During a medical procedure, two reactions often occur simultaneously: a physical stimulus and a stress response.
For a child, this feels like a single event. The brain directly links tension, threat, and physical sensation. The question is therefore not only: how do we limit pain?
The question is: how do we support the nervous system?
Sitting on a parent’s or caregiver’s lap, or holding a hand, is not a symbolic gesture but a neurobiological intervention.
Co-regulation is biology
Co-regulation means that a child’s nervous system temporarily relies on that of an adult. Young children cannot yet regulate their stress response independently. Their brains are simply not yet mature enough for that.
American researcher James A. Coan demonstrated in a well-known fMRI study that social proximity demonstrably reduces the threat response in the brain.
In the study Lending a Hand (2006), adults were threatened with an electric shock while their brain activity was measured.
When they held the hand of someone they trusted, activity in brain regions involved in fear and threat decreased significantly.
The more secure the relationship, the stronger the effect.
This research forms an important basis for what Coan later described as Social Baseline Theory (2014): our brain is designed with social proximity as a starting point. Being alone costs more energy, and regulating together is more efficient.
What happens to a child during, for example, a blood draw?
A child experiencing tension, for example because they are afraid of what is to come, produces stress hormones. The body immediately goes to work to prepare itself to fight, flee, or freeze to remove itself from that unsafe situation.
A series of reactions in the body follow, including: faster heart rate, muscles tensing, breathing accelerating, blood vessels narrowing, and extra glucose (fuel) being produced.
This can cause a child to become hyper-alert, less able to think clearly, and more sensitive to pain stimuli. In short, the child does not feel well, and the likelihood of the treatment or examination being experienced as positive decreases.
A child lying alone on an examination table has no help through co-regulation. Sitting on a parent’s lap is preferred. If lying on the treatment table is necessary for the treatment or examination, holding a hand is also of added value.
Lap contact, holding a hand, or an arm around the body gives the brain signals of safety. These signals dampen the threat response, stopping the production of stress hormones. This allows a child to think and cooperate better, creating a more positive memory of the procedure.
Letting a child sit on a lap or hold a hand is therefore not “comforting afterwards” but true co-regulation before and during the procedure.
Sources:
Coan, J.A., Schaefer, H.S., & Davidson, R.J. (2006). Lending a Hand: Social regulation of the neural response to threat. Psychological Science.
https://www.ncbi.nlm.nih.gov/pubmed/17201784
Coan, J. A., & Sbarra, D. A. (2014). Social Baseline Theory: The Social Regulation of Risk and Effort.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4375548/
NB The studies used for this article were conducted with adults.