Laughing Gas and Animated Movies: All Methods Used to Calm Children Prior to Medical Procedures

MAKO news site, Tuesday, October 26, 2021

Medical examinations and treatments can raise feelings of tension and anxiety in children. Specialists at Schneider Children's Medical Center explain the best and most effective ways to assist children prior to relevant procedures, and mainly, to reduce their fears through natural means.

If you have recently taken a child for a medical examination, undoubtedly you will agree with us that it is no fun. And let us admit that it is difficult to imagine any child happy to extend his arm to a needle ready to be inserted, or one who is willing to have a spatula forced deep into his throat. And this is yet before we have had a chance to speak about more complicated processes, which even us, as parents, do not find easy to endure.

In fact, anxiety prior to tests and medical procedures is very common among children. However, it is important to know that the proper treatment of this situation will prevent the child from having difficult fears and even trauma which could accompany him for the rest of his life. Schneider's specialists and the team in the Educational Center at the hospital collaborate in applying the most successful methods to cope with stress related to medical issues, ranging from music, to laughing gas, to the "white room".

Psychologist Dani Lotan, Head of the Anxiety Clinic at Schneider, explains that the most important rule prior to medical treatment is prior preparation. "The better we can prepare the child for what is anticipated, the more we can help him to cope before and during treatment. Accompanying the child to treatment without any explanation beforehand can result in a traumatic and frightening experience with long-term antagonism regarding any medical procedure", he said.

"It is important to know that complex medical processes could threaten the child's physical recovery and his self-image. They can also give rise to severe feelings of anxiety, helplessness and loss of control. Therefore, preparation must be accurate and suited to children, their age and ability to understand. The chief aim is to reduce fear while at the same time increase the sense of self. This process advances recovery and the child's coping mechanisms."

According to Lotan, providing information, demonstrating the procedure and talking about the new situation promotes results while also talking about the child's ability, strength and feelings – all contribute to attaining the aim.

In addition, Dr. Lotan suggests that a pre-surgery tour of the operating room be arranged. "Here at Schneider for instance, we offer a preparatory visit which includes explanations about the surgery to take place, uniforms of operating room staff, medical equipment and the process of anesthesia and awakening thereafter. The tours are aimed at making the unfamiliar familiar and in this way, minimize the level of fear on the day of the operation."

Supportive Environment
"Creating a friendly and warm environment, encouraging the involvement of the family in treatment, support for the family, social activities, support of the multidisciplinary staff dedicated to the child's medical needs, and the socio-psychologists all are essential tools in decreasing anxiety," said Lotan. Thus, for instance, he recommends that parents prepare the child for the anticipated treatment by reading a book about a child who undergoes similar therapy, watching a movie, drawing, playing a game and any other means that could promote a verbal or non-verbal discussion about the topic.

Medical Clowns
Not many are aware that medical clowning is an entire field unto itself called "Jellology" (lit.) – the science of humor. Maskit Gillan Shochat, Director of the Educational Center at Schneider Children's, explains that the model for medical clowning is personal communication between people. It empowers the individual by instilling coping skills during times of tension. The clown is an important figure in the treatment process and plays a key role in changing children's belief by deflecting the reality of discomfort through creative ways. Medical clowns adopt images of various figures and use a range of theatrical, medical and artistic tools in order to create an identity based upon the child's situation at that point. The main skill of the clown is his ability to see, emphasize and expose the child to his healthy, forceful and positive strengths."

Use of dolls is another important tool for many children. Many departments at Schneider are assisted by dolls in preparing the child prior to chest surgeries, catheterizations, urology procedures, EEG and more. Maskit Gillan Shochat, Director of the Educational Center at Schneider, explains that children identify more easily with dolls, which become a tool for the children and promote their ability to express their thoughts and feelings, even to "experience" treatments and tests just like they themselves do. 

"Ongoing experience has taught us that using dolls reduces the level of children's stress, and promotes better cooperation in situations involving multidisciplinary teams. One of the dolls which we have recently revitalized in the Educational Center is an octopus called "Damnun" [a play on "tamnun" (octopus) in Hebrew together with "dam" meaning blood] – a creation with long arms through which flows red food coloring mimicking blood. Through mediation and game playing, the child performs a blood test on the doll prior to his own procedure."

Private Screening
More complex medical procedures include those that require injecting an opaque medium into the child. These tests demand the child's full cooperation, where he must lie still in one place without moving. Non-compliance can affect the test results or extend its duration and lead to prolonged discomfort. According to Adi Reinzilber, Director of Administration at Schneider Children's, one of the ways to gain the child's cooperation is to focus his attention on something else such as calming music or screening a children's program or animated movie above his head. "In this way, the child focuses on the monitor above him and movement is reduced to a minimum while his thoughts are elsewhere, thus according optimal completion of the scan," she added. 

The White Room
According to Gillan Shochat, the White Room or Snoezelen was originally established in the Netherlands at the beginning of the 1980's. The significance of the word "snoezelen" in Dutch is to smell and doze. It is literally a white room filled with sensual stimulants which contribute to the tranquil effect. Within the room are lights, colors and special sounds that grab the child's attention.

Gillan Shochat notes that the Educational Center operates two mobile snoezelens which can be brought to bed-ridden children. In addition, there are two white rooms, one of which serves hospitalized children in the Oncology Department and includes, inter alia, a virtual reality device.

Virtual Reality
In the majority of cases, the fear of pain from medical tests and procedures is the pain related to the event. In fact, pain accompanies many medical diagnoses and frequently is a diagnosis in and of itself. Research shows that pain among children can lead to issues of health, function and emotion.

Virtual Reality is a therapeutic tool that assists treatment of severe pain following medical procedures and treatments and also a psychological tool to treat fears and anxieties. "Treatment aims to create a different reality to that which children sense and believe. Entering the virtual world assists children to interact with their feelings of pain, anxiety and negative thoughts that goad emotional distress," explains Miri Keller, Coordinator of Pain Prevention at Schneider Children's. According to her, children receive disposable glasses through which they can watch 3D movies on cellphones and thus withdraw from the treatment setting. In this way, they focus on a game or movie and can then ignore other stimulants and experience the tests and invasive interventions in a less threatening manner.

The Child's Best Friend
Using animals such as dogs in particular to assist children has long been known because animals can help them during a short- or long-term crisis. Dog therapy is a unique method involving social, educational, psychological and rehabilitative issues. Dogs have an ability to connect, promote feelings and reduce emotional barriers. "Dogs offer many healthy and supportive advantages by giving unconditional love, contributing to improved frame of mind, relieving distress and providing compassion and assistance during the recovery process of children coping with complex issues, illness and pain," explained Reinzilber.

In summary, the next time that you take your children to have a medical procedure, don’t hesitate to check whether there are tools that will help them better cope with their anxiety, and there are many of them available.