Procedural anxiety is common among pediatric patients. Many children with special health care needs have to undergo multiple procedures that can be anxiety provoking. Their anxiety is usually due to fear of pain (perceived or actual) or recollection of similar, negative experiences. These can range from fairly innocuous to really frightening events. Anxiety-provoking procedures may include: having a diaper removed, getting weighed or positioned on an exam table, lab draws, vaccinations, line placement, tube replacement, catheterization, interventional radiology or other diagnostic studies, oxygenation or ventilation, getting suctioned, wound debridement, being hospitalized or having surgery.
It is important to talk with the caregivers to determine how anxious they believe the child will be in the procedures and to help appropriately prepare the child. Observing the child and caregivers can help to gauge their comfort. Building rapport, distracting, reassuring, and playing are commonly used to help children before and during procedures. Lying about a painful procedure (“This won’t hurt at all.”) is not helpful. Medications, such as benzodiazepines, can be used but are frequently not necessary except in severe situations.
Encourage the family to familiarize themselves with resources available to help with anxiety if their child is getting a procedure done. Resources may include hospital-based specialists whose job is to help ease anxiety or use of tablets, bubbles, toys, or music, which can help distract the child when they are anxious. If a parent is very anxious, try to address this first so the parent can act as an effective ally to allay the child’s anxiety, or offer to let the parent leave the room if they prefer. Managing Procedural Anxiety in Children (NEJM) is a 10-minute video that presents a thoughtful, step-wise approach to reducing anxiety during clinic visits and medical procedures.