Strategies to Reduce Procedural Anxiety in Children
Procedural anxiety in children is a common and challenging phenomenon, often occurring during medical procedures such as vaccinations, blood draws, and diagnostic tests [1]. Common contributors include fear of pain, unfamiliar environments, and separation from caregivers. Cognitive factors, such as age-related development, also play a significant role in shaping a child’s response to medical procedures. The emotional distress associated with these procedures not only affects the child’s immediate well-being but can also have long-term implications for their attitude towards healthcare. Further, by alleviating a child’s anxiety, healthcare providers are better able to complete their procedures with ease [1]. Healthcare providers should focus on effective strategies to reduce procedural anxiety in children which may include environmental, behavioral, pharmacological, or technological interventions.
The first essential step in mediating a child’s procedural anxiety is performing an accurate evaluation of the patient’s emotional state and level of distress [1]. Assessment involves a clinician making observations of a child’s behavioral cues, responsiveness, and willingness to engage with the clinician. Parent anxiety level can also play a significant role in these interactions.
Creating a child-friendly and supportive environment is a fundamental part of a broader strategy to reduce procedural anxiety in children [3]. This includes modifications such as colorful and engaging décor and age-appropriate toys. Practices may wish to involve child life specialists who can help create a more comfortable atmosphere. Further, interacting with parents to reduce parental anxiety can also reduce any anxiety a parent may inadvertently transfer to their child [1]. Pre-procedural education for parents is essential to prepare them for supporting their child effectively. Providing information about the procedure in an age-appropriate manner as well as helping parents to avoid use of fear-inducing words, like needle or shots, can also contribute to reducing procedural anxiety [2].
Cognitive-behavioral interventions focusing on changing thought patterns and behaviors associated with anxiety in children before and during the procedure may also effectively reduce procedural anxiety. Techniques such as distraction, arousing curiosity, guided imagery, and relaxation exercises have shown promise in reducing procedural anxiety [2, 3, 4]. For example, pointing out a color or item in the room for a child to focus on can distract from the procedure. Often, technology such as a parent phone or iPad with interactive games can be used as a distraction technique to shift a child’s focus away from the procedure. In some cases, pharmacological interventions such as intranasal or oral anxiolytics based on the child’s age, medical history, and the nature of the procedure may be considered [1].
Procedural anxiety in children is a multifaceted phenomenon, but utilizing a combination of environmental modifications, parental involvement, cognitive-behavioral and technological interventions, and when necessary, pharmacological approaches can significantly reduce anxiety levels. By performing comprehensive assessments of a child’s anxiety and employing these techniques, healthcare providers can contribute to a positive healthcare experience for children, promoting their overall well-being and future engagement with healthcare.
References
1. Krauss BS, Krauss BA, Green SM. Managing Procedural Anxiety in Children. New England Journal of Medicine. 2016;374(16):e19.
2. Cohen LL. Behavioral approaches to anxiety and pain management for pediatric venous access. Pediatrics 2008;122:Suppl 3:S134-9.
3. Corrie E. Chumpitazi, Cindy Chang, Zaza Atanelov, Ann M. Dietrich, Samuel Hiu‐Fung Lam, Emily Rose, Tim Ruttan, Sam Shahid, Michael J. Stoner, Carmen Sulton, Mohsen Saidinejad, . (2022) Managing acute pain in children presenting to the emergency department without opioids. Journal of the American College of Emergency Physicians Open 3:2.
4. Bandstra NF, Skinner L, Leblanc C, et al. The role of child life in pediatric pain management: a survey of child life specialists. J Pain. 2008;9(4):320‐329.