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A challenge to Parents
and Health Care Professionals
A set of
standardized care techniques is presented here to help
prevent induced needle phobia in young patients
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A small
majority of needle phobics were
genetically predisposed to develop this potentially fatal condition.
The remainder develop it as a result of negative experiences with
the health care system. The majority, if not all of the cases,
can be said to be instigated or induced by
inappropriate care during their first encounters with the health care
system. The techniques described here may seem extreme
considering that only about 10% of patients develop needle phobia.
The special care suggested is justified considering the severe
negative consequences of needle phobia. Parents and health care workers
need to understand that their actions induce or trigger the
development of this phobia - it is not the result of a weakness in the
child's emotional constitution as has been assumed for so long. A
potentially life-long condition that causes such severe suffering and
can even be fatal that is induced by inappropriate care in one
of out every ten patients is simply worth the small extra effort
required to prevent it.
The many protocols used in modern medicine that we now take for granted
were historically developed when understanding of the cause of induced
illness became clear. The importance of sterility in surgery is a
good example. No doubt when first proposed many practitioners
felt that sterile fields were far too difficult, time consuming and
expensive to be practically implemented. The cost of these
precautions cannot be weighed unless the consequences of not
implementing them is fully appreciated. The cost of needle phobia
has not been appreciated until now because the consequences often do
not become apparent until long after the affected patients have left
the care of the original practitioners who's treatments helped induce
their condition.
While 10% of patients would benefit immensely from avoiding needle
phobia, as many as 50-70% of other patients would still benefit to some
degree from improved care even if they avoid developing clinical needle
phobia.
Below are improved care suggestions for both parents and health care
providers (including dentists) that will go a very long way to helping
prevent needle phobia. Other forms of blood/injury phobia might
benefit as well from these care suggestions:
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1.
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Identify
those children who are to receive their first invasive/painful
procedure, preferably at the time the appointment is made - avoid
having to deal with it during the first appointment.
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2.
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Survey
parents and siblings in order to discover whether they may have
exhibited needle phobic reactions.
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3.
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Ask the
parents whether the child has exhibited unusual sensitivity to pain.
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4.
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Find out
if the child has ever fainted upon exposure to fearful stimuli or has
fainted for no known reason.
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5.
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If a vaso-vagal reaction is suspected or experienced
during the first needle/blood exposure then it should be treated before
any more such procedures are attempted. A tilt-table test may be
indicated. If the reflex cannot be eliminated then all future
invasive procedures need to be handled in a way very different than
other patients, up to and including the use of general anesthesia.
Procedures which stimulate the reflex should only be attempted in
facilities staffed and equipped for cardio-pulmonary resuscitation.
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6.
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If
associative fears are detected then professional emotional health
treatment may be indicated prior to proceeding with any invasive/needle
procedures.
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7.
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The
first few procedures are so crucial that they need to be the best
health care experience of the child's life, not the worst. This justifies the prophylactic
administration of topical anesthesia such as EMLA or iontophoresis whether it is known to be needed
or not. The first few needle sticks need to be absolutely
painless. Let the patient's reactions be the guide as to if or
when anesthesia can be reduced or eliminated.
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8.
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It goes
without saying that there is no room in the child's first exposures to
health care for any negative emotional coercions or punishments such as
ridiculing the child for resisting fearful or painful procedures. Treat
the cause of the resistance, not the resistance itself.
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9.
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Restraint:
A child should not be physically restrained or otherwise forced to
undergo elective invasive/painful/needle procedures. "Elective"
means a procedure which is not immediately required to save
life, limb, or preserve long-term health. Even necessary
procedures should usually not be forced on children with the possible
exception of those patients who are mentally impaired or are so young
that they effectively are unaware. (Note: there is growing
evidence that even painful procedures performed at the age of a few days
is emotionally harmful and is remembered). When
necessary, care for the very young or mentally impaired, medication
(pharmacological restraint) might be a better approach. Emotional
restraint such as purposeful embarrassment, insult, or threat of
punishment is harmful and should not be used.
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10.
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Health
care workers must be completely honest with parents and patients.
There is no room for hiding the truth even if the intent is to be
helpful. Painful procedures should not be untruthfully described
with phrases like "this won't hurt a bit". When a patient
experiences pain after being told a procedure won't be painful they
feel confused, have self-esteem challenges, and ultimately become angry
and distrustful. Many needle phobics
trace their life-long distrust of health care workers to "being lied
to" when they were young. Even euphemisms should be avoided such
as "you might feel some pressure". Pressure and pain are
different things - don't confuse them. While you should not
exaggerate the discomfort, keep in mind that it is much easier to harm
a child when using half-truths, untruth's, and mistruths than by undo
frankness.
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12.
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If the
child is too young to understand then take actions to make procedures
physically painless and health care encounters as emotionally free of
stress as possible until such time as they are mature enough to
understand what is happening. A big helping of emotional support
and praise goes a long way.
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13.
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The goal
is to make encounters with the health care system non-tramatic and to build the perception that health
care is good and the workers involved are friends. You know you
are moving in the right direction when each encounter with the health
care system is less stressful rather than more
stressful. If the child is more stressed and expresses increasing
resistance with each health care encounter, then you are moving in the
wrong direction and you should stop and re-assess your approach.
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14.
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Start by
using anesthesia (like EMLA cream) so that the first procedures will
be painless. One recommendation for future
procedures is to ask the child if and when they want to stop using the
'messy' cream or an iontophoresis machine.
Be honest - tell them it will then hurt a bit, but for only for a
few seconds. Tell them if it hurts too much, they can ask for the
cream the next time.
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15.
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Give
the child as much control as possible as soon as possible. It
will serve them well for the rest of their life.
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From The Needle
Phobia Information Center, http://www.needlephobia.info write to
klamb@columbus.rr.com for reprint permission
©2007 by DK
Lamb, all rights reserved
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