A child entering a treatment room loses something fundamental: control over what happens to their own body. Someone else determines what is done, when, and how. This loss of control is a stressor in itself, independent of the demands of the treatment. Research shows that children who lack a sense of grip or control over the situation exhibit significantly more procedural anxiety and distress than children who can experience control in some way (Lerwick, 2016).
Giving control is therefore not an extra layer on top of the treatment. It is part of the treatment itself.
Small choices give the child back their grip
Giving control does not start with big decisions, but with small anchor points. Can the child choose which arm? Do they want to watch or look away? Do they want to indicate the moment you begin? Children from about four years of age benefit from explanations of what to expect: the steps of a procedure, what they might feel, and realistic choices regarding the action (Stinson et al., 2008). In this regard, the choice of words is extremely important. Words like “sting” and “needle” demonstrably increase anxiety and pain, while helpful language shifts the focus to what the child is doing: “your arm is staying nice and still, that helps me work well.” We previously wrote about how to apply this in practice: The power of positive words before and during treatment.
Simply an agreement that a child may indicate when to stop (briefly) and when to continue makes the child experience control. At such a moment, that sense of grip and control is more present than the fear.
Preparation as part of the treatment
Honest, child-centered preparation provides a greater sense of control and reduces the chance of a distressing experience. Advise parents to avoid statements like “this won’t hurt” or “it’s already over.” The end of a procedure cannot always be predicted, and the promise makes the moment of disappointment greater. Honesty, tailored to what a child can handle, builds more trust than withholding information (Stinson et al., 2008).
Coercion and its effects
Children with negative procedural experiences have an increased risk of anxiety and stress during subsequent treatments (Bray et al., 2015). Coercion reinforces that effect. It strips the child of their self-reliance and creates a foundation for mistrust in future healthcare contacts.
Healthcare professionals who have resorted to restraint describe it afterwards as a moment of failure, even if no other way out was visible. That feeling is correct: research confirms that it damages the child’s relationship with the healthcare provider and complicates future procedures (Schalkers et al., 2016).
Control begins before the treatment starts
The room in which a child waits or is received plays a role before anything has even been done. A child reads the environment before anyone says a word: tone, lighting, unfamiliar equipment. Based on those signals, the nervous system decides whether the situation is safe. An environment that invites looking and discovery gives a child something to focus their attention on. The child chooses what they find interesting, what they want to look at, and where they look.
Sources
Lerwick, J.L. (2016). Minimizing pediatric healthcare-induced anxiety and trauma. World Journal of Clinical Pediatrics, 5(2), 143-150. https://doi.org/10.5409/wjcp.v5.i2.143
Stinson, J. et al. (2008). Managing pain and distress in children undergoing brief diagnostic and therapeutic procedures. Paediatrics & Child Health, 13(2).
Bray, L., Snodin, J. & Carter, B. (2015). Holding and restraining children for clinical procedures within an acute care setting: an ethical consideration of the evidence. Nursing Inquiry, 22(2), 157-167.
Schalkers, I. et al. (2016). Health professionals’ perspectives on children’s and young people’s participation in health care: a qualitative multihospital study. Journal of Clinical Nursing, 25, 1035-1044.