Suggestions for preparing for medical appointments?

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My son who is 4 has a really rough time with Doctor's appointments. He is so scared that he'll be getting a shot, that he'll have major meltdowns every time we go. We've had some appointments where there has been no chance he'll get a shot and I'll let him know that, but if I can't say without a doubt (and even sometimes when I can say it without a doubt) that he'll not be getting one, he'll literally cry from the time we leave the house, sometimes until we leave the doctors office.

So, here's my problem. He has an MRI scheduled. I am anxious about this as it is, so it doesn't help. I have to take him to a pre-op appointment to see the anesthesiologist this Friday. This appointment will likely be just to do a history and get vitals, etc. But, it's possible they'll draw blood.... And, then when they sedate him at the actual MRI, clearly there will be needles involved.

I honestly don't know how to prep him for it!! I know he's going to cry. A LOT. And, I'll probably have to physically force him to go one way or another. By sort of guiding him by hand or picking him up.

I would really like these experiences to be less painful for everyone. I hate that he's so scared of the doctors office. I am curious if anyone has ideas on ways to calm him before we go.

if you could get some simple doctor visits scheduled, whether for a well child check, eye check, something simple and guaranteed no shots, that may help him see that its not always traumatic. you can use a reward afterwards, some kids respond to that well, for instance go for ice cream after a doc visit, or a pack of pokemon cards for a collector, etc. be sure to take something to the visits that calms him, a DS or PSP if hes a game player, a favorite book, something to do with a special interest.

if he has a fear of needles, he needs to know if a shot will be coming, otherwise he will spend the entire visit in anticipation of getting a shot. let the doc office know he has this issue, and communicate with them before each visit to find out if he is in need of vac update or anything requiring a shot. then you can let him know for sure whether there is or isnt a shot coming. and if you tell him there isnt, then there can be NO SHOT, even if you were wrong. if they try to change the game plan, reschedule a time to come back for the shot.

talk to your doc and the anesthesiologist/hospital staff about using a lidocaine or EMLA patch when your son needs injections. these are used commonly in childrens hospitals. your doc office and the your local hospital should be able to get them easily. its a cream that is applied to the skin where the injection will be, and a plastic patch put over that for an hour. it numbs the skin and a bit below the skin. there are also iontophoresis units which use electrical current to deliver pain meds to the area where an injection will take place; these are not easily available to the general public tho, altho your doc or hospital may have access to one.

to me, if a child is crying consistently through the whole visit whether they know a shot is coming or not, sounds like possible needle phobia. keep in mind if it is needle phobia, his reactions are as uncontrollable as autistic traits. when you are in a full blown phobic episode, its just like a meltdown. its uncontrollable, does not respond to reason, and is over-exaggerated.

the pain blocking methods are usually pretty effective for phobics. its not all about the pain tho, it could be anticipation of the pain, the feel or knowledge of a foreign object entering your body, etc. but if you can get the area numb, it helps address both the pain and the sensation of the foreign object.

i speak from the experience of having a needle phobia since i was a child, which was exacerbated by major surgery with botched anesthesia 14 years ago. i have a severe phobia now. i have used the EMLA patches multiple times, and for me it makes things acceptable. doesnt make things good, but with the patch, it doesnt take multiple adults to hold me down anymore for IV insertion.

I find that something heavy on my lap or to lie under really calms me down. Perhaps you could buy or make him a weighted blanket or lap cushion before the appointment?

Hmmm I'm not sure this is something that improves too much with age. I still freak when I go to the doctors. I'm really scared. Especially of gynae stuff, blood tests anything internal. One time my psych came with me to the appointment and she distracted me lots listening to my iPod and stuff and tbh I would recommend distraction as the best way to get through appointments in general but I never had MRI. If ipod or ipad is possible for me it is the best way.

If it is so bad that he has to be restrained which would just further his phobia you can ask for a VERY SMALL dose of valium to give him to calm him. Try it before the visit to see his reactions and then give him some 30 mins before you leave for the visit. Explain to him that the medicine will make him sleepy but help him not be afraid. If he becomes combative at the appt be sure not to allow them to restrain him as this will further his phobia. Try to find a dr/anesthesiologist familiar with autism-that will go a long way. Ours was VERY slow and good about telling my daughter EVERYTHING before it happened and let her touch everything and see everything first. My daughter doesn't do well with the surprise tactics they use on most kids.

My son had lots of doctor's appointments and operations at around that age. We found that telling him ahead of time and letting him cry and process beforehand was helpful (to a degree). We also learned to not tell him that "it's ok" and "don't cry" and instead said "we know this is hard" and "we're here together". We did lots of role playing with his stuffed animals and a toy medical kit as well.
For my son's MRIs, we always request that they use a mask to put him to sleep prior to putting his IV in. This is crucial in that they often had to stick him numerous times to find a good vein for the IV. You can usually request this ahead of time so you'll know to prepare him. They can use flavored chapstick on the mask to make it smell less gassy as well.
I hope it all goes well for you.
Carolyn

Would he be more or less upset if he was prepared? My son did a study on learning disabilities that used a functional MRI; they had an MRI simulator so he could practice keeping still and it helped him a lot. One of the things that initially interested him in the study was this episode of Fetch with Ruff Ruffman: http://pbskids.org/fetch/show/video/season2.html

I'd preview it beforehand and decide if it will make things better or worse (sometimes images of brains upset my son, but for some reason they didn't in this case)

Even though I typically dont agree with medicating children I agree in this instance. When I was a child I was terrified of going to the doctor and I had to go a lot as I had frequent urinary tract infections. It did not matter if my parents told me that there was no shot I still had an anxiety attack. I have a hard time explaining the horrible fear that would overcome me but I can still to this day feel it. It is a physical feeling that is worse than nausea, if that helps anyone to understand. I hated the smell of my doctors office and the second we stepped inside and that smell hit me my anxiety would go through the roof and no matter what anyone said to me I was "gone"....hysterical. It was like any trauma that I had suffered there would come flooding back and no logic or words could help me.
Strangely enough I grew up to work in the medical field and to become the person on the other side of the needle. In this respect my past fears only helped me to understand (empathize) with my patients but If I could go back and do it all again I would want some of that fear alleviated and valium (which is what I now use for my anxiety attacks) would have been about the only thing that would have worked. I would first try the weighted blanket or try holding your son very tight (squeezes) if he allows that for doctors appointments. However for an MRI I would definitely go the mild sedation route. I dont know if you have ever had an MRI but they put you inside a tube for about a half hour and it makes all sorts of horrible noises.....nightmare city for Aspies! Also they may inject dye, depending on what he is having the MRI for. Actually, If I were you, I would insist on mild sedation for this procedure. Good luck and I hope everything works out.

Thank you all so much for your responses!! I am not exactly sure how I'll do the appointment this friday, but I'll definitely bring the ipod and promise Chik fil a afterward! The appointment is a pre op appointment with the anesthesiologist for the MRI. He's definitely going to be sedated for that.

The idea of seeing if they will do a mask before inserting an IV on the day of the actual MRI is a great idea. Hopefully we can do that. I also would not have known before to ask for a local numbing agent for this stuff... also very good to know.

As far as the lap pad is concerned. I DO have a weighted blanket. He used to use it to fall asleep, but doesn't anymore. He tends to not want me to squeeze him anymore either. But, maybe in the moment, I can still try it and see if it calms him.

I think if we have a lot more appointments with tons of crying, I will talk to the doc about using a small dose of something in those circumstances. I'll be trying everything else first.

I don't know if talking to him about it and preparing him in advance will cause him more anxiety or not. I mean, we've had times where he can't sleep and will obsess over stuff like this. I think he'll enjoy the "fetch" episode. He likes that show and will probably think that one is really cool.. plus it has the blue man group on it, which he really likes!

Thank you all so much. You have given me a lot to think about!

FYI - you will be extremely limited in the things that can go in an MRI: no electronic devices, no clothing with metal, etc. We found an all-cloth stuffed animal for DS to take in with him, and it helped him a lot - most offices have a metal detector that you can test things with. Also, the MRI may have a projector on the top of the tube - ask if they can play your child's favorite DVD and prepare accordingly.

Thanks! I'm actually ASSUMING he'll be asleep for it. I'm not actually sure what they have in mind, but I'm sure I'll find out on Friday for the pre op appointment. But, I think even sedated, he won't be able to stay still for long enough without being asleep for it.

Thanks again for all of your responses. Both appointments went really well!! The preop appointment I just called "an appointment" and never mentioned a doctor. He seemed to accept that fine... also with promise of McD's with the playground after and ipod and tons of snacks during the appt.

The second appointment, for the actual MRI went well too. we were returning to the same place, so I told him we'd be going back so they could "look at his brain." He thought that was funny that they wanted to look at his brain and it didn't freak him out. So, the day of the appointment, I gave him a new electronic toy with little video games on it to keep him from thinking about the fact that he wanted to eat and drink! I was honestly surprised how well it went. The staff at the hospital did so well with him. They gave him gas before the iv and we walked him down to the actual room before they did all that... and the tech was getting him all excited about seeing an airplane on the ceiling before going into the MRI room.

So, again.. thanks for all the ideas... they were great! And, I plan to show him the "fetch" episode now because I think he'll be interested to see at how they looked at his brain!