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How to Help Children With Painful Procedures

Martha A. Askins, Ph.D., Clinical Psychologist

Invasive medical procedures such as venipunctures, lumbar punctures, and bone marrow aspirations are perceived as painful and distressing to many pediatric oncology patients.  Whereas distress may decrease over time for some children, others continue to experience significant anxiety surrounding the invasive procedures throughout the duration of their treatment.

As a professional or parent, you are an important part of the treatment team and can provide support to a child when he or she must undergo painful procedures.  A number of techniques may be used to facilitate children’s coping during painful procedures; however, most benefit from some combination of the following interventions:

  • During the anticipatory phase, distraction is often useful. Talk to children about non-procedurally related activities, read an animated book (e.g., pop up book; books that make sounds), or engage their attention with toys, preferably ones that they can manipulate.
  • Also, during the anticipatory phase, some children may benefit from using their imagination to visualize a pleasant, relaxing scene.  Ask the child to imagine a place that he or she would like to visit and encourage attention to different sensory experiences (e.g. the warmth of the sunshine, the sounds family members laughing). 
  • When the encounter phase begins (cleansing and insertion of the needle), the doctor likely will report each step of the procedure.  The report is helpful, because it conveys the doctor’s confidence and responsibility in managing the procedure and structures the child’s experience.  This structure helps contain and reduce the child’s anxiety.
  • During the procedure, children benefit from instruction to use coping strategies such as counting, hand squeezing, or deep breathing.  For example, you may encourage a child to breathe slowly, as if he or she is blowing away the pain.
  • At completion of the procedure, praise children for the efforts they make toward coping positively.  Listen empathetically to the aspects of the procedure they report to be most distressing and validate their feelings.  Finally, emphasize closure to the procedure and experience, "You did a super job of helping and now you are done."

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