Helping Children Cope Well (with pain, doctors, dental visits, etc)

"Kids are born remarkably resilient in regard to pain.  Our response to pain is largely a learned behavior that we adopt as we grow older." ~Moses' doctor, just 3 days ago

Several months ago, I mentioned in a comment that we work to help our kids process and deal well with medical visits and physical pain, and another mom asked me to share about how we do that.  Hearing Moses' doctor make the comment I quoted above reminded and prompted me to write about this topic.

There are several things we do to try to proactively teach our kids how to deal with pain and/or medical visits:

(1) We talk about and react to pain realistically, and we teach our kids to do the same.  We do not UNDERstate how something will feel/hurt (i.e., we do not say: "your shots won't hurt a bit!"), and we do not OVERstate what has happened (i.e., "oh my GOODness, that must hurt SO bad", overempathizing, etc.).  Essentially, we are "matter-of-fact" about pain.  If a kid starts screaming over a minor pain, we use a calm voice, and say something like, "It looks like you took a tumble! Let's try not to scream.  Yes, there is blood, but it's only a scratch.  Let's go get it washed off; mommy will take care of you.  I'll get you a band-aid and some neosporin, and you'll be all set to go play more if you want to."  There may be times to ask questions to probe deeper into "what's hurting?", or when the injury itself merits a very serious response (we've had our share of those!), but in normal situations from children's play, or in routine doctor's visits, we do not emphasize or stress out about plain old pain.

And even when pain is very legitimately bad, we talk about it honestly and what the solution will be.  Silas has had stitches twice-- once when he was 2 and had his pinky finger smashed in a door (and the tip was hanging off), and once when he was 3 and had sliced a cut in his finger with a chef's knife.  Both times, this approach of giving real empathy while talking honestly about what would need to happen ("you'll have to get a shot", "you'll have to hold very still while the doctor uses a needle to fix your finger", etc.) enabled him to get the stitches in a very calm and surprisingly strong way.  And he is quite possibly our most emotional and dramatic son (our daughter surpasses him but also responds well to this approach).

(2) Set accurate expectations in advance.  
  • If it's a dental visit, especially if it's their first one, or if the child is visibly nervous, I'll have them lay out on the couch and we'll go through the motions of what the visit will be like.  "There will be a bright light up above your head, they'll put a paper bib on you, and he'll ask you to open your mouth as big as you can.  Can you do that for me?  Then he'll take a funny-tasting paste and clean off your teeth and it will sound kind of like a soft hair dryer.  It will rattle a little bit and might tickle, but you need to hold as still as you can and keep your mouth open so he can do it and get done more quickly."  I'll even impersonate the dentist and show them how he'll sit, etc.  This same concept can be done with doctor's visits.
  • Or, if they'll be getting shots, we tell them & talk about it in advance.  (Remember #1-- we don't do hysterics, so if they start to freak out, we help them calm down & then talk about what it will feel like, or share about the last time we parents got shots, and what it felt like.)  "Yes, I think you'll need to get 2 shots at this visit.  It'll hurt at first, but they'll give you a bandaid, and then it will be over with.  It might feel sore for a little while, but it will keep you from getting sick.  Would you rather get them in your arms or your thighs?"  (Because we live overseas, we all get a lot of shots.  All of us.  A lot.  Kids really can be good troopers about this.)
  • Or, if we're going to have to wait for a long while, we'll bring a backpack and talk at home before we leave about how we'll probably be in a small room with other people and need to be quiet and have something to do.  
If we don't know what a procedure will be like, we ask enough questions or look things up on the internet in advance so that we can help our kids to anticipate what will happen and what they'll need to do.

(3) And of course, we listen to their concerns.  None of this that I've written should be taken to mean that we do not listen to genuine fears or worries.  We absolutely do!  If they're concerned about something, we want to talk it through with them.  But at some point, if there's an unavoidable visit, check-up, procedure or shot, after we talk it through, we wrap it up with realistic expectations, and end on a good note.  "Yes, we'll get shots, but then we can all come home and snuggle and watch Princess Bride."  Or, "I know it's frustrating to you that you have to deal with itchiness and red skin from eczema, and don't know anyone else who does.  I'm sorry; I wish you didn't have to mess with all that.  But I AM thankful for these creams that help keep it under control."  We just try to talk realistically about pain, and then look on the bright side of things. 

Our experience has been, and the doctor I quoted above seemed to support this idea, that kids tend to feed off of what their parents have taught them to do in stressful/new situations.  A melodramatic mother often breeds children who overstate their pain and are underprepared to deal with normal medical situations that could easily be anticipated & faced realistically, if they were just given the skills of how to do so.  Conversely, a calm, in-control mom and dad can teach their kids to deal well with pain or uncomfortable situations.  Of course shots will still hurt, or a skinned knee will still bring tears to the eyes, and some children will be more emotive than others, but they will be more measured in their response to pain if they know that they will be heard, and that their needs will be met by a loving and competent mom, or the doctor/dentist she trusts.

I should admit that it is somewhat instinctive for me to go into a kind of "stealth" mode when a medical crisis happens-- I typically become more efficient and calm during a crisis.  And I can't take credit for that initial response; maybe it's a personality thing, or maybe it's learned from my own parents.  So our initial response to a crisis might differ based on our personality & experiences, but my point here is that I think we can all work to help our kids cope well with regular medical situations that they encounter, despite our (or their) initial internal reaction.  

I hope these ideas are helpful to you as you think about teaching your kids about how to deal well with pain.  Thoughts/comments?  Do you have tips/experiences you'd like to share?


Conn Family said...

Absolutely! I had a friend who would really overreact. If my kid fell down she'd jump up and cry out- my kids would kind of look at me like ? :) I cannot say I am very calm or not overdramatic with myself but with my children we are the same way about pain. If our boys fall down we'll give them a high-five and say "nice one!" And then give a band-aid if needed. With shots, I just say you are going to get a poke and it'll probably hurt a little bit. If you need to cry quietly that is okay but you need to be in control (my 4-year-old gets this and actually doens't cry- my 2-year-old is a bit melodramic still :)

I don't remember my parents going over a lot of stuff with me and they often left out truths (of things that were hard to deal with like why my great grandfather died) so I tend to be very truthful with our children. I try not to give them any information that could be an excessive burden but they do have an amazing way of dealing with all sorts of things and pain is the same way. The things my 4-year-old understands really amazes me actually. He sounds like your son- has had stitches & 2 ER visits (one with the end of the finger like yours but the tip was actually missing so there was nothing to stitch on! and then on his head).

We also practice doctor at home to familiarize them. Plus, it's so much easier for everyone involved if the kid can open their mouth rather than the doctor pry it open with a wooden stick. Thanks for the thoughtful post. I love reading your blog.

Polly said...

Yep, totally!!

My little guy is very dramatic but deals with pain and medical situations well. Last year be had to get a blood draw and I talked it up excitedly for weeks--describing veins, like little tunnels, letting him watch me do my pregnancy glucose test without any fear etc. When his time came he was totally cool and collected, and the nurses and lab techs were AMAZED!!

Being realistic about the pain but also encouraging and honest and confident really goes a long way!

Diana said...

Stealth mode in a crisis...I can completely relate to that! It's been interesting having a baby again, especially with older siblings. I know I need to look away when she has a little tumble, because she will look at me to see if she should cry (whereas if she's really hurt, there's no holding her back!). If my olders are there though, they rush to her immediately. I am training them that she needs to learn not to freak out.

I wish I had done some dentist modeling with one of mine before he went to the dentist for the first time. It's not something I see as a big deal, so I didn't make a big deal of it. He lost it, though. He's another that does well with the big, sudden things--he's had 2 broken bones and stitches--but anything that you can anticipate he can get worked up about. He finally has enough tools in his toolbox that he does not generally freak out anymore.


Michelle said...

I'm not 100% on any of this since Lane is still too young to really understand a lot of what we would say to her, but I do know from experience that kids whose parents make a GINORMOUS deal out of everything tend to be extremely dramatic, whether it be about pain, fears, or dislikes. Talking about things in realistic ways (yes, bees can be kind of scary, but if one does sting you it's just a pinch and then a little itchy) helps children to know what to realistically expect and not build things up in their minds ('cause we all know how kids' imaginations can be!). Good points, Jess. =)

Anonymous said...

I had parents who were very calm and nonreactive about injuries or illnesses, and without somehow having sufficient understanding empathy or understanding for us, so I think it actually made us kids, when little, act up MORE because we felt we had to get SOMEONE to really know and understand that we were scared or in pain.

Then in later childhood, we actually became children who would hide our illnesses or injuries. Because of how calm and nonreactive our parents were (while ALWAYS caring for us with proper attention and medical care) we adopted the idea that nothing must ever be serious or that we shouldn't make much of it.

So we can all think of the examples of parents who overreact, but it really is a balance for those who don't want to run into issues erring in the other direction. I really like this post!

The Arab Musicians said...

I've found this discussion interesting. If we didn't have our third child, I would probably conclude that I had done something terribly wrong in this area, because my older two do not handle pain well. My oldest once burst a bunch of tiny blood vessels in her face from the crying she did BEFORE having blood drawn (she was four at the time). This was not because we hadn't talked about it, set a good example, assured her it would be over quickly, and all the other things you mention here. She freaked out anyway. She has a very low tolerance for pain, and reacts strongly to it. We're working on it, but she still has a lot of learning to do.

My two-year-old, on the other hand, does not even flinch when she gets a shot. She thinks it's fun. She's hasn't cried the last four times she's gotten shots (we're overseas as well, so we get some shots!). We've done all the same things with her, but I don't really think I can take credit for her calm response, since as far as I can tell, she's been this way from the beginning.

I guess my point is just that this is going to be a much bigger learning curve for some children than for others. I don't want other moms with kids like my oldest to think that somehow they've failed if their child has a freak out moment at the doctor's office. Get through it, talk about it afterward, and work on improving for the next time, but know that it may take years for them to learn that they really can handle it.


Lauren said...

I agree with your thoughts on a whole. We talk to our kids about expected pain, but also explain why we must undergo the pain, and that it will last for only a few minutes, etc. There is one exception, our second daughter. For some reason, she builds it up in her mind and panics unlike the other three children that we've trained the same way as her. Because she makes such a big deal out of it before hand, we no longer prep her until the last few minutes before a shot. Every child is different.

Phyllis said...

Our children are all VERY calm about pain. When our daughter broke her arm this summer, I could tell something was wrong. A friend who was with us thought that she was just whining a little.

However, even though we're overseas, none of them have ever encountered a needle. No shots. No blood tests. I dread the day we come to that! They know I don't handle them well, so I'm afraid they'll freak out.

I really do think the parents attitudes are what set the childrens' responses.