9-year-old has a serious fear of doctors

Posted by Barbara F. Meltz  December 28, 2009 06:00 AM

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Hi Barbara!  

My 9-year-old has a REALLY hard time at the doctor and dentist.  She gets extremely anxious and really protests about being examined.  Even relatively 'simple' things like just getting her teeth cleaned by the dental hygienist or opening her mouth for the doctor to look down her throat make her incredibly anxious.  I have been thinking she will grow out of this, but honestly it is just getting worse.  Today there was an H1N1 vaccination clinic at her school, and she was an absolute wreck and ultimately could not receive the shot.  I'm at a loss... should we try to accommodate her anxieties (go to a dentist that offers sedation, for example), or just be tough with her and try to make her cooperate?  I do think she is truly anxious and not just playing games.  Any advice?
From: Allison, Auburndale

Hi Allison,

No, being tough with her is not the way to go, it only makes matters worse. On top of her anxiety, she'll now think that not even her parents understand or can help her. But obviously not going to the doctor or dentist isn't the answer, either.

Ask her in a concrete way what upsets her: "Tell me, exactly, what makes you so upset?" She's old enough to have some idea of what it is and to be able to express herself clearly. Let her know you are sympathetic and want to help her; if you have showed frustration in the past, tell her you want to put that aside and start over.

Don't pooh-pooh, minimize or dismiss her fear; it's real to her. Validate what she says ("I see why you might think that.") and then address it head on ("I can stay with you the whole time; yes, it will hurt for a second, but let's talk about what can help the hurt.") For instance: squeezing mom or dad's hand; asking the doctor for a numbing agent; knowing they just need a little blood, not all of your blood.

These strategies are most helpful with a typically developing child who has mild to medium anxiety. With kids who are really anxious -- and psychologist Ellen Hanson of Children's Hospital Boston says your daughter sounds like she qualifies -- there's something called "social stories," a little book the child writes that helps her think about her fear and prepare for it. While a mildly anxious child may need only a day's notice of an appointment, a very anxious child might need a week that includes preparing the book and reading it several times.

A book might begin with the fact of the visit and the reason for it: "I have to go to the doctor to check to make sure I'm healthy." Page 2 would list what typically happens at such an appointment: "The doctor might look in my mouth, my ears and push on my tummy." The story would end with something positive: "When I am done with the doctor, I will get to go for ice cream." Encourage your child to draw or download pictures.

Hanson says, "The main thing is to choose a quiet time to talk about it; ask what she thinks she knows about the appointment. Sometimes they have a wrong expectation of what will happen."

The other strategy she recommends is systemic desensitization. For instance, with children who are very anxious about shots or drawing blood, research shows that pretend practice helps make them gain mastery over the process. The practice includes using a toy syringe, for instance.

Hanson is not a fan of sedation except as a last resort. "It has side effects," she says. Instead, she says the level of the anxiety and the length of time this is going on suggest that your daughter might benefit from professional intervention. There is a Medical Coping Clinic at Children's which can help you evaluate your daughter's fear and develop coping strategies for her.
 
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7 comments so far...
  1. Managing a doctor's office, we at first decided we would not take extra H1N1 precautions beyond the normal vaccinations, continuous hand washing, and sanitization procedures. After we saw a severe rise in H1N1 cases, particularly in children, we decided additional measures were required. We bought some UV sanitizers from germtools.com (a doctor's office secret!) and use them twice a day on everything in the office. Heck, I might even get one for the house.

    Posted by Melissa Owens December 28, 09 08:51 AM
  1. I was terrified of needles as a child, finally my parents decided to show me it wasn't so bad by taking me with them when they had blood drawn. It really did help, I saw that it wasn't that bad, it wasn't going to kill me, and I wasn't the only person having this done to them

    Posted by JT December 28, 09 10:40 AM
  1. This sounds similar to White Coat Syndrome. WedMD has an excellent article on dealing with this sort of anxiety here: http://www.webmd.com/anxiety-panic/features/beyond-white-coat-syndrome

    When I was little, I did just what that child in the article did. I hid from the vaccination. Apparently, I did better at choosing my spot - the doctor gave up and didn't vaccinate me.

    I still have this anxiety though. I don't mind the visits themselves, but when it comes to blood draws or vaccinations, I'm a wreck. In the military, I had to be held down to receive some of my required shots a few years ago. Thankfully, I was allowed to sleep off the stress for about an hour. But believe me, this type of anxiety isn't a joke and taking the "tough" route will only make it exponentially worse.

    Posted by phe December 28, 09 12:53 PM
  1. I wish the writer had mentioned Child Life Specialists, professionals who specialize in helping children cope with medical procedures. Most hospitals employ Child Life Specialists, and some pediatric doctors and dentists offices do, too. There are also Child Life Specialists in private practice. Child Life Specialists should be certified through the Child Life Council - www.childlife.org - and can be incredibly helpful in decreasing stress and anxiety and increasing coping. Please check them out!

    Posted by Robyn December 28, 09 12:57 PM
  1. I hated going to the doctors office as a child. HATED it. I gave my mom big problems. Not the dentist as much, but i still didnt like the dentist, but I remember just being rude to them a little, I still had teeth cleaned and all that...

    Anyways, for me it was just that I didnt like undressing. It was embarressing to have to undress in front of a stranger. I still dont like it, but I'm almost 32 and have 2 kids so I've just had to get over it. And realize that I am not the only person with body issues.

    Posted by KHALL December 28, 09 01:09 PM
  1. I hated visiting the dentist as a kid, and over years and decades it developed into a severe, debilitating phobia. Even worse, I came to associate brushing my teeth with visiting the dentist, and so for years and years I avoided basic tooth care. As a result, I've had to spend literally tens of thousands of dollars on repeated dental work, and my phobia has reached the point where a dentist stopped an appointment mid-cleaning because I was freaking out so badly. Now, at last, I am seeing a sedation dentist, and talking to a counselor. But I wish I'd been able to address these issues when I was 14 instead of 34. Moral of the story: take this seriously, be supportive, no matter how frustrating it is to you try not to get mad at your child. Help her deal with her fear now, lest she come to neglect her health badly due to being unable to see doctors/dentists as an adult.

    Posted by Real fear December 29, 09 02:09 AM
  1. Exposure therapy for blood/injury/injection/medical phobia can be helpful for a child this age. If she has a tendency to faint (and has thus developed a fear of anything that might cause her to faint, such as a needle or blood draw), applied muscle tension techniques (look up vasovagal syncope and applied muscle tension for more information) can be extremely helpful and can prevent symptoms of fainting.

    Medical/dental phobia can also be linked to a history of a traumatic event (meaning traumatic for her, not necessarily what one would label "traumatic") involving loss of control of her own body/integrity.

    Posted by M2B December 31, 09 09:23 PM
 
7 comments so far...
  1. Managing a doctor's office, we at first decided we would not take extra H1N1 precautions beyond the normal vaccinations, continuous hand washing, and sanitization procedures. After we saw a severe rise in H1N1 cases, particularly in children, we decided additional measures were required. We bought some UV sanitizers from germtools.com (a doctor's office secret!) and use them twice a day on everything in the office. Heck, I might even get one for the house.

    Posted by Melissa Owens December 28, 09 08:51 AM
  1. I was terrified of needles as a child, finally my parents decided to show me it wasn't so bad by taking me with them when they had blood drawn. It really did help, I saw that it wasn't that bad, it wasn't going to kill me, and I wasn't the only person having this done to them

    Posted by JT December 28, 09 10:40 AM
  1. This sounds similar to White Coat Syndrome. WedMD has an excellent article on dealing with this sort of anxiety here: http://www.webmd.com/anxiety-panic/features/beyond-white-coat-syndrome

    When I was little, I did just what that child in the article did. I hid from the vaccination. Apparently, I did better at choosing my spot - the doctor gave up and didn't vaccinate me.

    I still have this anxiety though. I don't mind the visits themselves, but when it comes to blood draws or vaccinations, I'm a wreck. In the military, I had to be held down to receive some of my required shots a few years ago. Thankfully, I was allowed to sleep off the stress for about an hour. But believe me, this type of anxiety isn't a joke and taking the "tough" route will only make it exponentially worse.

    Posted by phe December 28, 09 12:53 PM
  1. I wish the writer had mentioned Child Life Specialists, professionals who specialize in helping children cope with medical procedures. Most hospitals employ Child Life Specialists, and some pediatric doctors and dentists offices do, too. There are also Child Life Specialists in private practice. Child Life Specialists should be certified through the Child Life Council - www.childlife.org - and can be incredibly helpful in decreasing stress and anxiety and increasing coping. Please check them out!

    Posted by Robyn December 28, 09 12:57 PM
  1. I hated going to the doctors office as a child. HATED it. I gave my mom big problems. Not the dentist as much, but i still didnt like the dentist, but I remember just being rude to them a little, I still had teeth cleaned and all that...

    Anyways, for me it was just that I didnt like undressing. It was embarressing to have to undress in front of a stranger. I still dont like it, but I'm almost 32 and have 2 kids so I've just had to get over it. And realize that I am not the only person with body issues.

    Posted by KHALL December 28, 09 01:09 PM
  1. I hated visiting the dentist as a kid, and over years and decades it developed into a severe, debilitating phobia. Even worse, I came to associate brushing my teeth with visiting the dentist, and so for years and years I avoided basic tooth care. As a result, I've had to spend literally tens of thousands of dollars on repeated dental work, and my phobia has reached the point where a dentist stopped an appointment mid-cleaning because I was freaking out so badly. Now, at last, I am seeing a sedation dentist, and talking to a counselor. But I wish I'd been able to address these issues when I was 14 instead of 34. Moral of the story: take this seriously, be supportive, no matter how frustrating it is to you try not to get mad at your child. Help her deal with her fear now, lest she come to neglect her health badly due to being unable to see doctors/dentists as an adult.

    Posted by Real fear December 29, 09 02:09 AM
  1. Exposure therapy for blood/injury/injection/medical phobia can be helpful for a child this age. If she has a tendency to faint (and has thus developed a fear of anything that might cause her to faint, such as a needle or blood draw), applied muscle tension techniques (look up vasovagal syncope and applied muscle tension for more information) can be extremely helpful and can prevent symptoms of fainting.

    Medical/dental phobia can also be linked to a history of a traumatic event (meaning traumatic for her, not necessarily what one would label "traumatic") involving loss of control of her own body/integrity.

    Posted by M2B December 31, 09 09:23 PM
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Barbara F. Meltz is a freelance writer, parenting consultant, and author of "Put Yourself in Their Shoes: Understanding How Your Children See the World." She won several awards for her weekly "Child Caring" column in the Globe, including the 2008 American Psychological Association Print Excellence award. Barbara is available as a speaker for parent groups.

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