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

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. Explaining the procedure will also be of value in reducing your child's anxiety. Let your child participate and make as many decisions as possible.

PRE-PROCEDURE PREPARATION:
Limit your 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 terminology.
• Make sure your child understands the exact body part to be 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. Discuss how long the effects will last.
• 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 (spinal tap).
• 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.
• Suggest ways for maintaining control:
  o counting
  o deep breathing
  o relaxation (thinking of 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 (these depend on the time
  constraints of your health care provider and the type of procedure being
  performed, but where possible, let your child make some decisions).
• Encourage participation during the procedure, such as holding an instrument,
  if allowed.
• Encourage the child to hold your hand or the hand of a nurse or someone else helping with the procedure. Physical contact like this can help reduce pain and anxiety.

PLAY PREPARATION:
Play and third-person communication can be wonderful in revealing ways of
demonstrating the procedure for your child, and identifying his or her concerns. For younger school age children, this technique is very appropriate.

Older school age children might view this approach as childish. Consider the
intellectual needs of your child before implementing this type of communication.

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

This technique needs to be individualized for each child, and most health care
facilities that are oriented towards children, such as a children's hospital,
use this same technique to prepare your child. This type of communication can
take some practice.

Children asked direct questions about their feelings often are 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 the child to withdraw.

Most 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 7-year old girl who is clearly afraid, has a doll named Karen, and is going to have her blood drawn.

You could look at the girl and tell her that Karen 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.
Young school age children continue to manifest concrete thinking. Concrete
thinking involves taking everything literally, and an inability to make deductions or generalizations.

Once you have been briefed by your health care provider about the procedure, demonstrate on the toy or object what your child will experience. For example, show positioning, bandages, stethoscopes, and cleaning the skin.

Medical toys are available, or you can ask whether your health care provider can share some of the noninvasive items you need for the demonstration and play period. 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.

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. Your child
may or may not desire your presence, and it is best to honor his or her wishes.

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, and ask your child if he or she would
mind your presence.

Out of respect for your child's growing need for privacy, do not allow peers or siblings to view the procedure, unless they request that a sibling be present for comfort and this is possible.

Other considerations:

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