Fear not: 4 ways to counter kids’ exam anxiety

Doctors certainly don't need a statistically valid sample size to prove it: Young children aren't thrilled with doctors' visits, and their ensuing fear can detract from parents' interactions with the care team.

In a report recently released  by the C.S. Mott Children's Hospital National Poll on Children's Health, half of surveyed parents said their child feared doctors' visits, while 1 in 5 parents reported the resulting struggle to calm those anxieties made it difficult to concentrate on what the health care provider was saying. The poll oriented toward general pediatrician visits where preventive care services such as immunizations drove most children's fears (66%); however, the report primed insights that can help both patients and doctors of optometry ensure young children have an easier experience during their first eye exams.  

Aside from shots, stranger anxiety was the next most-cited reason for children 2-3 and 4-5 years of age to fear doctors' visits (43% and 14%, respectively), and that fear didn't waver based on whether the child saw the same doctor or not each visit, the survey says. But, to parents' credit, they tried numerous intervention tactics to calm frazzled nerves.

Most often, parents tried educating youngsters about doctors' visits by talking about what will happen (61%), playing with a toy medical kit (26%) or reading a book/watching a show about doctors' visits (23%) prior to the appointment. On the other hand, some parents tried placating their children either via a reward afterward (31%) or assuring children they wouldn't get a shot (21%)—though authors point out the latter could backfire and worsen the child's fear.

"In normal circumstances, taking a young child to the doctor can be a hassle for parents, requiring arrangements to leave work, rushing to arrive on time, and perhaps waiting for the appointment to get started," the report states. "When a child is upset or uncooperative due to fear, the situation can be frustrating for the child and parent." 

Looking fear in the eye 

It's natural for young children to feel apprehensive toward doctors' visits, especially when shots are involved. However, when it comes to their eye exam, children may not make a distinction between the doctor of optometry's or pediatrician's office. Shots aren't typical of pediatric eye exams, yet there are analogous anxiety drivers for children with which many doctors of optometry are familiar.

"Definitely tonometry," says Katherine Schuetz, O.D., an InfantSEE^® provider and owner of a pediatric eye care practice in Carmel, Indiana. "But, there's also fear of reading the letters wrong, or saying the wrong thing and ending up in glasses unnecessarily. Well-meaning parents will even coach their kids about being honest when reading the shapes or letters correctly, 'so the doctor will know if you need glasses,' which make the kids too nervous to say anything.'" 

How does Dr. Schuetz calm those little nerves? It helps to have a little fun. The entire patient experience, from the waiting room to the exam chair, caters specifically to her target patient group, infancy through age 13. There's an arcade game in one corner and colorful, kid-friendly furniture in the other, while children receive a "Treasure Token" after exams to claim a prize. It's all about creating a welcoming and comforting experience that puts children at ease. 

"When kids are comfortable, we get excellent retinal pictures from 2- and 3-year-olds, along with autorefractions," she told AOA Focus in September 2015. "If they're scared or uncomfortable, the doctor gets nothing to start with, which means more time in the exam chair. Having the kids feel excited and comfortable gets us good data."  

That data is key. The first six years of a child's life are crucial developmental years when youngsters are most susceptible to vision changes. Likewise, any unaddressed vision problems during this time can have an undue impact. But often, parents don't know their child suffers from problematic vision until they enter school.  

In fact, 1 in 5 preschoolers in the United States have vision problems, and by the time they enter school, 1 in 4 will need or wear corrective lenses, studies say. That's why AOA recommends parents adhere to a frequency of their child's eye care. The AOA's evidence-based clinical practice guideline, Comprehensive Pediatric Eye and Vision Examination, recommends children be given comprehensive eye and vision exams at key milestones in their development:

• Infants. A comprehensive baseline eye exam between 6 and 12 months, immediately following a critical period when the eye undergoes rapid and profound changes, and therefore is most vulnerable to interference with normal development.
• Preschoolers. At least one in-person, comprehensive eye exam between 3 and 5 years to prevent or diagnose any condition that may have long-term effects.
• School-aged children. A comprehensive eye exam prior to entering first grade and annually thereafter.  
  Failure to address significant eye and vision conditions early may have long-term consequences on not only eye health but also educational attainment, professional opportunities and quality of life.

Parents: Read more about how vision disorders can hinder kids' development and school performance, and learn more helpful hints to ensure your child's exam day goes smoothly.

4 ways to counter kids' exam fears  

Interested in expanding your practice to include pediatric care or simply searching for practice pearls that can help ease kids' anxieties during an exam? Dr. Schuetz offers four tips that help her and her staff make the most of the available chair time with minimal fuss.  

1. Communication, first and foremost. This applies not only to pediatric exams but a calm, cheerful and enthusiastic voice also sets the tone for any exam, Dr. Schuetz says. Likewise, be sure to clearly state what will happen before you do it. "Kids are nervous because they don't know what to expect," Dr. Schuetz says. "At every step, give a quick, age-appropriate explanation of the instrument you are using and what it does. Even a toddler feels better if they see how bright the light is first and know what you're going to do with it."
2. Throw pre-testing under the bus. "Not really," Dr. Schuetz jokes. "But, typically the instruments are the most intimidating part of the exam process for kids, so once they've gone through pre-testing you can assure them that the exam room is easy." If a child does successfully complete pre-testing, reinforce how well they've done and that "the hard stuff is over."
3. Stretch the truth. It sounds counter-intuitive to the first point, but sometimes doctors must do the best with what they've got. If a child is particularly afraid of pre-testing, try asking them to look in and find a specific color or picture that isn't really there. "They'll look harder and longer to try and find whatever you tell them they should see," Dr. Schuetz offers. As a result, you'll have a few extra moments of their attention.
4. Consider changing it up. If all else fails and the patient is too afraid, simply get on their level. Make the patient as comfortable as possible and "start with the easy stuff." Try the 'target setting' on your ophthalmoscope and shine the light around the room, or "put a cartoon on the digital chart while you do Bruckner and Hirschberg testing," Dr. Schuetz says. "You don't have to be as intimidatingly close and they forget to be nervous when they're watching Disney movies."

Looking to bolster your pediatric practice? The AOA offers a new Provider-to-Provider Toolkit for doctors of optometry to initiate community outreach to local pediatricians about the eye health and vision care services available to their patients. The resource includes a template provider letter, as well as a summary of the AOA's Comprehensive Pediatric Eye and Vision Examination for pediatricians to review.