Don’t let fear keep your patients away!

Sarah J. Clark, MPH

No matter how many cartoon characters grace your walls, or whether there is a fish tank in your waiting room, some kids just won’t like coming to see you.

In a recent report from C.S. Mott Children's Hospital National Poll on Children's Health at the University of Michigan, 26% of parents said that their children were afraid to visit their pediatrician some or most of the time, and another 24% were scared once in a while.¹

Sarah J. Clark, MPH, of the Child Health Evaluation and Research Center (CHEAR) at the University of Michigan, Ann Arbor, helped report the Mott Poll results and says pediatricians should take this information and use it to be proactive in helping allay the fears of young patients and the anxiety of their parents.

The problem isn’t as simple as dealing with a few tears and pouts. The Mott Poll reveals that 1 in 25 parents actually postponed vaccinations because of their child’s fear of the pediatrician, and another 1 in 5 admitted that they heard little of what a doctor or nurse told them during a visit because of their child’s fear or anxiety.

The Mott Poll collected data from 726 parents with children aged 2 to 5 years, and explored what contributes to fears of the doctor’s office and what parents and pediatricians can do about it. Breaking down the source of a child’s fear is key, and the report found that 66% of parents of children aged 2 to 3 years said their child was most scared about getting a shot and 43% had stranger anxiety. Not much changes as they get older: 89% of parents with children in the 4- to 5-year age range also reported shots as a big stress inducer; 14% reported stranger anxiety; and 13% said their children were fearful due to past memories of being sick.

In addition to causing fear in children, anxiety-ridden visits can also interfere in a parent’s ability to receive important health information. Twenty-two percent of parents weren’t able to hear what a doctor or nurse was saying because of their child’s reaction to a visit; 9% said they didn’t bring up questions or concerns in their rush to end the visit because their child was upset; 4% of parents delayed vaccinations; and 3% of parents cancelled appointments altogether to appease their child.

Bribery was the most common tool to alleviate these fears, with 31% of parents admitting to promising a treat after the visit. Another 21% promised their child they wouldn’t get any shots during the visit, and 22% just toughed it out and did nothing special to prepare their child for an office visit. Some more helpful strategies included talking out the purpose and plan for the visit (61%); playing with a toy medical kit (2%); or reading a book or watching a show about going to the doctor (23%).

How to ease patient anxiety

Clark says parents whose children are fearful of healthcare visits should involve their pediatrician and offer emotional support. Distraction can help decrease anxiety, but parents should never lie, she says.

"Telling the child there will no shots at the visit when the child is due for a vaccination or saying 'it won't hurt' may backfire and only increase anxiety ahead of future visits," Clark wrote in a statement about the Mott Poll.

Pediatricians can help by offering anticipatory guidance at well-baby visits between the ages of 6 and 18 months, specifically addressing stranger anxiety.

“It takes just a few more seconds to note that a young child’s stranger anxiety may include doctor’s visits, and to recommend that parents prepare for future visits by educating the child using the strategies outlined in this poll report,” Clark says.

Involve the whole office, too, by getting staff on board with helping parents use strategies to minimize anxiety and doing it proactively rather than waiting until the child is crying.

Clark says she hopes pediatricians especially recognize the role fear may play in vaccine delays or refusal and help parents address these issues.

“A substantial proportion of US children are delayed on their immunizations. We hope this research will be one strategy to mitigate the problem of delayed immunizations, if pediatricians commit to addressing children’s fear-and parents’ anxiety-in a proactive and collaborative manner,” Clark says. “Most pediatricians recognize that some patients are afraid of going to the doctor, but they may not have thought about the implications of that fear in terms of delayed vaccines or skipped appointments.”

References:

1. C.S. Mott Children’s Hospital. Mott Poll report: Educate or placate when young child is afraid of doctor’s visits? Available at: https://mottpoll.org/reports/educate-or-placate-when-young-child-afraid-doctors-visits. Published October 15, 2018. Accessed November 30, 2018.