Finding Their Comfort Zone

Sande
Riesett
Kennedy Krieger's Pediatric Psychology Clinic Helps Calm Children's Fears of Medical Procedures by Teaching Them What to Expect, What to Do, and How to Relax

Sam SpringLast year, 5-year-old Samuel Spring came to Kennedy Krieger Institute for evaluation of autism. The genetic and metabolic tests he was to undergo required giving a blood sample. When the nurse tried to tie the tourniquet around his arm in preparation for the needle stick, Sam began to cry and break away. His behavior made it difficult for the nurse to draw his blood. Sam's doctor, William Trescher, M.D., a pediatric neurologist at Kennedy Krieger, referred the Springs to the Institute's Pediatric Psychology Clinic for consultation and treatment of Sam's anxiety and distress over the medical procedure.

Children with disabilities and health conditions often require medical services, such as diagnostic scans, physical tests, bandage changes, medicine intake and injections, which they typically fear and avoid. Sometimes their anxiety and behavior issues can interfere with the delivery of these important services. Kennedy Krieger's Pediatric Psychology Clinic helps children and their families learn to participate in various physician-prescribed, medical care activities.

The Pediatric Psychology Clinic teaches children and their families about the medical care procedures they need, as well as coping and stress reduction skills. "I've been amazed over the years that children can cooperate with most of the procedures that adults can. They only need a little more time to learn about what is going to happen and to develop the skills adults have already acquired along the way," says Keith Slifer, Ph.D., program director of the Pediatric Psychology Clinic. The clinic serves children and adolescents with a wide range of medical conditions, including asthma, brain injury, cancer, chronic pain, immune system disorders, renal disease and sickle cell anemia, among many others.

The anxiety that children have when receiving medical care is not unusual. "It's normal for a child to get upset and try to escape getting stuck with a needle," explains Jo Anne Gorski, Ph.D., a behavioral psychologist at the Pediatric Psychology Clinic. "We try to help children adjust to an unusual situation by teaching them new strategies to help them relax and tolerate the necessary procedure."

Melissa Beck, Ph.D., a behavioral psychologist at the Pediatric Psychology Clinic, provided a treatment program to desensitize Sam to the materials used in the needle stick procedure. Using a task analysis technique, she identified the steps in the process and broke them down into their component parts. Sam was introduced to each step gradually. "We started by having him play with the tourniquet and get accustomed to its color and texture," Dr. Beck explains. "Once we familiarized Sam with the material, we started to rub it gently on his arm to help get him comfortable with it touching his body. Then, we loosely tied the tourniquet around his arms for a few seconds, building up to a couple of minutes." Dr. Beck used the same technique with a mock needle to desensitize Sam to the rest of the blood draw routine.

The Pediatric Psychology Clinic also offers relaxation therapy, teaching children and their caregivers skills to manage anxiety, distress or pain. Children who can cognitively understand and follow instructions are taught various stress reduction techniques, such as visualization exercises and deep, abdominal breathing. In 2002, the clinic implemented new biofeedback tools to help teach children how to control and monitor their bodies' responses, such as blood pressure, heart rate and muscle tension.

Biofeedback helps psychologists at the clinic gauge and direct a child's treatment progress. Providing a concrete visual screen, the biofeedback machine gives children feedback on how their bodies are responding to the relaxation techniques. "Biofeedback is presented as a video game for the body," Dr. Gorski says. "If a child raises his temperature over certain degrees, a robot walks or plays music. It is very entertaining." While useful for many children, biofeedback was not appropriate for Sam. Distraction was the optimal intervention for reducing distress and keeping him calm. "Sam would sit in my lap, and my wife would distract him with games, books and toys," Mr. Spring says.

After three months of treatment at the Pediatric Psychology Clinic, Sam was ready for the actual needle stick procedure. "We scheduled the blood draw with Dr. Trescher, and Sam did fantastic!" Mr. Spring says. "Dr. Beck did a great job with us. I would highly recommend Kennedy Krieger to anyone who needs such a service for their child with special needs. It certainly helped us."