Procedural Distress

Pain and anxiety are inevitable with illness and treatment, but for children, these emotions can be intensified by medical procedures. This is called procedural distress.

"A sick child doesn't understand why an examination or treatment is necessary, and will resist," explains Leroy. "Soon, the situation escalates because healthcare providers want to thoroughly examine and treat the child. However, being restrained just once to look into their ears can be a very unpleasant experience for a child that they will remember."

Experiencing procedural distress has not only immediate consequences for young children, such as additional pain and anxiety at that moment, but it can also hinder healing and foster distrust towards healthcare providers.

Accumulation

From his early years as a pediatrician, Leroy has been focused on reducing procedural distress. Initially, he did this by putting children into a deep sleep for procedures that were clearly very painful or unpleasant, so they wouldn't be consciously aware of them. Later, a personal experience led to a shift towards procedural comfort—even for procedures that are not objectively very painful. "My daughter survived a severe illness thanks to excellent medical care. But six months after her treatment, she became completely panicked when her preschool teacher tried to give her a band-aid: she received a band-aid in the hospital after every injection. The psychological impact of the accumulation of small procedures lasted for a few years." As a result, Leroy devised practical solutions, conducted research, wrote guidelines, established a knowledge center, and now holds a chair in the field. "My daughter always says I was able to build my career thanks to her," Leroy laughs.

How can it be done differently?

"I am not a top researcher by nature; that has never been my primary ambition. I am a caregiver, a clinician, a pediatrician, and in my field of pediatrics, I have long been concerned with an area that is rarely addressed: the pain and anxiety of children who come to the hospital. Within that domain, I look for practical workfloor methods for when a child must undergo a medical procedure, answering the question: how can this be done differently?" Piet explains. 

Research shows that there is an extensive library of better methods available, scientifically backed, but rarely applied on the floor for various reasons. Mostly because people are not skilled in them, the methods are not always deployable, not all stakeholders share the same goal, but most importantly, because every child is different when it comes to fear and pain. This makes it quite different from many other aspects of medical practice. When a caregiver has to determine the correct dosage of medication for a child, they can easily calculate it based on weight. Clear protocols exist for most conditions. This is a standardized method and is the same for every child, thus can be applied over and over again regardless of the child's age or personality.

However, when it comes to a child's experience of fear or pain during a hospital visit, it is different for each child. To gain a child's trust, a caregiver must consider individual factors such as the child's developmental level and personality traits, the kind of parents the child has, whether the child has been in the hospital before, and so on. All these variables play a role in determining the right treatment method. Whether a particular method will work depends significantly on the relationship between the caregiver and the child/parents. Trust is built between individuals, and that process is difficult to predict. For caregivers, this presents a complex and uncertain task. Protocols can help but do not hold the solution. The real solution always lies in the relationship that develops between all involved. How the caregiver communicates and acts as a person plays a crucial role. Too often, this skill is attributed to the caregiver's personality. However, I believe it is an expertise that can be learned and has been neglected in our medical training programmes to date.