Proper preparation for a test or procedure may reduce your child's anxiety, encourage cooperation, and help the child develop coping skills.

Understand that your child probably will cry, and that preparation may not change the fact that your child will feel some discomfort or pain. Use play to demonstrate what will happen during the test. You may also discover your child's concerns about the test.

The most important way you can help is by preparing your child ahead of time, and supporting the child during the procedure. Explaining the procedure will be of value in reducing your child's anxiety. Let your child participate and make as many decisions as possible.

PREPARING FOR THE PROCEDURE:

Limit explanations to 20 minutes each, in several sessions, if necessary. School-age children have a good concept of time, allowing for preparation in advance of the procedure. The older your child, the earlier in advance you can begin preparation.

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

• Explain the procedure in language your child understands, and use concrete terms, avoiding abstract terms.
• Make sure your child understands the exact body part involved, and that the procedure will be done only on 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. Discuss how long these effects will last.
• Give your child permission to yell, cry, or otherwise express any pain verbally.
• 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 (spinal tap).
• Stress the benefits of the procedure and talk about things that the child may find pleasurable afterwards, such as feeling better or going home. After the test you may want to take your child for ice cream or some other treat, but do not make this conditional on "being good" for the test.
• Suggest ways for staying calm such as counting, deep breathing, and relaxation (thinking pleasant thoughts).
• Allow your child to participate in simple tasks.
• Include your child in the decision-making process, such as the time of day or the body site where the procedure is performed (this depends on the type of procedure being performed).
• Encourage participation during the procedure, such as holding an instrument, if allowed.
• Let your child hold your hand or the hand of someone else helping with the procedure. Physical contact like this can help reduce pain and anxiety.
• Distract your child with books, bubbles, games, or other activities.

PLAY PREPARATION:

Play and third-person communication can be wonderful in revealing ways of demonstrating the procedure for your child, and identifying concerns.

For younger school age children, this technique is appropriate. Older school age children might view this approach as childish. Consider the intellectual needs of your child before using this type of communication.

Older children may benefit from films that show children of the same age explaining, demonstrating, and undergoing the same procedure. Ask your health care provider if such films are available for your child's viewing.

The play technique should be tailored to each child, and most health care facilities that are oriented towards children (such as a children's hospital) will use a similar technique to prepare your child. This type of communication may take some practice.

Children, when asked direct questions about their feelings, are often avoidant and elusive. Of course, some children are happy to share their feelings with you, but as anxiety and fear increase, it is not uncommon for a child to withdraw.

Most young children have an object or toy of importance that may be a tool for a type of interaction called third-party communication.

It may be less threatening for your child to communicate concerns through the toy or object than to express them directly. For example, imagine a fearful 7-year-old girl -- about to have her blood drawn -- holding her well-loved doll. Such a child may be able to understand if you discussed how the doll might "feel" during the test.

Toys or dolls might help you explain the procedure. Young school age children are still concrete thinkers -- they take everything literally, without making deductions or generalizations.

Once you are familiar with the procedure, demonstrate on the object what your child will experience. For example, show positioning, bandages, stethoscopes, and cleaning the skin.

Medical toys are available, or you can ask your provider to share some of the noninvasive items used in the test for your demonstration. After your demonstration, allow your child to play with some of the noninvasive items. Watch your child for clues to concerns and fears.

Drawing is another way for children to express themselves. Ask your child to draw the procedure after you have explained and demonstrated it. You may be able to identify concerns or misconceptions through your child's artistic expression.

DURING THE PROCEDURE:

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. Ask your provider if you are not sure about this. If your child does not want you to be present, it is best to honor this wish.

Out of respect for your child's growing need for privacy, do not allow peers or siblings to view the procedure, unless this is allowed and requested by the child.

Avoid showing your anxiety. This will only make your child feel more upset.

Other considerations:

• Ask your provider to limit the number of strangers entering and leaving the room during the procedure, since this 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 hospital bed or room so the child does not associate pain with these areas.

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