What to Expect the Toddler Years (104 page)
Read What to Expect the Toddler Years Online
Authors: Heidi Murkoff
Being sympathetic and recognizing the reasonableness of his feelings are the first and most important steps to take to help him overcome his fear. The next steps:
Read up.
The more your toddler knows about doctors and doctors’ offices, the less trepidation he’ll be likely to feel when faced with them. Take an easy-to-follow, clearly illustrated book out of the library that deals with a child’s visit to the doctor and read it to your child, offering plenty of comforting commentary along the way. But try not to overexplain or get too complicated or technical. The most important points are that the doctor is a nice person (make sure that your child’s doctor comes across that way) whose work is keeping children healthy and that the doctor’s office is a safe place.
Talk up
.
Occasionally talk to your toddler about the doctor, about how nice he or she is, about the fun you have at the office, about how the doctor is a friend who helps keep children from getting sick and helps get them better when they do get sick.
Let him play doctor.
Buy a toy doctor’s kit for your toddler, and encourage him to practice playing doctor on you, on friends or older siblings, on his stuffed animals, on himself. Show him the various instruments and how they are used to examine the ears and throat, to listen for a heartbeat, to take a blood pressure read ing. Knowing what to expect will
help your child feel more in control of the exam and less like a helpless victim. Let him take the kit along to the doctor’s office, if he’d like, and practice on you while he’s waiting. When he’s ushered into the examining room, ask if your toddler can turn the (examining) tables, and check the doctor’s heart before the exam begins.
Don’t make any promises you can’t keep . . .
Assuring your toddler that a doctor’s exam won’t hurt is likely to make him very suspicious. You don’t after all, say it won’t hurt when you go shopping for a new coat or visit a friend. Simply suggesting the possibility of pain to a highly suggestible toddler could make him more apt to expect and experience it. And, if the exam does hurt, even slightly, he won’t accept your assurances next time around.
. . . and don’t make empty threats, either
. “You’d better take your medicine (or your vitamins, or put your hat on), or you’ll get sick and I’ll have to take you to the doctor for a shot” may be a perennial parental favorite, but its use makes a child equate doctor visits with punishment.
Schedule for success.
If you can, avoid appointments that coincide with your child’s usual nap times, mealtimes, or cranky times, or peak hours at the doctor’s office (Saturday mornings or after school), when the staff is less likely to have the time or the patience to coax along reluctant patients.
Give him something to look forward to.
Planning a treat for after the doctor’s visit—a dish of frozen yogurt, or a trip to the playground, the children’s museum, or a favorite friend’s house—will give your toddler something pleasant to think about during the exam. Follow through with the plan no matter how your toddler handles the visit; withholding the treat because he didn’t cooperate isn’t fair and might further undermine his cooperation next time. Make a ritual out of the after-visit treat (going to the playground after every visit, for example) so that your toddler will have at least one pleasant association with the doctor.
Concentrate on comfort.
Offering your toddler comfort when he needs it most can’t be considered coddling. So do everything you can to make him feel comfortable. Bring along his favorite blanket to drape over the crackly paper on the examining table. Encourage him to take a favorite stuffed animal or other toy for support during the exam. (Perhaps, time permitting, the doctor will be willing to check the toy animal’s ears, nose, eyes—or yours—along with your toddler’s.) And if you think your toddler will do better on your lap, let him sit there—at least for as much of the exam as possible. If he cries, don’t scold. Let him know it’s okay to cry, but that he must sit still when the doctor asks him to, or the exam will take even longer.
Check your own anxieties
. Fear and anxiety are more contagious than chick-enpox. Observing that
you
have no fear of doctors’ visits can help your toddler to overcome
his
, so try to appear relaxed and confident. When it’s time to leave for the doctor’s office, make the announcement a cheerful, “It’s time to go visit Dr. Jones now,” instead of an ominous, “You
have
to go to the doctor’s now” or a resigned, “Guess we have to go to the doctor now.” At the doctor’s, show your courage. Volunteer to have your heartbeat listened to with the stethoscope first, or your ears checked with the otoscope. Don’t cover your eyes (or your toddler’s) when the hypodermic needle appears.
Don’t let anxiety about your child’s possible misbehavior make you ill at ease either. The doctor and the staff have seen it all—and then some—before.
BLOCK THE OUCH!
It’s true: You can now greatly reduce the pain of injections and immunizations, most of the time, with several new topical anesthetics. Ask your child’s doctor about EMLA, an “ouch-proof” anesthetic cream, when making an appointment for the next immunization. The cream must be applied about an hour before the shot is given in order to be fully effective, so the doctor may want you to pick it up at the office or pharmacy and apply it at home before the visit. There’s also a faster-acting, 30-minute cream called ELA-Max. Like any other medication, EMLA may trigger some side effects, including slight redness of the skin, possible puffiness from water retention, alterations in temperature sensations on the skin, itching, and rash. It should not be used by anyone with a history of drug sensitivities, especially to lidocaine and/or prilocaine. Also keep in mind that the cream is expensive, and though it reduces pain, one study showed it didn’t reduce the fears children have about getting shots. It’s most valuable when children have to undergo repeated blood tests, shots, or IVs.
For the toddler who knows how to blow, blowing while getting a shot also reduces pain.
If you’re more anxious than most at doctor’s visits because your toddler (or a sibling) has experienced serious health problems (low birth weight, chronic illness, surgery, and so on), you will have to try harder than most to mask your feelings.
Prepare the doctor
. An empathic physician moves through the exam slowly, allowing the toddler to examine the instruments before they’re used to examine him, and usually has a few other anxiety-relieving tricks up his or her white-coat ed sleeve (often including not wearing a white coat). But it can’t hurt to call the doctor or nurse ahead of time to discuss your toddler’s fears and what can be done to diminish them. In the unlikely event that the physician brushes off your concerns, or is not toddler-friendly during the exam, consider changing doctors.
Do your waiting in the waiting room
. Many pediatric waiting rooms are play centers, filled with toys, books, and climbing equipment. A wary child may be less anxious if he can wait his turn there rather than in the confining and sterile examining room. So ask the receptionist if it’s possible to hold off calling your toddler in until the last possible minute. If it’s not, ask if there are toys in the exam room, too. If there aren’t, bring along a few diversions from the waiting room or pull some out of your tote bag to keep your child occupied. If undressing is necessary, ask if it can be put off until right before the doctor’s arrival; being unclothed can make a child feel more vulnerable.
Don’t hold the applause
. Offer praise when your toddler cooperates, even if it is minimal (“You hardly cried at all”), but don’t criticize if he kicks and screams. And don’t belittle his fears. Empathize instead (“I know you’re not happy about this, but checkups are very important, and everybody has to have them”). Keep in mind that for some children, keeping cool at the doctor’s office takes a monumental effort. After the appointment, tell him how well he did, giving specific examples of points at which he really
did
do well; it’ll help give him the confidence to do even better next time.
EAR OF THE DENTIST
“I’ve always dreaded visits to the dentist. Now our daughter has to see the dentist and I’m afraid she’s going to respond in the same way.”
Most adults would prefer an encounter with the IRS to one with a DDS. But a young child who’s never come face-to-face with a drill has no such negative feelings about dental care. To her, a trip to the dentist’s office can just as easily represent a fun adventure as a scary ordeal. Her attitude toward dentists and dentistry is still to be form ed and will ultimately depend on parental attitude, prior preparation, and the tone set by the dentist.
Probably the most important factor is the dentist. Look for one who specializes in children’s dentistry (a pediatric dentist) or in family care, and whose subspecialties are patience and good humor (get the candidate to chat with your child, if you’re uncertain). Look, too, for a friendly office staff and an office fur nish ed and decorated with young patients in mind.
The second most important factor is you. The best predictor of a child who’s afraid of the dentist is a parent who’s afraid of the dentist. So try to keep your own fear under wraps in front of your toddler.
Prepare your toddler for the visit as you would for a visit to the doctor: Read books about dentists; let her play dentist on you, on dolls, stuffed animals, or other toys; avoid the subject of pain. Ask the office assistant exactly what can be expected at the visit so you can rehearse it in advance with your toddler. You can play the dentist—then reverse roles. Find out what incentives are offered after a visit (toys, stickers, toothbrushes) so you can tell her in advance what’s in it for her.
If it’s possible, speak to the dentist about your concerns when you make the appointment. Explain that you would like the first visit to be just a get-acquainted session, with some friendly conversation, an introduction to the dentist’s office, and a quick exam. Any needed work should wait until another visit. Also discuss whether the dentist prefers you to stay in the room during the exam. Some find they get better results when parents wait in the waiting room (just as teachers usually get better results when parents leave the classroom). Others ask parents to stay.
And remember that although the combination of preplanning, a sensitive dentist, and relaxed parents can do a lot to reduce a toddler’s fears, it may not be possible to prevent a scene at the dentist’s office. If your toddler does panic, accept her fears, and help her cope with them as well as she can.
EAR OF THE BARBER
“I tried to take my son to the barber for his first haircut, but he wouldn’t sit still and seemed really frightened when the barber approached with the scissors. I had to take him home with his hair still uncut.”
If you think about it, a fear of barbers is really quite reasonable. With a perfect stranger aiming straight for his head with a pair of scissors (an implement you’ve probably warned him is dangerous), is it really any wonder your toddler is squirming, ducking, and generally terrified?
That in perspective, once in a while it is still necessary to get a toddler’s hair cut. These tips may help keep the shearing from becoming sheer torture:
TELL IT LIKE IT IS
Being up front builds trust. Don’t spring any surprises, whether it’s a visit to the dentist for a checkup, to the doctor for a shot, or the barber for a trim. Be honest about it with your toddler. Don’t leave the house as though you’re on your way to the playground, then detour to the dentist. Don’t tell your child there won’t be a shot at the doctor’s when you know that there will be. Don’t promise that a procedure won’t hurt or that it will be over quickly unless you’re absolutely certain that’s true. Prepare your child for each experience as completely as possible—without risking increasing his or her fears by giving too much information or needless details.
Explain that hair grows back. Some toddlers view hair cutting as they would view cutting any part of the body. Helping such a toddler to understand that it doesn’t hurt when hair is cut and that it grows back afterwards may help him to overcome that concern. Snip off a little piece of your own hair, and then encourage him to touch it, bend it, crumple it up (“See, hair doesn’t hurt”). Show him pictures of himself as a baby and now as a little boy to illustrate how hair grows (“Your hair was that short when you were a little baby. Then it grew this much . . . and after it’s cut, it will grow again”).
Open a barber shop for teddy bears. Improvise a play barber kit with a pair of child-safe scissors (he will probably lack the coordination to actually “cut” with the scissors, but may have fun trying), a comb, a brush, and a towel. Set up shop in front of a full-length mirror, and let him “style” his stuffed clients. Do explain that a teddy’s hair, unlike his hair, won’t grow back after it’s cut.
