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. You can
try the use of play in demonstrating what will happen during the test and in
discovering your child's concerns. The most important way you can help your
child is through this kind of preparation and by providing support around the
time of the procedure.

PRE-PROCEDURE PREPARATION:
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, and use concrete
  terms, avoiding abstract terminology.
• Make sure your child understands the exact body part involved and that
  the procedure will be limited to that area.
• If the procedure affects part of the body that serves a noticeable function
  (such as speech, hearing, or urination), explain how the procedure will affect
  or not affect the function.
• While talking about the procedure with your child, avoid words that have more than one meaning.
• Give your child permission to yell, cry, or otherwise express any pain
  verbally.
• To the best of your ability, describe how the test will feel.
• Allow your child to practice different positions or movements that will be
  required for the particular test or procedure, such as the fetal position for a
  lumbar puncture.
• Stress the benefits of the procedure and anything that the child may find
  pleasurable afterwards, 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.

PLAY PREPARATION:
Play and third-person communication can be wonderful and revealing ways of
demonstrating the procedure for your child and identifying his or her concerns.
This technique needs to be individualized for each child, and most health care
facilities that are oriented toward children use similar techniques to prepare
children for procedures.

Many young children have an object of importance they keep close to them. This
object or toy can be a tool for a type of interaction called third-party communication. It is less threatening for your child to communicate concerns through the toy or object than to express them directly. For example, consider a 2-year-old girl who is clearly afraid, has a doll named Debbie, and is going to have her blood drawn. You could look at the girl and tell her that Debbie looks like she might feel afraid. Your child may or may not share those feelings at this point, and additional questioning along this line may be necessary.

The same object or doll can be a productive tool for explaining the procedure.
Children of this age are very concrete thinkers. Concrete thinking involves taking everything literally and assuming an inability to make deductions or generalizations. For younger children who have a limited vocabulary, visual examples and experimentation may be helpful.

Once you have been familiarized with the procedure by your health care provider and/or other sources of information, briefly demonstrate on the toy or object what your child will experience. For example, show positioning, bandages, stethoscopes, cleaning the skin, and how incisions are made, injections are given, and IVs are inserted. After your demonstration, allow your child to play with some of the noninvasive items. The way he or she plays can also give you clues regarding concerns and fears.

Regardless of the test or procedure 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. Having specific information about the test may further reduce your anxiety. For more information please see the section regarding the specific test or consult your health care provider.

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, if your child needs an X-ray, clear test results require there be no movement. Furthermore, in radiological and nuclear studies while the films are taken, all staff must 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 are important to help prevent injury to your child: if the child moves, he or she could be seriously cut by the needle, for example.

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

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 you are not asked to be by your child's side and would like to be, ask your
health care provider if this is possible. 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.

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.
• 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 care provider who has spent the most time with your child be
  present during the procedure.
• Ask that anesthetics 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 associate pain with the crib.
• If you are in your child's line of sight, imitate the behavior the the child needs to do, such as opening the mouth.