AceOfSpuds: Technology, Life and Art ...blogged by Richard Berlin

A shot in the arm

Friday late afternoon my five year old came bounding into the rooom: "I have good news and bad news! The good news is (something about what Morph Gear Batman bought at IKEA? Better get my ears checked!) and the bad news is I have to have a shot!" After delivering this news he broke down crying.

It's true, he was rapidly approaching his five-year visit to the doctor, and that meant required vaccinations. He was actually going to get off easy: he's not entering kindergarten yet, so technically the mid-childhood doses of DTaP and Polio aren't legally required and we asked to have only one of them given at this visit. And with the pediatrician's assent and some email advice from folks at the Boston Medical Center's Pain Free Pediatrics program, we were fully equipped to replicate the Reis and Holubkov injection protocol

None of this, of course, is likely to comfort a five year old; what was called for was a lot of Active Listening and just an occasional reminder that the shot was non-negotiable. It was fascinating to watch his process over the course of the weekend. We supported him through a range of emotional responses as he gradually worked around to acceptance and putting into context; life would go on afterward. His mom told me that anxiety did mount on the way over to the doctor, and by the time I met them there he was resolved to negotiate on his own behalf, :-) but he seemed to be in pretty fair shape and tolerated the poking and prodding quite gracefully. His examination showed nothing out of the ordinary except for his impossible-to-miss obesity, about which we got an insipid lecture. (In fairness, obesity is never easy to treat, but I would have liked for the doctor to have done some investigation--and demonstrated that she had read the OT report on the extent of his motor disabilities--before assuming that we needed to be taught about portion control, quality of food, etc. Sigh.)

Then came the moment that the nurse walked into the room carrying that little tray, and all of what he'd built up came crashing down around him. The nurse was unusually good, I thought, about following our lead, but he was panic-stricken, hollering "No shot! No hole in my skin!" in a manner that was really uncharacteristic for him. So when the doctor stuck her head in and told all of us "there's no hurry," the nurse gave us a 10 minute break. A few moments later he was calm again, and we started a bit of "play therapy:" he kept pretending to stick me with needles all over the place and I said (in a Dracula voice, I don't remember why) "I feel nothing--I have my cold spray!" We also pointed out to him his inability to find any of the spots where he or I had received injections in the past, since by then he'd made it clear that the thought of the hole in his skin was bothering him at least as much as fear of pain. The idea of a band-aid going on the spot immediately also seemed to cheer him a bit. By the time the nurse came back we had coaxed him up onto the table, but he was cowering against the wall, his shoulders well out of reach. He asked if he could have the shot in his leg. She agreed, and helped him choose a style of band-aid. She also tried to get him to think beyond the moment by asking what he would be doing when he left. (Going shopping for food, including little mozzarella balls that he likes to have painted to look like eyeballs, an idea courtesy of a Halloween episode of PMK.) Unfortunately, she had to come back and report that she was wrong, she couldn't give that shot in the leg (I think she didn't have the right gauge needle for someone his size). After a few more suggestions from her--and once again I have to say, she followed our lead better than any other nurse I've ever seen--he finally settled on a position in which he felt safe, I sprayed the spot with Pain Ease until it started to turn white, and a few seconds later the nurse had finished giving him a shot that he essentially couldn't feel. Which was what I was pretty sure would happen; I had been very careful not to overpromise, but I've given myself several shots with the same procedure and felt only the slightest pressure.

He was shaky for awhile afterward, which might have been due to what his mom labeled as "Post-traumatic stress disorder." But soon it became clear that he was totally freaking out about the hole in his skin. I agreed to take him back in and ask someone how long it would be for that hole to close; when the nurse told him that "by the time you're eating those eyeball cheeses it will be closed up" he was ready to put it all behind him. (We need to write a note to the doctor complimenting that particular nurse.)

Now if I can just get him to let me massage the arm so it doesn't get too sore....

Posted at 10:11PM Aug 01, 2005 by AceOfSpuds in Parenting  |  Comments[1]