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Preparation for every procedure is essential. Unexpected stress is more difficult to cope with than anticipated stress. If parents and children understand what is going to happen, where it will happen, who will be there, and what it will feel like, they will be less anxious and better able to cope. Methods to prepare children are:

• Verbally explain each step in the procedure.

• If possible, meet the person who will perform the procedure.

• Tour the room where the procedure will take place.

• Small children can "play" the procedure on dolls.

• Older children can observe a demonstration on a doll.

• Adolescents may observe a videotape describing the procedure.

• Encourage discussion and answer all questions.

For my child, playing about procedures helped release many feelings. Parents can buy medical kits at the store or simply stock their own from clinic castoffs and the pharmacy. We had IV bottles made from empty shampoo containers, complete with tubing and plastic needles. Several dolls had accessed ports, and many stuffed animals in our house fell apart after being speared by the pen during countless spinal taps. Katy's younger sister even ran around sometimes with her own pretend port taped onto her chest. Some suggestions for the child's medical kit are: gauze pads, tape, tubing, stethoscope, reflex hammer, pretend needles, syringes, medical chart, and toy box. Of course, lots of dolls or stuffed animal patients are required.

My daughter (3 years old) took an old stuffed animal to the clinic with her. Having the nurse and doctor perform the procedure first on "Bear" helped her immensely.

Hypnosis is a well-documented method for reducing discomfort during painful procedures. If performed by a qualified healthcare professional (psychologist, physician, nurse, social worker, or child life specialist), hypnosis can help your child control painful sensations, release anxiety, and diminish pain. The professional helps guide children or teens into an altered state of consciousness that helps to focus or narrow attention. To locate a qualified practitioner, visit the web page for the American Society of Clinical Hypnosis at http://www.asch.net/find.htm or call (630) 980-4740.

Imagery is a way to deliberately create a mental image of sights, sounds, tastes, smells, and feelings. It is an active process that helps children or teens feel as if they are actually entering the imagined place. Focusing on pleasant images allows the child to shift attention from the pain. It can also allow the child to actually alter the experience of pain, which simultaneously gives the child control and diminishes pain. Ask if the hospital has someone to teach your child this very effective technique.

The following description of using imagery was written by Jennifer Rohloff when she was 17 years old, and is reprinted from the Free to Be Yourself newsletter of Cancer Services of Allen County, Indiana.

My Special Place

Many people had a special place when they were young—a special place that they still remember. This place could be an area that has a special meaning for them, or a place where they used to go when they wanted to be alone. My special place location is over the rainbow

I discovered this place when I was 12 years old, during a relaxation session. These sessions were designed to reduce pain and stress brought on by chemotherapy. This was a place that I could visualize in my mind so that I could go there anytime that I wanted to—not only for pain, but when I was happy, mad, or sad.

It is surrounded by sand and tall, fanning palm trees everywhere. The blue sky is always clear, and the bright sun shines every day. It is usually quiet because I am alone, but often I can hear the sounds of birds flying by.

Every time I come to this place I like to lie down in the sand. As I lie there, I can feel the gritty sand beneath me. Once in a while I get up and go looking for seashells. I usually find some different shapes and sizes. The ones I like the best are the ones that you can hear the sound of the ocean in. After a while I get up and start to walk around. As I walk, I can feel the breeze going right through me, and I can smell the salt water. It reminds me of being at a beach in Florida. Whenever I start to feel sad or alone or if I am in pain, I usually go jump in the water because it is a soothing place for me. I like to float around in the water because it gives me a refreshing feeling that nobody can hurt me here. I could stay in this place all day because I do not worry about anything while I am here.

To me this place is like a home away from home. It is like heaven because you can do anything you want to do here. Even though this place may seem imaginary or like a fantasy world to some people, it is not to me. I think it is real because it is a place where I can go and be myself.

Distraction can be used successfully with all age groups, but it should never be used as a substitute for preparation. Babies can be distracted by colorful, moving objects. Parents can help distract preschoolers by showing picture books or videos, telling stories, singing songs, or blowing bubbles. Many youngsters are comforted by hugging a favorite stuffed animal. School-age children can watch videos or TV, or listen to music. Several institutions use interactive videos to help distract older children or teens.

My daughter went through her therapy prior to the days when kids were given any pain medications for procedures. She and I would make up a schedule of songs for me to sing during the spinal tap or bone marrow. I would stroke her skin and sing softly to her. She visibly relaxed, and the staff found it soothing, as well. I'll never forget the time that the oncologist, nurse, and I were all quietly singing "Somewhere Over the Rainbow" during the spinal tap.

Other adjuvant therapies that are used successfully to help deal with medical treatments are relaxation, biofeedback, massage, acupuncture, and accupressure. Ask the hospitals child life specialist, psychologist, or nurse to discuss and practice different methods of pain management with you and your child.

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