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Adapted speech helps children during a procedure

As a parent or professional, what can you do to best support a child with cancer who is having a procedure? Tirza Schuerhoff explains that appropriate or supportive language is important to reduce a child's anxiety and stress. 

Words can trigger images in the mind. Research shows that talking about pain or warning about a prick can lead to more anxiety and pain. It's often a reflex to say: ‘It'll only hurt for a little while’ or ‘If you don't cry, you'll get ice cream’ or ‘It won't hurt at all’. This only feeds the child's fear. As a care professional or parent, what is the best thing to do and say? 

Child life specialist Tirza Schuerhoff and her colleagues deal with a child undergoing a procedure several times a day. She says: ‘If you use helping words or positive language, you actually make a child feel more comfortable during a procedure. If the parents are calm, it has a positive effect on the child. In fact, we know that children are particularly receptive to their parents' emotions. Anxiety is contagious. If there is stress, pain, or fear, appropriate language can help direct the child's thoughts away from it. After the procedure, it is important to provide comfort and attention to the child's emotions, but most importantly to affirm that what went well was good and that it will be even better next time.’ 

No forbidden words  
Tirza: ‘You have to use language that serves the purpose you want. Often you can easily use other words. For example, I myself talk about ‘connecting the line’ instead of 'pricking', and other colleagues in the Máxima Center do the same. However, it is important not to create forbidden words. If a child asks me ‘Will I get a prick?’ I don't shy away, I remain honest and say: ‘Yes, that's right’. Appropriate language works best when everyone around the child speaks the same language. For example, if one professional says: 'It's all very exciting too' while the other tries to deflect attention away from the tension, that's not effective.’ 

Kiss of the Polar Bear 
‘From the very first moment, we use adapted language,’ Tirza continues. ‘Parents and children pick up language from us. When a care professional says: 'Here comes the polar bear kiss', it sounds nice, but it also indicates that something cold is coming, which is not usually associated with a positive experience. So even before the child feels the actual cold of a cloth with alcohol on it, they are already thinking about it. So, this definitely does not reduce anxiety, although some people think they are doing a good job. Another example is counting. For some children this actually increases anxiety. So first you have to know what a child needs in the situation of a procedure. Do they want to know exactly what is going to happen or do they want to be distracted? As child life specialists, we want to do more psychoeducation for care professionals and parents about the effects of adapted language.’ 

Focus together 
Everyone knows that distraction helps, but it's still a skill in itself, one that child life specialists know all about. Tirza: ‘When a child focuses on something else, he forgets the stress or fear. It's all about appropriate distractions that match the child's experience and development. To increase the effect of the distraction, it is important to link it to a cognitive and developmental task. This anchors the distraction and leads to attention retention. The more involved the child is in the distraction, the better it works.’ 

In brief 
Tirza: ‘Often we play a game or look in a search book around the procedure, then we say for example 'Wow, how well you can sit still' or 'Come on, let's find Wally, then the doctor can do his job well’. There is room for emotions and feelings before and after, but we know that this is not helpful during the procedure. In general, we are very clear in our support and say: 'I am with you and I will help you to make sure it goes well’. And afterwards, we focus on what went well because the children remember that it was a positive experience because they did well. It gives them confidence for the next time.’ 

Want to know more? Read the brochure, created by Child and Hospital, Skills for Comfort, Prosa and the Charlie Braveheart Foundation.