Is it okay to lie to children about pain?
Ever said "don't worry, it won't hurt" to try and overcome any worries on the way to the doctor or dentist? Well, that could make it worse, according to the experts.
When Allison Sweet Grant needed an intense limb-lengthening procedure as an 11-year-old, she had been under the impression she wouldn’t be in as much pain as she was, for as long as she was.
The American psychiatric nurse practitioner told Afternoons so-called white lies about pain to children can backfire and cause more emotional trauma.
“We can’t always protect our children from the pain itself, but we can shield them from the double pain of the hurt and also of being deceived, of being betrayed by people who we’re supposed to trust. I think we owe children the truth, I think we owe them dignity and as much of a sense of control as possible.”
Allison Sweet Grant is a writer published in the New York Times and The Atlantic; she holds dual master’s degrees from the University of Michigan.
Supplied / Joanna R. Grant
Related stories:
"Don't worry, this won't hurt"
Christchurch-based specialist paediatric dentist Arun Natarajan says it’s a common problem that parents, with the best of intentions, tell these white lies - but it only makes things harder when it doesn’t validate the child’s experience.
Auckland-based clinical psychologist Jacqui Maguire says avoiding the truth stops tamariki from learning how to manage challenges in life and can shake their trust in adults.
Nicola Woollaston, who manages the Play specialist team at Starship Hospital, says honesty is also important if you want your kids to go with you at ease to see healthcare professionals over the long-term.
Nicola Woollaston is a mother of four, trained early childhood educator and the team leader of Starship Hospital's Play specialists.
Supplied
How do I talk to my child about surgery, a blood test or a dentist visit?
Woollaston’s team – most of whom are early childhood educators – explain procedures in a way that is developmentally appropriate for children up to 16 years old.
For common procedures, like getting tonsils out or grommets, consider how far ahead you tell a child, because a 4-year-old’s sense of time is different to an older child, Woollaston says.
“For a 3-year-old or 4-year-old, we'd really advocate that you're telling them the day before or two days before, so that they have a chance to understand the process, a chance to ask questions, but it's a really clear, simple explanation.”
Should you lie to your children about pain?
Explaining your trip to the hospital using toys (when you'll go, how long you'll stay, and when you'll come back), as well as letting them take their favourite toy, may help quell some nerves.
Unsplash / Getty Images
Advise children it might be uncomfortable, but don’t jump to assumptions, she says.
“The other thing that we often will come across is parents saying, ‘oh, my kid can't do blood tests’. When parents make statements like that in front of kids, it reinforces ‘it must be super scary, or really painful, and I'm definitely not capable of it’.”
Use “minimally threatening language” and avoid talking about how much it will hurt because your pain threshold will differ, she says.
"Some medications can feel quite stingy, so we might say things like: 'Some kids tell me that it feels like a scratch, some kids tell me it feels like a bit of a pinch, you tell me what it feels like for you, and that will help me explain it to other kids as well'."
Christchurch-based specialist paediatric dentist Arun Natarajan.
Supplied / Happy Smiles
Natarajan agrees that honesty is key and you don’t need to pretend going to the dentist will be a fun trip either. Explain why you are going in a simple way, how long it will take, if you can stay with them, if they can bring their favourite toy or blanket and ask what they want to know.
Be aware of raising experiences you’ve had, such as pulling teeth out, in front of the child, he says. Instead, let them talk to a sibling or school pal whose dentist visit went well or let them go to your regular check-up to role model for them.
How much detail do I give them?
Some kids are information seekers while others do not want to know much, Woollaston says.
"We always take a bit of guidance from parents [on what the child would want], but we're really clear that kids who understand the general process and expectations often cope much better."
Specialist play services are equipped with medical play equipment to give children an idea of what the experience of going through procedures, like MRI scans, might look like.
Unsplash / Getty Images
Be conscious of words like 'cut', which could trigger trauma of previous painful incidents like falling off a bike, she says. Play specialists might refer to "a little wiggly straw", the "tippy top of the needle", and making a "tiny hole" when talking about hooking them up to an IV, instead of jabs and fluids.
Similarly, a dentist might say "sleepy straw" which help “turn feelings off” instead of needle or electric toothbrush instead of drill, which he might describe as “Mr Motorbike Sound”, Natarajan says. It’s not about tricking the child but making sure they feel safe, he says.
Children up to 10 are often curious about the role of each person in the room, Woollaston says, and making that clear helps the child know what to expect.
What other tactics can help children?
Hospital Play specialists give young children dolls to decorate which the specialists then use to explain medical procedures.
Supplied
- Read a book or watch cartoons about going to the doctor or dentist to normalise the experience ahead of time.
- Communicate your child’s needs to the dentist. Suggest your child writes a letter to the dentist with bullet points of what they plan to do (for example, bring a toy or play music) during the check-up, what they are uncomfortable with (minty tastes, suction noises), and what they can be swapped with (other flavours if available and ear muffs), if they want to take breaks, and agree on a ‘stop’ signal.
- Specialist play spaces are equipped with toys like any early childhood centre as well as medical play equipment to help walk kids through what to expect and keep their hands busy to calm anxious minds.
- Guardians can also use forms of play at home to hash out the trip to the hospital or take a virtual tour of the rooms to mitigate any stressors of being in an unfamiliar place with strangers.
- Grant, Woollaston and Maguire all agree giving children a sense of control with small choices can help limit psychological stress. Let them choose the colour of their band-aid or cast, ask if they want to count to 10 or five before starting, if they want to look at a book or iPad or listen to their favourite music, if they want to hug you or would rather focus on mindful breathing.
Give children a sense of agency by allowing them to make small choices, like the colour of their cast.
Unsplash / Getty Images
If things don’t go to plan…
Even with all their knowledge and expertise, there are times when nurses or doctors have to try a few times to draw blood or hook a child up to an IV because of their tiny veins, Woollaston says.
"We'll say, look, that did not go the way we planned, what can we do differently next time? And we'll actually reframe that for kids before they leave the hospital, and parents can do that as well."
You can also ask about the options for pain management, Woollaston says. For example, breastfeeding infants during vaccinations lowers stress response. There are also numbing creams or sprays or Buzzy4Shots.
Dr Natarjan agrees discussing what went wrong and what went well is important as well as telling them they did well and recognising that with a small reward.
