Anxiety and Fears about Needles

Transcription

1 Anxiety and Fears about Needles Helping You and Your Child to Cope Dr. Yvonne Duane Our Lady s s Children s s Hospital

2 OVERVIEW Aims Definition What is Needle Phobia Prevalence How Common is it? Anxiety and Fear are Normal Causes Why? Role of Psychology Guidelines for Parents / Carers Conclusions

3 Aims To help understand needle anxiety and procedural fear Guidelines to help you and your child cope with needle procedures

4 Definition of Needle Phobia Needle phobia is an irrational excessive fear of Needles. (Muscari,, M, 2007) An immense fear of a needle or injection that is not in proportion to the actual danger. (The Haemophilia Society, U.K., 2006) A phobia is the presence of a fear an avoidance behaviour.

5 Prevalence How common is it? Affects at least 10% of the population (Hamilton, J. G., 1995) 1 in 4 adults avoid medical contexts (McKenzie, A.) 70% had bad experience<10 years of age (McKenzie, A.)

6 Common Symptoms of Needle In adults - Rapid pulse, rise in blood pressure, tremor fainting, nausea, vomitting and feelings of panic and anxiety. Phobia Children may show similar symptoms or may cry, become agitated, cling to parent, have a tantrum or be unable to move.

7 Phobia or normal? Children find needles one of the most frightening aspects of coming to hospital 28.3% of children (from a sample of 103) either VERY or EXTREMELY fearful of injections (McDuff( McDuff,, A.) Not an irrational fear For older children the fear and anticipation of the procedure can be worse than the actual pain they experience With support children usually overcome their fears

8 It is normal to be anxious and scared Having an injection is a negative experience for most children it is normal not to like needles and to be afraid Loss of control Fear of pain

9 It is normal to be anxious and scared FEAR is a normal responses to a threat and involves 3 types of responses How the child behaves How the child feels and thinks Physical reaction Distress is common Whilst many children tolerate needles, some present with such distress that results in their being; Restrained Sedated Procedure abandoned

10 Fear and Anxiety It s s natural to squirm and scream during a procedure. Remember a good indication of how the child has coped is how fast they can recover and get back to playing.

11 Some fears The What if s - what if it hurts a lot and nobody listens to me what if they put the needle in my arm and all my blood runs out and I die what if I loose control and they hold me down and hurt me

12 How does a fear develop Usually starts in childhood following a bad needle experience Memory of pain and distress 80% have a close relative with a similar strong fear of needles.

13 Common Risk Factors History of being restrained (especially at a young age) while being forced to undergo needle punctures or other painful procedures Painful past experiences with needle sticks Extreme pain sensitivity Feeling of a loss of control Being influenced by the similar fear of a parent or sibling (Lamb, K., 2009)

14 Individual experience Each child s s experience is unique For some it s s the waiting times which cause a problem for others it is something sensory like the smell Others it relates to a difficult experience in the past.

15 Interventions Children (and adults) are often afraid of a needle procedure and often grown ups think that if we remove the pain using freezy spray (ethel chloride) or magic cream (ametop)) that child will not be fearful.but often the fear goes beyond the sensation and so we need to go a little deeper and try to understand the fear.

16 Role of Psychology Psychological approaches to pain and fear attempt to shift the focus from helpless recipient to active participant Aim to involve the child and facilitate control where possible Importance of learning about your child's fear listen! Supporting parent to support child

17 Role of Psychology continued.. Information / preparation and planning with staff :Child is part of a system important to work together as a team collaborate!!! Child Parents and family Medical staff

18 Role of Psychology continued.. Prevention education to staff and families re best practice and to develop good practice early on to prevent problems developing When a child is significantly distressed then, our role is to work with parents and child to find out what works for that child individual approach Which distraction works best for your child? Facilitate the child to have some control where possible Teach coping strategies

19 Helping children with injections Coping strategies Learn about child s s fear and teach them about fear and to recognize their own body s s response to fear their own personal vicious cycle Teach cognitive-behavioural approaches Check and challenge thoughts Use mental images and distraction Desensitization - Gradual exposure to feared situations from least feared to most feared

20 Coping Strategies Guided Imagery visualisation Relaxation training teach relaxation skills such as deep breathing and visualisation, which can be used during procedures Progressive muscle relaxation Reward systems

21 Age appropriate techniques Babies: swaddling/ breastfeeding/soother/rocking Age 2 to 7: Play therapy and Medical Play Young children can be distracted using bubbles, noisy toys, watching dvd s etc. Older children 6+ and teenagers: Guided imagery and visualisation Desensitization

22 Parents / Carers Look at yourself and your own reactions Remain calm and try not to let the child pick up on your anxiety You are a mirror for your child see photograph what not to do

23 Tips for Parents and Carers Listen to your child find out what they are scared of Advocate for your child be their voice! Be an active participant in your child s s care plan with staff, e.g., pharmacology p freezy spray or magic cream (45 mins wait for cream) Provide emotional support holding hand, listening, cuddling etc.

24 Tips continued Explain why the medicine is needed Use distraction: Looking away dvd / books / Guided imagery Imagining something pleasant Counting backwards in 2 s 2 s from 100 (older kids) Blowing bubbles / noisy colourful toys (preschoolers) Be creative and use what your child is likely to connect with

25 Planning if child has an established fear link with the team beforehand and have a planned procedure try to reduce waiting time. Preparation (sensory and procedural) - Talk the child through what will be happening and the sights sounds and smells the sequence of events

26 Tips continued Be honest!! Don t t pretend it won t t hurt Be matter of fact no negotiation on needle happening Participation (not procrastination) Involve the child, if possible give some control, e.g., which arm. What will we do while we wait?

27 Tips continued Be patient take breaks Permission to cry (as opposed to being brave ) - Normalise child s resonse it s s ok to be scared Excessive reassurance, criticism or apology is likely to increase the child s s distress - balancing act! Humour, games and distraction decrease distress.

28 Tips continued Practice relaxation skills e.g., deep, slow breathing No negative instruction, e.g. don t t tense your arm instead positive reframing to make your arm floppy

29 Case example Unless you know what child is scared of you may not have any success Case example 12 year old boy with chronic fear of needles to point where the medical team were going to have to stop treatment because they were not able to do a blood test

30 In Summary Preparation (sensory and procedural) Participation (not procrastination) Pharmacology (freezy( spray / magic cream / sedation) Permission to cry (as opposed to being brave ) Patience (take breaks )

31 Conclusion Not straightforward - trial and error Creativity and collaboration with child Importance of working as a team for the child It is very stressful emotionally - Important to care for yourself, so that you can care for you child