Like many kids, Lisa Sparrell's daughter never liked getting shots at the doctor's office. "At first she'd cry some, but was quickly placated with rewards like a lollipop or a sticker," says Sparrell, who lives in Honolulu.
But last year, Sparrell's 10-year-old daughter was diagnosed with a heart defect. In preparation for surgery, the little girl's trips to the doctor sharply increased –and so did her anxiety.
"The frequency of appointments — many of which included blood draws and IV placements — made her fears worse," Sparrell says.
The concerned mom tried bringing electronics and books to medical appointments, hoping distraction might short-circuit her daughter's fear. She also tried addressing the worries by asking the child, ahead of appointments, "OK, what's our plan?"
None of these tactics worked. In fact, her daughter's medical anxiety became so severe that she'd scream, "Please don't do this to me!" whenever a health care provider tried to prick her with a needle.
That might sound extreme, but results of a nationally representative survey, released earlier this year by researchers at the University of Michigan, suggest that a significant number of young children fear doctor visits. In fact, of the 726 parents surveyed, roughly half said their kids disliked going to the doctor.
Not surprisingly, 66 percent of children between the ages of 4 and 5 hated getting shots, while 43 percent of 2- and 3-year-olds fear doctors as part of a more generalized stranger anxiety. The report also revealed that 1 in 25 parents surveyed had postponed a vaccine appointment because of their child's medical anxiety.
Sparrell says she can relate. "When my daughter screams at the doctor's office, I feel like I'm doing something terrible — even though it's the right thing to do." She, too, has delayed getting her daughter vaccinated against the flu this year, Sparrell admits, just to avoid that stress.
Seeing their child unhappy upsets many parents, especially when they can't stop the pain. And witnessing an anxious kid's tears and pleas to avoid getting pricked and probed can raise a parent's anxiety levels, too.
When this happens, says Sasha Albani, a child and adolescent psychotherapist in San Francisco, many well-meaning parents either ignore the wails or jump into rescue mode. Both approaches can boomerang.
"Parents may avoid discussing the problem because they believe it will make things worse," Albani says. "Sometimes, they cancel their child's medical appointment." Unfortunately, these behaviors undermine a child's confidence that they can weather difficult situations, and only reinforce kids' worries.
Children who withdraw from frightening situations or environments may be more likely to struggle with social anxiety, later in life, psychologists find. A 2018 report released by the Child Mind Institute suggests that untreated anxiety also can lead to depression, academic difficulties and substance use down the road.
But there's hope! Albani suggests parents calm themselves and find age-appropriate ways to help children face their medical fears instead of fleeing them.
For very young kids, who have a hard time putting words to thoughts and emotions, imaginary play with mom or dad before the appointment can help, Albani says.
"Use a toy doctor kit to explain what will happen at the appointment and to discuss your child's specific worries," she advises.
Reading books and watching movies depicting children getting shots, going to the hospital, or visiting the doctor can remind kids they're not alone, and introduce different ways of dealing with the anxiety.
Children under age 6 may benefit from the book, "Daniel Visits the Doctor" by Becky Friedman.
Kids with needle phobias may be helped by reading, "Lions Aren't Scared of Shots: A Story for Children About Visiting the Doctor," by Howard S. Bennett. And the book "Imagine a Rainbow: A Child's Guide for Soothing Pain," by Brenda S. Miles, may be useful for older kids between the ages of 8 and 10.
Playing The Coping Skills Board Game can bolster the confidence of preteens like Sparrell's daughter, as it teaches techniques for handling life's challenges. And smartphone apps like "Stop, Breathe & Think Kids" can be a fun way to learn mindful breathing techniques and other relaxation tips that help turn down the alarm of worrisome feelings.
Doctors have also had some success using more novel interventions with kids, like virtual-reality technology, says Dr. Tom Caruso, a pediatric anesthesiologist at Lucile Packard Children's Hospital Stanford in Palo Alto, Calif.
"Virtual-reality technology can redirect a child's attention by immersing them in a more calming experience," says Caruso, who co-founded the hospital's Chariot Program, a group dedicated to reducing the anxiety of hospitalized children.
Hospitals and clinics already have begun testing VR to soothe kids' fears during a range of medical procedures, including IV placement, blood draws and vaccines. A 2017 review suggests the approach lessens pain and anxiety by diverting a child's attention from the feared stimulus — and may be more effective than other distraction techniques.
But there's no single best approach to easing fear, Caruso says. "It's important to use tailored interventions. Children with mild worries may be calmed by listening to music, while others may be helped by virtual-reality techniques."
Talk therapy can be helpful if anxiety persists or grows. Some children won't outgrow their fears without such support, doctors find.
"Therapy doesn't have to last forever," Albani adds, "and brief cognitive-behavioral treatment or exposure therapy has been shown to help."
Whatever strategy parents or other caregivers choose, acknowledging the child's fear is the important first step, therapists say. Just like adults, kids feel validated when we acknowledge their worry, find them help and then let them know that everything is going to be OK.
And kids who learn to feel safe with their doctors early on are more likely to trust them with serious health concerns as they get older.