A child’s fear of and protest against the hemophilia infusion process often create a stressful situation for himself and his parents, who can feel powerless. Toddlers and preteens can express high levels of distress as their parents prepare the needle and look for the vein, but they can also become anxious anticipating the procedure.
In recent years, pharmacological interventions, such as topical cream that numbs the area and other local anesthetics, have reduced stress, but only in the actual infusion phase. To manage the anxiety and fear of pain that occur before the procedure, there are well-established change-of-focus techniques. These include distraction, visualization, relaxation and hypnosis. (See cover story, “Needle Know-How.”)
These techniques work by altering the perception in the brain. The brain and body are powerfully connected. A mother’s kiss or gentle rubbing is almost an automatic response to distract and comfort a child from a minor acute pain. Only recently have electroencephalogram and positron emission tomography allowed us to begin to understand the changes observed in the brain during deep relaxation and hypnotic induction.
Relaxation and hypnotic techniques are not new in the bleeding disorders community. It is historic lore that Rasputin used hypnosis to control bleeding and pain experienced by Alexei Romanov, heir to the Russian throne in the early 19th century, who had hemophilia. Wallace LaBaw, MD, taught self-hypnosis to a group of schoolboys with hemophilia in 1975; pediatrician and medical hypnotherapist Karen N. Olness, MD, co-authored a pamphlet with psychiatrist David Agle, MD, in 1981 on self-hypnosis in hemophilia, published by the National Hemophilia Foundation. They all reported that self-hypnosis has a positive impact on pain control, bleeding reduction and relaxation during vein puncture. And it’s well established that children learn relaxation imagery exercises faster than adults do because of their natural use of imagination.
It is unrealistic to expect that one technique fits all. Relaxation, visualization, hypnosis, biofeedback, meditation and mindfulness practices have been researched and used extensively for the management of pain. Acquiring some of these change-of-focus techniques helps enhance children’s self-efficacy and mastery. It not only empowers them to handle acute crises, but also strengthens the development of their autonomy, responsibility and ability to assert themselves.
Elizabeth Fung, MSW, PhD, a social worker at Children’s Memorial Hospital in Chicago, has researched techniques that reduce needle anxiety in children.