce the level of discomfort your child will feel.
• Ask that painful procedures not be performed in the crib, so that the child does not associate pain with the crib.
• If you are in your child's line of sight, do what the child is told to do, such as opening the mouth.
• Use your child???s normal sense of curiosity to help distract them during the procedure.

Khan KA, Weisman SJ. Nonpharmacologic pain management strategies in the pediatric emergency department. Clin Ped Emerg Med. 2007;8(4):240-247.