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Preparing Your Child for Visits to the Doctor

When children anticipate "going to the doctor," many become worried and apprehensive about the visit. Whether they're going to see their primary care doctor or a specialist - and whether for a routine exam, illness, or special problem - kids are likely to have fears, and some may even feel guilty.

Some fears and guilty feelings surface easily, so that children can talk about them. Others are harbored secretly and remain unspoken. In preparation for a physician's examination, you can help your child express these fears and overcome them.

Most Common Fears and Concerns About Medical Exams
Things that often top children's lists of concerns about going to the doctor include:

• separation. Children often fear that their parents may leave them in the examining room and wait in another room. The fear of separation from the parent during mysterious examinations is most common in children under 7 years old, but it may be frightening to older children through ages 12 or 13.
• pain. Children may worry that a part of the examination or a medical procedure will hurt. They especially fear they may need an injection, particularly children ages 6 through 12.
• the doctor. Unfortunately, one of a child's concerns may be the doctor's manner. A child may misinterpret qualities such as speed, efficiency, or a detached attitude and read into them as sternness, dislike, or rejection.
• the unknown. Apprehensive about the unknown, children also worry that their problem may be much worse than their parents are telling them. Some who have simple problems suspect they may need surgery or hospitalization; some who are ill worry that they may die.

In addition, kids often harbor feelings of guilt: They may believe that their illness or condition is punishment for something they've done or neglected to do. Children who feel guilty may also believe that examinations and medical procedures are part of their punishment.

What Can I Do to Help?
As a parent, you can help by encouraging your child to express his or her fears and by addressing them in words that your child understands and isn't likely to misinterpret. Below are some practical ways to do this.

Explain the purpose of the visit.
If the upcoming appointment is for a regular health checkup, explain that: "It's a 'well-child visit.' The doctor will check on how you're growing and developing. The doctor will also ask questions and examine you to make sure that your body is healthy. And you'll get a chance to ask any questions you want to about your body and your health." Also, stress that all healthy children go to the doctor for such visits.

If the visit is to diagnose and treat an illness or other condition, explain - in very nonthreatening language - that the doctor "needs to examine you to find out how to fix this and help you get better." Address any guilty feelings your child may have.

If your child is going to the doctor because of an illness or other condition, he or she may have unspoken feelings of guilt about it. Discuss the illness or condition in neutral language and reassure your child that it isn't his or her fault: "This isn't caused by anything you did or forgot to do. Illnesses like this happen to many children. Aren't we lucky to have doctors who can find the causes and who know how to help us get well?"

If you, your spouse, other relatives, or friends had (or have) the same condition, share this information. Knowing that you and many others have been through the same thing may help relieve your child's guilt and fear.

If your child needs a doctor's attention because of a condition that resulted in ridicule or rejection by other children (or even by adults), you'll need to double your efforts to relieve shame and blame.

Head lice, embarrassing scratching caused by pinworm, and involuntary daytime wetting are examples of conditions that are often misunderstood by others. Even if you've been very supportive, you should reassure your child again, before the visit to the doctor, that the condition is not his or her fault and that many children have had it.

Of course, if your child has suffered an injury after disregarding safety rules, it's a good idea to point out (as matter-of-factly as possible) the cause-and-effect relationship between the action and the injury. However, you should still try to relieve guilt. You could say, "You probably didn't understand the danger involved in doing that, but I'm sure you understand now, and I know you won't do it that way again."

If your child repeatedly disobeys rules and becomes injured, speak to your child's doctor. This sort of worrisome behavior pattern needs a closer look.

In any of these cases, though, be sure to explain, especially to young children, that going to the doctor for an examination is not a punishment. Be sure your child understands that adults go to doctors just like children do and that the doctor's job is to help people stay healthy and fix any problems.

Tell your child what to expect during a routine exam.

You can use a doll or teddy bear to show your young child how the nurse will measure height and weight. It also helps to show your child how the doctor will:

• look in his or her mouth (and will need to hold the tongue down with a special stick for just a few seconds to see the throat)
• look at his or her eyes and into his or her ears
• listen to his or her chest and back with a stethoscope

And it helps to explain to your child that the doctor may also:

• tap or press on his or her tummy to listen to or feel what's inside
• look quickly to see that the "private areas" are healthy
• tap on his or her knees
• look at his or her feet

It's important for parents to let their kids know that what they've taught them about the privacy of their bodies is still true, but that doctors, nurses, and parents must sometimes examine all parts of the body. Emphasize, though, that these people are the only exceptions.

Tell your child what to expect during other exams.

If your child is going to the doctor because of an illness or medical condition or is going to visit a specialist, you may not even know what to expect during the examination.

When you're calling to make the appointment, you can ask to speak to the doctor or a nurse to find out, in a general way, what will take place during the office visit and exam. Then you can explain some of the procedures and their purpose in gentle language, appropriate to your child's age level. Your child will feel more secure if he or she understands what's going to take place and why it's necessary.

Be honest, but not brutally honest. Let your child know if a procedure is going to be somewhat embarrassing, uncomfortable, or even painful, but don't go into alarming detail.

Reassure your child that you'll be beside him or her and that the procedure is truly necessary to fix — or find out how to fix — the problem. (Adolescents may prefer to be examined without a parent or with only a same-sex parent or same-sex chaperone present. That preference should be honored.)

Children can cope with discomfort or pain more easily if they're forewarned, and they'll learn to trust you if you're honest with them.

Admit to your child if you don't know much about the illness or condition, but assure him or her that you'll both be able to ask the doctor questions about it. Write down your child's questions.

If a blood sample will be taken during or after the examination, be careful how you explain this. Some young children worry that "taking blood" means that all their blood will be taken. Let your child know that the body contains a great deal of blood and that only a very little bit of it (usually no more than 1 or 2 teaspoons [about 10 milliliters]) will be taken for testing.

Again, make certain that your child understands that the visit, with its embarrassing or uncomfortable procedures, is not a punishment for any misbehavior or disobedience.

Involve your child in the process.

• Gathering information for the doctor. If the situation isn't an emergency, allow your child to contribute to a list of symptoms that you create for the doctor. Include all symptoms you've observed, no matter how unrelated they may seem to the problem at hand. Also, before the visit, prepare a history (in the form of a list) of your child's previous illnesses and medical conditions and a history of illnesses and medical conditions among close members of the family (parents, siblings, grandparents, aunts, and uncles).
  
• Writing down questions. Ask your child to think of questions that he or she would like to ask the doctor. Write them down and give them to the doctor. Or, if kids are old enough, they can write down and ask the questions themselves. If the problem has occurred before, list the things that have worked and the things that haven't worked in previous treatment. Your child will be reassured by your active role in his or her medical care and will learn from your example. At the same time, you'll be prepared to give the doctor information vital to making an informed diagnosis. Doctors report that this information is very helpful in determining diagnoses.

Choose a doctor who relates well to children.

Because your child's doctor is your best ally in helping your child cope with health examinations, it's important to carefully select a doctor. Of course, you want a doctor who's knowledgeable and competent. However, you also want a doctor who understands children's needs and fears and who communicates easily with children, in a friendly manner, and without talking down to them.

In the course of a physical examination, the doctor inspects, taps, and probes various parts of the body — procedures that may be embarrassing (or even physically uncomfortable) for your child. A good rapport between doctor and patient can minimize these feelings.

If your child's doctor seems critical, uncommunicative, disinterested, or unsympathetic, do not be afraid to change doctors. Ask for recommendations from other parents in your area or from other doctors whose opinions you trust. If your child's illness or condition requires a specialist, ask your child's doctor to recommend someone who's knowledgeable, experienced, and friendly.

After all, adults want these characteristics in their own physicians, so as a parent you should serve as your child's advocate in seeking this type of care.