How can I get my daughter to be more relaxed about and manageable in doctor office visits?
September 7, 2012 11:52 AM   Subscribe

How can I get my daughter to be more relaxed about and manageable in doctor office visits?

My daughter recently turned four years old. She is strong-willed and decisive. Those traits are great attributes that should serve her well, and I love that she has a strong character, but when it comes to taking her to the doctor's office, they are nightmare traits for a child who absolutely hates going to the doctor's office.

I was able to take her for her annual checkup earlier this week by promising her (truthfully of course) that there would be no shots.

She cooperated with one very friendly and smiley nurse in measuring her height and weight, checking her blood pressure, heart, and pulse.

But she wanted nothing to do with the next nurse (less skilled in terms of dealing with children) who was the one qualified to do the rest of the examination. My daughter wouldn't let that nurse touch her belly or look at her ears, nose, and throat.

I consider myself to be a skilled parent who can finesse out all kinds of good results. I try to get things done without offering extrinsic incentives. Nevertheless I tried sticker and lollipop incentives, but they didn't help.

The only thing I forced on this visit, with great physical effort and lots of stress for both of us, was the administration of the nasal mist flu vaccine. My daughter screamed bloody murder, kicked and punched, and was crying and yelling for about three minutes afterwards even though it certainly didn't involve any physical pain.

Of course she recovered later just fine, as kids do, but I don't like to force her physically unless absolutely necessarily, and I'm hoping that's not going to be my only option in the future, especially when she does need to get shots within the next year.

I envision a scenario of having to carry her into the doctor's office if she stops in her tracks in the parking lot or won't get out of the car. Just thinking about that scenario practically makes me break out into a sweat.

Uncharacteristically for me when it comes to parenting, and most everything else, I'm just at a loss what to do.

Any suggestions?

Thank you so much.
posted by Dansaman to Human Relations (30 answers total) 6 users marked this as a favorite
My sister was the same way and it sucked because she had asthma and constantly needed shots or doctor visits. My mother combated it by turning doctor days into fun days. She would do something we enjoyed before going in, such as going for lunch, buying a new shirt or watching a fun movie.

After the visit, she would reward her good behaviour with another fun activity. My sister still kicked and screamed during shots - no way out of that, but she warmed up to going to the doctor's and eventually stopped dreading it so much because it also coincided with things she liked to do.

My mother also emphasized any good things my sister did throughout the visit. So in your case, you could praise her for being so patient with the first nurse, and maybe remind her that next time, she should extend the same courtesy to the second nurse.
posted by cyml at 12:02 PM on September 7, 2012 [4 favorites]

Can you talk with the doctor beforehand and find out EXACTLY what is going to be done in that appointment, and then lay it all out for your daughter. Maybe do a pretend doctor visit where you go through all the stuff that she'll be doing. Also explain exactly WHY they need to do all of those things. (ie. "Honey, the doctor is going to make you sniff something up your nose. It might be a little weird for you but it will help to keep you healthy and feeling good and it should make sure that you don't get sick!") My step son is currently 5, but when he was 4 we explained stuff like that to him and he understood and would repeat it to the doctor as they were doing it, explaining "You're going to put that needle in my arm so that I don't get sick!". That way she'll know what comes next and things aren't such an unknown scary thing where grownups keep doing things to her and she doesn't know why.
posted by PuppetMcSockerson at 12:03 PM on September 7, 2012 [10 favorites]

Don't know if this will help for your daughter, but it helped me deal with the idea of receiving vaccines in particular as a child.

A parent explained to me what vaccines were as a child in child-friendly language (i.e. helps give you something to protect vs. a particular type of bug-causing illness, or even more kid friendly if you can think of it).

Also being told in advance what to expect also helped me.

It was the unpredictability (not being told in advance) and not knowing why that used to scare me as a young child. And yes, I remember this; I was scared about vaccines when a team of health care professionals held me down and gave a shot in a hospital with no warning, a lie (look at the mobile!) and no explanation as to why. In future years, I was okay with it...when someone told me why it was going to happen and what to expect. I gave (unsupervised) practice shots to the dog for a while...but in retrospect, I bet you could prepare her by giving practice shots to a teddy bear.

posted by Wolfster at 12:03 PM on September 7, 2012 [1 favorite]

I was a screamer and fighter when it was shot time as a child. When I was 11, I had to go in for elective surgery (bone chip in the ankle), and I was required to undergo therapy for my fear of needles. After a course of hypnotherapy, I've had a lot easier time with shots.

Based on your report, that's likely overtreating the problem, but the option is out there in case working through with roleplay or other methods don't work for you.
posted by immlass at 12:10 PM on September 7, 2012

Is she at the age where you can reason with her? Can you ask her why she's so freaked out by going to the doctor? Because it sounds like this goes a little beyond the shots issue.

Can you promise bigger rewards for cooperative behavior? Not "I'll give you a lollipop if you stop crying and behave right now" but "If you're very good at the doctor today, afterwards we can go to the bookstore and get a new book" or some other small yet actually special reward?

I know that the shot thing is super irrational, and I remember being equally horrendous when shots were potentially in the picture, but my advice about shot stuff is NOT to spring them on her. I remember part of my fear and tension about going for checkups as a kid was that I didn't trust anyone and didn't know what was going to happen. There was always the possibility of a surprise shot or scary thing happening.

Can you walk her through the visit in advance and say, "now the nurse is going to look in your ear with a special machine, which might feel a little bit weird. But it's going to be over very quickly, and it won't hurt you"? Start when she's still rational and before the freakout, if possible. Make it seem like a normal thing that might be a little scary, but won't actually hurt.

Another thing I remember working well with my younger brothers was sort of personifying/romanticizing any equipment used. So for example, "do you want to put on this cool astronaut mask and breathe in some stuff? Wow, look at you, you look like such an awesome astronaut!" One of my brothers had to use a nebulizer sometimes, and framing it this way really helped him relax about it.
posted by Sara C. at 12:10 PM on September 7, 2012

I would try the same trick I used on my dogs (and yes, I'm doing this now with my child as well).

Go in for visits for no reason. Just go to say hi. Have your daughter (help you) make some cookies or something to drop off for the nurses, and let her give them to them. (It sounds like she is outgoing). Things like that, so that the doctor's office is not always a bad thing.

In addition, before the visits with exams, explain in detail what will happen, and see if you guys can practice at home. Let your daughter check out your throat, eyes, etc with a play doctor set.
posted by jesirose at 12:19 PM on September 7, 2012 [5 favorites]

My dad did the same thing as cyml. I was stubborn and terrified of any sort of change.

My mom was the primary caregiver. So to get a day alone with dad was always a bit special. We would wake up and head to McDonalds for breakfast* and plan our day. We were going to go to the dentist or doctor. That was the price of admission. Afterwards, I'd get to be in charge. Looking back, it was clear he'd steer the direction away from expensive fantasies towards a day at the zoo, or one of the museums.

Sure, it's a bribe. But it made me look forward to an unpleasant experience. And because we spend the other half of the day having fun, I went to bed barely thinking about the terrible experience. Now I only vaguely remember hating the doctor. I only know that I was just about as bad as your daughter because my parents gossip about it.
posted by politikitty at 12:24 PM on September 7, 2012 [1 favorite]

I was like this as a small kid, even though my dad's a doctor and I was always walked through the entire visit and procedure in advance. I knew what would happen when I got a shot; I just didn't want it to happen, and I hated losing bodily autonomy even for a second. It felt horribly claustrophobic.

But, like most kids, I admired particular characters from books and cartoons, and my mom used to shame me by pretending they were in the room and relaying to me how shocked they were that I was throwing a tantrum instead of being brave and strong. I swear to God this worked on me and had no lasting traumatic effects. I resolved to be brave so that Cheetarah and Laura Ingalls Wilder wouldn't be disappointed in me and I always was. My mom swears she never did this and would never be so mean, but I actually found it to be a valuable coping technique.
posted by pineappleheart at 12:26 PM on September 7, 2012

Oh right. The asterisk.

*My dad didn't realize that you're supposed to fast before the cholesterol test. So I'd get to have hashbrowns, sausage, eggs and a buttermilk biscuit, with orange juice. It took a year for them to figure out why I had the cholesterol of a 60 yr old man.

So while I recommend the game plan, maybe leave out the terrible terrible food.
posted by politikitty at 12:29 PM on September 7, 2012 [3 favorites]

My niece was a strongwilled drama queen like your daughter and all the bribing etc in the world didn't help. In the end my brother sat her down and firmly and calmly said these things are going to be happening to you they can happen the easy way and we all go out to a nice dinner at your favourite restaurant afterwards (McDonalds she was only 5). Or you can do it the hard way and we go home straight after, you will be getting your shots/dentist visit/check up either way.

She got surprisingly brave and drama free once she realised that having a hissy fit to get out of it wasn't going to work with her Dad like it did with her Mum. She's now 13 and goes to all these things with no problems except a tween eyeroll or 2.

I know in this day and age such an attitude with kids isn't the hip way to handle things but it worked for them.
posted by wwax at 12:31 PM on September 7, 2012 [5 favorites]

Can you ask her why she's so freaked out by going to the doctor?

I agree with this, I would just ask her. She might have some specific fear that you can help address, or it might just help her feel better to be heard. People of all ages need to feel like they're being heard.
posted by sweetkid at 12:37 PM on September 7, 2012 [2 favorites]

When I was little I was terrified of seemingly everything, and doctor's visits went pretty much exactly as you described in your question. Apparently, what was happening was that I reached a sort of full gauge of stimulation. So many new sensations all at once tipped me over from cautious and confused into terrified and angry about it and I just wanted out. It didn't matter that there wouldn't be any shots or that they just wanted to feel my neck or something. The crinkly paper or the taste of a tongue depressor was the straw to break my camel's back.

This sort of thing happened everywhere I went. I was scared of clowns, not because clowns were actually scary but because I always encountered them in new, overly stimulating situations.

The way Mom got me to stop being scared of clowns and costumes is the same way she got me through doctor's visits: I learned as many of the new sensations as possible ahead of time. I pretty much destroyed the VHS our local movie rental place had about behind the scenes at the circus, and my friend's father was a doctor who gave us a pile of objects for me to explore at my leisure. The tongue depressors and the really long cotton swabs I remember vividly. I know also he let me borrow and play with his actual stethoscope, and there were a few sheets of that tissue paper stuff. Mom explained, in a very detailed way, everything that the doctor was going to do and why, including basic vaccine information, why they measured my height, even why there was paper on the table.

Through a combination of growing up and processing the information at my own pace, I got super stoic at doctor's visits by the time I was 7.
posted by Mizu at 12:55 PM on September 7, 2012

She is strong-willed and decisive.

Or, perhaps, you're a permissive parent that frames parenting as negotiation and "finesse." Seriously think about that. A four-year-old that kicks and punches is not "decisive." It's a four-year-old that has learned that kicking and punching works.

But ... the best method for dealing with anything like a doctor's visit is a dry run. "We're going to go the doctor's office today so you can see what it will be like when you go next week." Go, sit in the waiting room. Maybe have a nurse hold a stethoscope to her chest. Leave, go get ice cream. "See, that's what's going to happen. OK, time has passed. Tomorrow, we're going to the doctor. It'll be just like last week."
posted by Cool Papa Bell at 1:00 PM on September 7, 2012 [16 favorites]

I started getting weekly allergy shots at 5. When I went in for the scratch test, I lost my mind over all the pricks and poking. I was screaming and hysterical and nothing could be done to fix that. Afterwards, my mother told me that if I ever acted like that when I wasn't actually in real pain, I would be in a great deal of trouble. (I wouldn't recommend this course of action. It resulted in a daughter who broke her nose three times and finger once without ever saying anything about it.)

However when it came time for the actual allergy shots, a nurse calmly and sweetly explained that it would hurt, but it would only hurt for a few minutes. And most importantly, I needed to be calm because that would make it hurt less. It took a few weeks of shots, but eventually I realized the nurse was right and flinching made the shot hurt longer. As I got older, I became the kid they would train new nurses on, because I didn't flinch or freak out at shots. I remember at 10, a new nurse was so nervous to give me shot that I held her free hand to comfort her.

Knowing things sometimes hurt, but they are limited and eventually they make you feel better made dealing with medicine and shots way easier for me.
posted by teleri025 at 1:01 PM on September 7, 2012

I have three 4 year olds, so I feel your pain. Before they got their shots at their 4 year visit (the doctor warned me there would be several), I had them watch this Sid the Science Kid episode. Actually, there's a whole DVD of Sid the Science Kid episodes that deal with health, and they helped the boys understand a lot of what was going on, and why they needed shots, etc.
posted by pyjammy at 1:04 PM on September 7, 2012

Jeff Atwood speaks highly of the book "How to talk so kids will listen & listen so kids will talk." I have purchased it but not read it yet (since our child is still a theoretical) but it might also be worth looking in Parenting Stack Exchange.
posted by phearlez at 1:07 PM on September 7, 2012 [1 favorite]

Thank you all for so many very useful ideas.

Not sure what the respondent's definition of "permissive" is.

Just like adults, kids have a wide range of temperaments and personalities. Some kids are more passive and pliant and some are less so. Although it sometimes makes things more challenging, I'm very glad my daughter is not passive and pliant.

As for my parenting, I believe in respecting a child as a human being and I practice attachment parenting and the Montessori approach. I don't call that negotiating, rather I see it as giving the child a sense of having some control over her life. But I can see how a parent who is a traditional strict disciplinarian could see it as permissiveness from their perspective.

The kicking and punching were while we were trying to administer the nasal spray, and we did administer it. So the kicking and punching were not behaviors that resulted in the outcome my daughter wanted. She does not normally kick and punch, and she is not aggressive by nature. She is strong-willed, determined, and decisive, and those are good traits that will be very beneficial for her and I don't want to try to "break" them.

A bit of a diversion here but wanted to address that point.
posted by Dansaman at 1:19 PM on September 7, 2012 [4 favorites]

I've heard a lot of good things about "Raising Your Spirited Child", from friends who have spirited children. (Mine are a bit more sedate, so I can't vouch for it personally, but it might be worth a look.)
posted by pyjammy at 1:31 PM on September 7, 2012

I know lots of really great children with really awesome parents who are good at setting boundaries and expectations -- who still have to be held down for shots, fyi.

My daughter is nearly six, and is definitely strong-willed. (Haaaaaa.) We recently had to do a last-minute trip to get the last three shots she needed to start school. I told her straight up, we need to go get you shots. They will suck, I am so sorry. Breathe with me -- in and out -- they will hurt, but only for as long as it takes you to breathe in and out, and then they will be over. I know you are scared, but I also know you are brave, and I know you can do this. It will hurt for as long as it takes you to breathe in and out, and then they will keep you from getting sick with those diseases for YEARS!! Isn't science wonderful?

She was completely nonchalant about it until they actually brought the shots in, and then she wanted me with her. When they alcoholed her arm, she grabbed me tight and began to cry, and when they did the shots she straight-up screamed and sobbed, but she did not have to be held down and she did not try to stop them. I held her hand and breathed with her after, and then she got suckers, and then she was fine. I told her how proud I was of her for doing that thing that she didn't want to do, that that's what it means to be brave, and also that I was proud of her for asking for help from me. Because when you know you won't be able to do something without help, and you know you need to do that thing, asking for help is ALSO brave.

I think having her fears and her experiences validated helped a LOT. She knows shots hurt, she's no dummy. (She also hates having her nose messed with; she actually chooses the flu shot over the flumist. Your daughter may be similar.) By giving her a time frame for how long they will hurt, she could focus on when it would be over.
posted by KathrynT at 1:50 PM on September 7, 2012 [11 favorites]

Have you tried the maturity-shame tactic, e.g. "Well, I thought you were too big and grownup to have tantrums, but I see you're still a baby. Guess I'll have to pick up some diapers on the way home."
That's a last resort though.

Before that, I would have a sit-down grownup talk with her to ask why, exactly, she hates it so much. If she can verbalize problems, or draw them, or use dolls to express herself, you can address the factors that are affecting her.
posted by L'Estrange Fruit at 4:24 PM on September 7, 2012

Is there an older/favorite aunt/cousin/babysitter who can talk to her about this? Maybe go with you to the visit? Someone she trusts and looks up to.
posted by radioamy at 4:57 PM on September 7, 2012

Is a new doctor's office an option? That took us from loads of apprehension and inevitable sobbing over appointments to "I think we need to go see Dr X!" for stubbed toes and the like.

Laying out, kindly, that it has to happen (and here's why), and no fuss will change that, is a good way to roll, too. Ask what you can do to make it more pleasant; frame yourself as an ally...
posted by kmennie at 6:17 PM on September 7, 2012

Maybe this is a dumb idea, but maybe a toy doctor kit would be fun and helpful? She could sort of act out her own play therapy with her dolls and stuffies. Maybe pretending that SHE'S the doctor could make her feel a little more in control and also maybe give you a glimpse into what's going on in her head when she's freaking out at the doctor's office. Maybe she could even bring the kit to the doctor's office and the doctor/nurse could play along a little?
posted by Aquifer at 7:03 PM on September 7, 2012

My daughter was unhappy about going to the doctor for a long time and I realized it's because at basically every check-up until age 4, there are shots. (And I've actually heard that the nasal spray is more unpleasant than shots for kids.) My daughter knows why she gets the shots (and knowing that Grandpa had polio and was one of the lucky ones, brings the point home a bit), but getting them still isn't fun. We usually have a treat afterwards, but less a bribe, and more of a, that sucked, this will be better. We plan a bigger treat for visiting the allergist, because having your arm being painfully itchy and not allowed to scratch, is terrible (and unlike shots, will actually bring my 5 year old to tears). I hold her, remind her she's okay, and talk about the merry-go-round or bakery we're visiting after. It helps to have the good thing to focus on.

I also think being able to act out some of doctor visits helps make sense of it. (Also, getting to give your bears shots every day for two weeks, well, at least she doesn't have it that bad.)
posted by Margalo Epps at 7:31 PM on September 7, 2012 [1 favorite]

I was like this as a child, and still have a mild dislike of the typical doctor's office and specifically hate/fear needles (I'm lucky if my tetanus shot is up to date, and don't even consider the optional flu shot). I can tell you a bunch of things that didn't really work and a few that did:

Did not work:

- Holding me down. This worked for that visit but just caused an escalation on subsequent visits.

- Explaining how important it was. I knew how important it was (and certainly know now) but not in an immediate/real way that counteracted being afraid.

- Shame. This just gave me Issues, made me more upset and angry, and meant that I had no one who I could trust to take my part at the doctor's office. Just imo using a bullying tactic like shame is less than stellar even when it's for your kid's own good.

- Seeing needles in non-doctor contexts. I still have to look away when my pony gets his shots even though he doesn't even slightly twitch. Even just thinking about a needle makes me squirm.

Kind of worked:

- Having control over the situation. I walked out of the optometrists office when I was 15 because he explained the eye exam results to my mom instead of to me when we were both standing right there. If you think about it talk-to-the-parent is standard operating procedure for a lot of doctors--imagine if your doctor reported your test results to your partner instead of you (when you weren't completely incapacitated), you'd be livid! This obviously improved with age, but I also do a lot of prep beforehand using doctor review sites and asking around to make sure I get a doctor who's good at patient interaction. (Especially as you said the visit went downhill after the switch in caregivers.)

- Non-needle doctor visits. I quite like the MRI and I do fine with the listen to your heartbeat and tap on your knee sort of checkup.

- Extreme pain. When I cracked a wisdom tooth the dental surgeon had to stab me about fifteen times to find a vein (no joke, he tried both hands and an elbow, I had big bruises up and down my arms for a week after)... but I hadn't been able to sleep for two days because of the pain in my tooth, so I held still for it. I did cry and whimper and hyperventilate (big no-no with the nitrous), but I didn't move. (The moment when he finally found a vein and the darkness came crashing down was probably one of the nicest moments of my life.)

Things I haven't tried yet but am interested in trying someday (when I can better afford to and am somehow forced to stop avoiding the whole topic): Therapy and anti-anxiety drugs (Xanax et al.) for the needle phobia.
posted by anaelith at 8:50 PM on September 7, 2012

It doesn't sound like you're the type to do this, but please don't use shame (i guess you're not a big girl, time for diapers, etc). Those sorts of things can take root and last forever. I totally agree with not trying to talk her out of her fear, but instead helping her find ways to manage it. I love the idea of just stopping by to say hi to the nurses.
posted by nadawi at 11:42 PM on September 7, 2012 [1 favorite]

When I was a kid, I got a shot of penicillin in the butt and had a bad reaction and was paralyzed for many days afterward. I eventually recovered, but literally would hyperventilate, scream, and barf into a trash bag in the car on the way to the doctor's for YEARS.

My mom would dope me up with dramamine and/or benadryl to keep me calm and from barfing in the car (please don't do that - but you don't sound like that kind of parent.) What DID work was:

- having my favorite relative come and pick me up from school or spend the morning with me first, or come with us

- telling me that afterward if I was (mostly) calm and didn't cause a scene, I could go to the bookstore and pick out any book I wanted

- if shots were involved, I had to be told how many and they promised to tell me funny weird stories and cover my eyes so I couldn't look/see/feel the needle until it was already done

-on shot days, I got one book per shot instead of the single book for the whole visit (obviously the reward doesn't have to be books, but they held my attention, which was good for everyone as I was also a strong-willed and loud child)

It's weird, but I still close my eyes when having blood drawn, ask the nurse to tell me something happy/nice about his/her life or describe something they love (it helps me to focus on happier things). And I also go to the comic book store or something else I enjoy afterward, if possible. But I have to get my husband to pull off the band-aid or let it fall off in the shower, because I'm so grossed out just by where the needle has BEEN.

She may have a phobia, and those are hard to overcome with logic. Positive reinforcement usually helps, though.
posted by Unicorn on the cob at 11:48 PM on September 7, 2012

people of all ages need to feel like they're being heard.

Amen!! Poster, stop invalidating your daughter's experience and start LISTENING to her and putting yourself in her shoes. This comment of yours disturbs me greatly: "even though it certainly didn't involve any physical pain". You're not in her body and you don't know how she feels. You DO NOT KNOW whether the nasal mist caused her pain. Try some compassion, and try some active listening.
posted by parrot_person at 4:24 AM on September 8, 2012 [1 favorite]

Our 4-yr-old is like this. Even the stethoscope freaks her out.

Her dad came up with a genius solution. He told her the doc was going to look in her mouth and ears to find her "special" numbers. (there's a 3 in her left ear). This helped her calm down to the point where shots went from flip-out terrifying to hold-my-hand scary. And at her 4-yr-old checkup we counted down from 5, with 5 being the shot point and 1 being when the pan would go "poof!". That did it for her. She clapped through her tears at 1, and the nurses immediately got her up to rummage through the prize box they keep for especially brave children.

It also helps that her younger brother goes at the same time for his shots; she can empathize with his fear, and sings his favorite song to him while he cries.
posted by tigerjade at 1:12 PM on September 8, 2012

Reduce the strangeness of the event. Go visit the doctor's office. Say hello, get a free sticker or colorful bandaid, go home. Repeat a bunch of times. Knowing the office staff will really help.

Kicking and punching people, and screaming are not acceptable. Explain why, ask her why it was so awful, and what can be done so that her important medical requirements can be met. Her behavior should result in a combination of natural consequences, "You were very stressed and wound up at the doctor's office; you need calm-down time, maybe even a nap" and punishment "We don't punch people. This is very serious behavior and there's no tv for a week."

It's hard to give parenting advice when we don't know if you're usually a very structured parent, and your child is unusually freaked out by the doc's office, or if you're pretty casual, and your child is allowed to be in control. You sound pretty smart; you can assess this and respond accordingly.
posted by theora55 at 4:36 PM on September 8, 2012 [1 favorite]

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