Anxiety is a normal part of childhood and every child goes through phases where he might develop anxiety over a variety of issues such as the dark, going to school and being separated from parents. In addition, children with bleeding disorders may also perceive invasive medical procedures, such as repetitive blood work, injection and venipuncture, with fear and anxiety. The difference between children and adults when confronted with anxiety and stress is that most adults have found ways to manage their anxiety while children need to be taught and guided to manage their emotions. This article provides an overview of what you can do as a parent to help your young one develop adaptive anxiety management skills that can be used in different difficult situations.
Brief Look at Anxiety
First, let’s look at what anxiety is. Simply put, anxiety is a normal response to a real or imagined threat. When we perceive something as dangerous, many rapid changes occur in the mind and body to help us deal with that threat. This reaction is known as the ‘stress response’ or ‘fight or flight’ reaction. This fight or flight response is automatic and causes a range of changes in your body.
- Breathing rate becomes heavy and quicker
- Heart rate increases
- Muscle tension
- Increased sweating
- Dizziness, numb or tingling hands and feet
- Mind becomes preoccupied with the threat, unable to reason, concentrate or process information as normally would
In children, other signs and symptoms may include constant crying, moodiness, trouble sleeping, unexplained gastrointestinal problems, headaches, and a need to repeat certain behaviours such as hair pulling, head banging or repeated blinking.
What Can You Do?
i) Have a Discussion with Your Child
Children get anxious when they do not understand what is happening to or around them. For example, they may not understand that the bodily changes they are experiencing are signs of anxiety and thus, would benefit from being taught how to recognise anxiety. Let your child know that you understand he is afraid and allow him to express his feelings. Remind him that everyone gets frightened at times, even parents and tell him how you managed your anxieties. Let your child know that you are here to help him.
ii) Set a Good Example
Children are like little sponges. They learn from observing their environment. The child of a nervous, anxious parent will most likely be nervous and anxious. Hence, at all times, model positive coping behaviours and try to remain calm in stressful situations. This will help your child to learn to respond positively. For example, if you miss a vein during venipuncture, you could say “well, I missed it this time, but let’s stay calm and try again”. In addition, getting impatient with your child (e.g. telling him to “get over it and stop being a baby”) serves to increase his anxiety and escalate the situation. On the other hand, praise your child when he attempts to face his fear and where appropriate, provide a small reward to reinforce the behaviour.
iii) Teach Your Child Coping Strategies
Finally, teach your child relaxation strategies to manage his anxiety. A number of useful techniques are listed in this article. It is best to help him develop these skills during peaceful times where he is calm and has time to learn. Remember that relaxation is a skill that needs to be practised over time (just like learning to drive a car) and best integrated into your child’s daily routine.
Relaxation Strategies and Techniques
The aim of teaching relaxation is to alleviate your child’s anxiety and fear of situations (or in the case of haemophilia, an invasive procedure) so that he develops a good ability to cope, self-calm and self soothe. The important thing to note is that techniques should be selected and adapted based on your child’s age, level of understanding and interests. Also, you may wish to find out more about a particular technique before teaching your child as this article provides a brief overview only. For specific tips on how to manage fears surrounding needles, go to http://www.hemaware.org/story/needle-know-how.
Controlled Deep Breathing
This is a highly effective method to help children relax and focus attention away from the anxiety-provoking stimulus. Deep breathing helps to bring about positive changes in blood pressure and heart rate, thus helping your child to regulate his breathing, to prevent hyperventilation and reduce symptoms of anxiety. It is important that your child uses an abdominal breathing style (i.e. use the tummy to breathe in and out) rather than a chest breathing style. You can check this by getting him to place one hand on his stomach and one had on his chest. The hand on his stomach (at the base of his rib cage) should rise when he breathes in.
The following steps can be read to your child.
- Breath in for three seconds
- Hold your breath and count to three
- Breath out for three seconds
- When you get to three, say the word ‘relax’ to yourself, in a calm and soothing voice.
There are some fun ways to help children master this skill.
- Have your child imagine 10 candles in a row and then blow them out one by one
- Have your child actually blow bubbles with a bubble solution and wand
- Use a straw to blow a cotton ball across a table or the floor
- Use a easy-to-turn windmill to teach breathing
These visual exercises (seeing the bubbles and cotton ball move) can help reinforce children’s efforts and provide a means for them to monitor their breathing. Once your young one has mastered the art of controlled breathing, you can get him to practice it in his daily life, or during anxiety-provoking situations like receiving a treatment. Note also that controlled deep breathing is often paired with progressive muscle relaxation and imagery (these techniques are explained below) to enhance relaxation.
Progressive Muscle Relaxation
Progressive muscle relaxation (PMR) consists of systematically tensing and relaxing specific muscle groups twice before moving on to the next muscle group. It helps children become more aware of their bodily changes that take place when they tense and relax. You may do this relaxation technique in any comfortable, well-supported position, sitting or lying down. To get the most out of relaxation, prepare your child and his surrounding by reducing potential distractions, such as from the telephone and television. A good time to practise is at night just before sleeping. There are many PMR scripts for children available online (e.g. http://www.yourfamilyclinic.com/adhd/relax.htm and http://www.aboutkidshealth.ca/En/Documents/
Progressive_Muscle_Relaxation_Script_EN.pdf), in books and in audio formats which you can use with your child. Choose one that suits your child’s developmental stage.
Visual/ Guided Imagery
Imagination is a special form of distraction that comes very easily to young children. The idea is that by concentrating on a pleasurable image, your child will no longer be preoccupied with the source of anxiety. The important thing is to help your child select an image or scene that is meaningful or pleasant for him (somepeople call it a “safe place”). Once chosen, help your child to focus on his senses – the sights, sounds, smells, touches and tastes. So for example, if your child enjoys being in the playground, you can gently guide him (using a slow, calm and reassuring voice) by asking him about the sound and feel of the wind, smell and colour of the grass, and the taste of his favourite drink as he sits on the swing. Finally, what good are skills if you forget to use them? You can supplement the above techniques with visual reminders such as:
Children can benefit from creating a portable calming down kit that they can bring around to potentially stressful situations (e.g. planned surgery). This kit can take various forms and depends largely on your child’s age and interests. You can get your child involved in the creation of such a kit. Things that are typically used include bubbles, colourful squeeze balls, small stuffed animals, candles, cotton balls and straws.
Calming Cue Cards
Some children and teens may not be interested in completing an actual kit. A good alternative would be cue cards that are created, laminated and connected by punching a hole in the card and stringing the cards together. Examples may include pictures of a bottle of bubbles, a squeeze ball, calming images or picture and speech bubbles with self-talk statements (e.g. “take 5 deep breaths slowly”).
Knowing when it’s Time to Seek Professional Help
Anxiety in children with chronic conditions is common and can be effectively managed using simple techniques. It is normal for children to experience anxiety and as a rule of thumb, you should be more concerned if your child’s anxiety and fears are excessive and he is not able to cope in everyday living. If that happens, seek professional help for your child. Information for this article is taken from the following sources:
Fung, E. (2009). Psychosocial management of fear of needles in children. Haemophilia, 15, 635-536.
Friedberg, R. D., McClure, J. M., & Garcia, J. H. (2009). Cognitive therapy techniques for children and adolescents: Tools for enhancing practice.New York, Guilford Press.
This article originally appeared the December 2011 issue of National Haemophilia magazine. Reprinted with permission from the Haemophilia Foundation of Australia