We love our pediatrician, and we used to look forward to check-ups. That was until our last visit, which was a nightmare. We had had to make a sick visit a month earlier because Angela had a fever and we wanted to make sure nothing else was wrong. When it came time to check her ears, she wouldn’t stay still and resisted hugely when the doctor tried to examine her. It wasn’t our regular doctor, and I think we were all nervous. We wound up having to hold her down, and even though the doctor was quick, Angela was hysterical. Fortunately, she didn’t have an infection so we didn’t have to go back the next week.
Yesterday was the date for our regular visit. When we got out of the elevator, Angela started to cling to me like a baby monkey. Once we got into the office she turned her face into my neck and started crying. I comforted her and got her interested in a book, but when the nurse called us in, Angela started to cry. As we walked down the hall she got louder. She refused to let the nurse weigh her, and the doctor came in right away because she was making such a ruckus. She LOVES her doctor, but she shrieked when she saw him and wouldn’t stop. We could barely talk, so he did a quick exam (thank goodness it wasn’t a day for shots) and we got out. But now I’m worried about going back—What can I do? She just turned two and she’s not talking much yet, so I can’t really ask her what is upsetting her. HELP!
It sounds like Angela coped with her sick visit to the pediatrician just like many young children do when they are scared or upset. She screamed and cried, resisted with all her might, got through the difficulty, and once it was over, went on with her life. For many toddlers, a stressful experience is just that—an experience—and when it’s over, it’s over. Parents are relieved, everyone forgets how upset the child was, and everyone moves on.
Sometimes, however, a child will get through a difficult experience and seem fine, but when she is brought into a setting that reminds her of that experience she becomes fearful, worrying that the same thing might happen again. She doesn’t remember all the pleasant visits to the doctor, she only remembers the last visit. Angela coped with her fear by seeking comfort from you and then by resisting going into the examining room and the approach of the doctor. Once she was in that hysterical state, it was hard to calm her because from her point of view, she was trying to protect herself from something awful
In addition, you are also dealing with a child who is now a toddler. Even when children have had pleasant experience on doctor visits, most toddlers get to a stage when they refuse to cooperate with medical exams. It’s as if they suddenly realize that it is THEIR body and they don’t want to lie down or sit still for someone else (you’ve probably seen this at diaper changing time at home). If it’s a new doctor, it’s even worse.
So you have to deal with Angela’s fears from the sick visit combined with normal toddler behavior. Fortunately, there are ways to help her cope with future visits.
Even if a toddler is able to listen to you talk about what has happened or is about to happen, she doesn’t have enough life experience to get much from conversation alone. Instead of just talking to Angela, you can engage her in playful activity that will help her deal with her past unpleasant visit and prepare her for future visits.
If Angela has a teddy bear or a favorite doll, you can tell a story about how the Bear goes to the doctor and what happens there. First, act out a story of how Bear went to see her favorite doctor and what was nice about the visit, Talk about how Bear’s mommy helped her, about the toys in the waiting room, and how the doctor played with her during the exam. Then, you can say that Bear usually liked to visit her doctor, but one day she was sick and she didn’t have fun at all. Watch Angela for cues on how far to take the story. If she’s upset, this is a good time for her to express in words, play, or just by her expression what was hard for her. If you talk about Bear, not Angela, it will be easier for her to think about how she felt without being overwhelmed. In your story, you can talk about how Bear felt, and how she knew that it was important to have the doctor examine her, but that it was still really hard and she was scared, or sad, or angry.
You can also act out with Bear what the next visit will be like. Bear can sit in Angela’s lap while you can use a play medical kit to listen to Bear’s heart and look at her ears. Angela can do the exam, too. While you are doing the exam you can talk about why the doctor uses the tools, what happens next, and how it feels. It’s OK to say that Bear doesn’t like to have her ears examined, or that she cries when she gets a shot. Toddlers love to play pretend and it’s not just fun, it’s a way for them to practice and prepare for what happens in real life.
Since Angela has had a difficult experience, she may not want to listen to the story for very long. Some children love to hear stories like this, but others want you to stop the play right away! Go at her pace and don’t force her to play, but don’t stop the stories altogether. Try again the next day, and the next, a little at a time—two minutes a day will go farther than a long session once a week.
Another way that you can help Angela prepare for her next visit is by practicing relaxation techniques with her. Toddlers get scared and anxious when they are confronted with a new situation that seems threatening to them. (Big people feel the same way!) You can practice soothing techniques at home that you can then use on your next visit to the doctor. One good technique is to blow soap bubbles together while you sing a song. When a toddler is blowing bubbles she will be breathing evenly and watching the bubbles. Your song can be familiar, fun and imaginative and will engage her attention away from the medical procedure. By keeping her distracted with a pleasurable, rhythmic activity, you will help her stay calm. That doesn’t mean that the exam will be comfortable, or easy, but she will feel more in control and less frightened than she did last time.
Keep in mind that you will be able to help Angela best if you are feeling calm yourself. You can call for advice from the office nurses about what will be helpful the next time you visit. It’s OK to ask for extra time to prepare her for her exam. Sometimes it’s helpful to visit the office and just watch other children go in and out. Sometimes you can even arrange for the doctor to come greet you in the waiting room. Angela isn’t the first child to be fearful of a medical visit, and it’s part of good pediatric care to help children cope with and overcome their fears.