Injections, tears and laughter: working on fear to get through unpleasant medical procedures
author By Emilie Leeks,

All children are very likely to have to undergo some sort of unpleasant medical procedures in their young lives - some more challenging than others. This story describes our experience of getting our very sensitive youngest child (AKA 'Tiger') through a set of injections at 4 years of age. We read up on ideas of what we could do to prepare him and tried different things out, and we also prepared ourselves for things being tough in the moment itself. Ultimately, he got through it very upset but listened to, and having been given enough time to reach a point where he himself could say he was ready. Here's how we did it.

syringe toy

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How different children are!
I remember taking Tiger for injections when he was just a few months old, with his older sister ('Penguin') tagging along. At the time I mentioned to the nurse that I thought our middle one was due some injections as well. The nurse looked up Penguin's details, found she was about due, and then decided that Penguin should have hers on that day, instead of Tiger. The nurse's reasoning was that if Penguin saw her little brother having his injections, she then would be too fearful to come back to have hers done in the future. Well, this was definitely a no as far as I was concerned!! I had assured Penguin that whilst she would need injections in future, she definitely wouldn't be having any that particular day, and there was no way on earth I was going back on that and losing her trust! And besides, I knew her well - I knew that although she would be challenged by having injections herself, she would understand the necessity and would be able to override the fear and discomfort enough to get it done. I was right - when we went back a few weeks later for hers, she sat still, cried a little, and the job was done. Afterwards, she played away some of the big feelings she had about the experience, and that was that.

As for Tiger - I was not so confident! I kept thinking 'maybe as he gets older he'll find these sorts of things a little easier' but I was really clutching at straws! In reality, I knew that without some work before we went, it would be unlikely that I would even get him in the room, so we began to prepare.

Make it real
I found some articles about injections (which I've listed in the 'Useful resources' list below, along with some other, related articles), and got some inspiration for what I could try. As every child is different, I wanted a good few ideas in mind because I knew that some would go better than others. I'm a big believer in honesty and not trying to skirt around difficult issues, so the first thing we did was to openly discuss with Tiger what was going to happen. We told him that we sometimes have injections to help us fight off serious illnesses* and that yes, it would hurt. This is a crucial step in helping a child to confront a fear - if we hide the reality of a situation, they have no chance to prepare, and to experience and release the feelings about what is coming up.

Let's play!
We then experimented with some play ideas. I first started with getting out some toy doctor's tools, including a syringe (you could use anything to represent this though of course!). I tried setting up a quick doctor's surgery with me as the patient, and was saying 'But don't give me any injections will you?!!' in mock fear. This kind of playfulness, where we take the less powerful role, is an example of the Hand in Hand tool of Playlistening. It allows children to be in charge as they face something they are afraid of, and to laugh away lighter fears. It led to a few giggles, but then Tiger, who is very aware of how others are feeling, decided he really didn't want to give me injections (not even pretend ones) - I think he didn't want to upset me for real, even though I was totally hamming it up!

We then moved on to giving injections to his teddies. At first, he was the one holding the teddies and giving them injections, and he was giggling a bit. But then it switched around to me holding the teddies for him to administer their medicines - and then they just would NOT sit still!! He laughed and laughed as he tried to give his wiggly teddies their injections, as they flopped around, jumped up, or whipped themselves away to hide behind my back. They also moaned and groaned and squeaked and made lots and lots of silly, over-the-top fearful noises! This went on for a good while with lots of laughter, and in the end Tiger managed to persuade them in his own sweet way, and then was very kind to them and told them they needed to have it done, but that it would be ok.

injections tiger eeyore

Probably the trickiest part of this was the older two children wanting to join in (which is fine) but trying to take the play in a way that didn't help Tiger to feel in control of the injections, so I had to give them a bit of a nod and a wink and a quiet explanation that they needed to follow my lead - it went better after that! I would have liked to have found the time to have done this more than we managed as I think that would have ultimately been helpful, but life gets busy! I also would have liked to have ramped up the Special Time in say the week before the injections, to increase Tiger's feelings of safety, but again this didn't happen as I'd hoped. We did the very best we could.

Getting ready to listen
As the date of the injections grew closer, we would occasionally mention 'your injections are coming up next week' etc - we wanted to give him a chance to feel the fear, and express whatever he needed to. When we reached the night before and I mentioned it to him, he said 'Don't say that! Don't say that word!' and was clearly worried about the next day. I said 'It's hard to hear isn't it' and he kept saying things like 'I don't want you to say that word'. At this point I thought some laughter might help, as he wasn't looking like he was going to release any emotions through tears or physical aggression/ rough-and-tumble play. I started out by saying 'You don't want me to say "injections" - oh!! I just said it!' and clamped my and his hands over my mouth with mock surprise - he got the idea then, and I kept 'accidentally' saying "injections" and he would laugh and clamp my mouth shut, but the word just kept popping out! Then he started saying it as well, and I would say in mock horror 'Oh no! You said it!' and would put my hands over his mouth - of course he cleverly was always able to sneak his face away to shout 'injections' again, to which I responded with very melodramatic terror. There was a lot of laughter! In fact, it was hard to keep the 'fear' going in my voice and face, as we were both giggling so much! But again, he was back in the driver's seat, being in control of this word that seemed to hold some power for him.

hands over mouth Em (2)

The other thing that has really helped in these sorts of situations, is taking my own fears to Listening Partnership before the big day! I knew it would be hard to see Tiger in pain, but to be honest, my biggest fear was just that he would refuse altogether! Listening Partnerships, where another adult just listens with warmth to what we have to say (and then we do the same for them) mean that we can work through our own worries, and shed our own fears, so that we go into difficult situations carrying as little emotional baggage around it as we can. It can be especially helpful if you have had difficult experiences in similar situations in your own past - fortunately for me on this occasion, that wasn't the case, but Listening Partnerships are incredibly helpful for exploring past challenging experiences and working through them. If you haven't got an LP already, I would highly recommend it!

LP Em Stuart

On the day
We had decided that the whole family would go to the appointment, so that we had some flexibility - and so that the whole of the responsibility wasn't just on me! Tiger had decided which teddies were going to come along with us (of course it was those which had had lots of injections themselves!), and gathered them together. There were a lot! When we arrived, he didn't want to chat to the nurse much, so I answered questions for him. We gave him as much control as we could, making sure we took our time - we asked who he wanted to sit with (me or Daddy), and which way round he wanted to sit etc. He was clearly nervous but was working with us and had no objections at this stage, as long as we took it slowly. So we then asked if he was ready, and he said yes, so the nurse gave him the first of two injections. And he screamed - I think it genuinely just was more painful for him than even we might have expected, and in spite of all our preparation he was shocked.

So the first one was done but he was very upset now - crying, wriggling, and definitely not yet ready to contemplate a second injection. I gently said a few quiet words, like 'That was really hard' and if his crying eased a little I would remind him that he still needed to have the second one - my aim was to allow him the time to release as much of the difficult feeling around the first injection (and the prospect of the second one) as possible, so that he could get to a point where he would tolerate the idea of having the other one.

The nurse was very patient, and I had already established on making the appointment how much time we had (20 minutes) and that we would not be holding him down and forcing him against his will to have the injections at any point, and that we would come back for the second one at a later date if needs be. But I didn't want to! I knew that would then be a huge amount of work, so I was hoping the nurse would wait long enough. He just need time to get enough of the fear out through his tears and trashing around, so that he would manage the second one. She tried to distract him gently a couple of times, but to be honest it was pretty easy to ignore that as it was entirely ineffectual, what with him being so upset! Holding in my mind what we were trying to do, and what we knew was right for us, was really key at this point - we knew that he would be able to have the second one without being forced, whether it was on the same day or another, and we knew that that was the best for him. Sometimes as parents we may find ourselves in that extremely challenging situation having to physically force our children to accept some sort of medical intervention (and then having to repair afterwards, which of course can be done), but this was not a life-saving or immediately serious situation, so that was not justifiable for us in this instance.

So we carried on listening for a while, and setting the gentle limit that the other injection would need to be done. We offered for him to choose who he wanted to be with for the second one, which led to fresh waves of tears and protestations. After what felt like a lifetime, but in reality was probably about 5 minutes altogether, he indicated that he wanted to go to Daddy, and then told Daddy to 'stand up'. I asked 'Do you want to do it standing up' and he said 'yes'. He was still scared but held completely still for the second injection - although the scream he gave was completely heart-rending. Again, it felt like it hurt him much more than we might have expected. But it was done. Ultimately, he was the one to let us know that, even though he was still terrified of the pain, he was ready to face it. And if that's not bravery, I don't know what is. Bravery JiP meme

Afterwards
Daddy carried a still-sobbing Tiger out and all the way back to the car, all the while listening to his tears and offering gentle reassurances like 'I'm right here' 'I won't leave you' and 'That was really tough'. By the time we got to the car, the tears had stopped, and Tiger was ready for something to eat and drink. He wasn't his usual perky self when we got home, but he was smiling and gently laughing again, and by the time we'd had a few stories and some lunch, he was back to normal.

I have no doubt that Tiger will benefit from some time to play through any residual feelings from his experience and get some laughter going - I think we'll try some doctoring of teddies again, as that seemed to go down so well before. Some extra Special Time is a must as well - like his sister did all those years ago, he believes that taking the plasters off will hurt, so he will need a good sense of safety to cry to us about it all if he needs to. But by the evening, he was able to talk about the injections calmly, and was playing and enjoying himself as he usually would.

Finally, there is one other thing that will need to be done: my husband and I will need to take some Listening Time for ourselves. We felt relieved but completely emotionally (and physically!) drained by the experience, and we will need to let go of how hard it was to see our little one suffer, even whilst we hold onto the fact that he will be absolutely fine. Our bodies are so good at knowing how to release the tensions of difficult experiences if we just let them, and Listening Partnerships are a great time to do it. Ultimately, we're very glad that we put so much into what we knew would be a challenging experience - in spite of the exhaustion, it was definitely worth it!

bunk bed climbing Tiger Dragon

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*We are well aware that vaccinations are a hot topic! Through our own research, we decided that vaccinating was the best way forward for our family, but we understand and respect that others may have different views. This story is not meant as a judgement on vaccinations one way or another, but instead can be used for ideas when your children need to have treatment of any kind which is worrying or unpleasant for them.

Useful resources:

Special Time to address a frightening situation - how our daughter used laughter to work through her fears around injections

Scrapes, cuts and dustups: helping your child heal - how listening can help your child work through big feelings about being hurt

The day I first partnered with my child - how listening to a child helps them overcome their fears about procedures

Preparing children for doctor visits replay - free audio recording about visiting the doctor

Preparing your child for surgery - another on preparation, lots of practical ideas

Healing without medicine - how a parent's listening helped her child after an accident

My child's crying helped with a major accident - another parent helps her child through lots of listening

Healing hurts from vaccinations - how Playlistening can help a child work through a difficult experience

Parenting that heals painful memories - working on your own feelings when your child is hurt or unwell

Setting New Dentist Template - this mother ended up cancelling a dentist appointment in order to listen through her son's fears about it, with a very successful outcome

A word or two about Journeys in Parenting; a responsive parenting community

Emilie is a Hand in Hand Parenting instructor, and was a paediatric speech and language therapist in her former life. She provides support and coaching for parents via the Journeys in Parenting community. Emilie lives in Berkshire in the UK with her husband and 3 children.

Journeys in Parenting is a community group for parents, carers and parents-to-be, who want to find out more about parenting in a responsive and peaceful way. The community offers information, advice and emotional support for this hard work we do as parents. The vision of the group is to be a safe space, where parents are supported in guiding their families in ways which: are respectful to children; meet the parents' needs; and lead to a more peaceful planet for all.

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