FEAR OF THE DOCTOR

Parent Concern: My 3 ½ year old screams and cries in the waiting room at the doctor’s office! What can I do to reduce her anxiety when visiting the doctor?

GENERAL

1. A common problem seen in the pediatric clinic are children who fear or experience discomfort when visiting the doctor.
2. It is normal for children to be wary of visiting the doctor and to even be afraid of the doctor.
3. Some toddlers and preschoolers are truly terrified of the doctor. Typically, these children tear, squirm, fight and make the visits uncomfortable and traumatic for themselves as well as parents.

CAUSES

1. Maturity level, emotional susceptibility and the child’s temperament are contributing factors to a fear of the doctor. No matter what you do, some children will cry upon entering the doctor’s building or office.
2. A child’s memory may contribute to anxiety related to visiting the doctor, particularly when the child remembers bad experiences (e.g. vaccinations, throat swabs). Some children cannot handle seeing a drop of blood or do not want the doctor to touch a scraped knee or bruise and may insist to have a bandage (they pay attention to their body integrity).
3. Young children may simply be afraid of the examination room, especially if it is not child-friendly (e.g. no fun characters posted on the wall, murals, and toys) and which is different than the usual room.

WHAT TO DO

Before Visit	Act excited about visiting the doctor. Be relaxed & confident. Do not show any of your own anxieties or fears. Instead of saying “you have to go to the doctor”, say “it is time to visit the doctor”. Prepare your child & be honest about the visit. Honesty is key for a healthy parent-child relationship. For e.g. when your child is going to receive a vaccination, let her know that it may hurt for only a second and then she will feel better. Do not over-explain the doctor’s visits and do not focus on painful procedures since this can make her more anxious. Reassure her that you will be with her at the doctor’s office the whole time. Do not make promises you cannot keep. For e.g, if you promise you will buy her a cookie after visiting the doctor, and then make sure you do it. Educate your child about doctor’s visits and let her practice being a doctor on her toys. The more your child knows about the visits, the less anxious and fearsome she will be. Tell her that the doctor helps children from being sick. Time the doctor’s visit so that it is not a time when she is hungry or tired or at peak of his hours (hard to predict waiting).
During Visit	Show courage when you are at the doctor’s office, especially if your child is going through a painful experience (e.g. receiving a vaccination). You can have the doctor check your ear or throat first and then your child’s. This will show your child that there is nothing to be afraid of. Make your child comfortable & allow her to express her emotions. You can bring a comfort item from home to help her feel secure. Provide endless kisses if she needs them.  If she cries during the visit, then let her know that it is ok to cry. Allow her to sit on your lap (if possible) during an examination to help her feel safer and secure. Do not make threats like “if you don’t stop crying, then you will not go to the ice cream store”. Threats are counterproductive.
After Visit	Allow your child to play with the toys in the office after her visit, so that she knows the doctor’s office is not “all bad”. If your child continues to cry when leaving the examination room, then allow her to calm down and play with the toys in the office before leaving. Plan a treat for when you leave the doctor’s office such as going to the playground or the ice cream store. Follow through with the treat, regardless of her behavior during the visit. This may help your child associate the doctor’s visits with something pleasant. Praise your child for visiting the doctor and being brave, even if she cried a little.

 

ADDITIONAL COMMENTS

1. For emergency visits to the doctor, you will not have time to prepare your child for the visit.
2. The less frequent the visits and the longer gaps in between visits, the more anxious some children may be when visiting the doctor.
3. Infants have three basic innate fears: sudden motion, loud or abrupt noises and sudden approach. A 2 year old is more secure than the infant, however is fearful of such things as the dark, bathtub, thunder, toilet training, loud noises, strangers, falling, etc. 3 year old fears become more concrete or real (fear of bodily harm, falling, dogs, dark, parent not returning, etc)
4. Sometimes, the examination may be difficult regardless of what you do to help your child relax and feel comfortable. You may just have to visit the doctor as quickly as possible!

 

Question: "Do formula-fed infants require vitamin D?"

Answer:

For breastfed infants, breast milk usually provides full nutrition for an infant and is enough to support their growth and development at this stage. It provides the nutrients your baby needs for at least the first 6 months of life, except for vitamin D. The American Academy of Pediatrics (AAP) and the Canadian Pediatric Society (CPS) recommend supplementing vitamin D to breastfed babies. Both the AAP and the CPS state that vitamin supplements are probably not necessary for healthy children over 1 year who consume a varied diet.
 
For formula-fed infants in Canada, formula contains 100 IU of vitamin D for 250 mL of formula. This indicates that the infant should consume at least 1 L of formula per day to receive the necessary amount of 400 IU per day of vitamin D. Although formula-fed infants are at low risk of rickets, all infants who consume formula should receive about 400 IU per day of vitamin D as a supplement at least until the total amount received per day reaches 1 L.

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My child is a good eater (eats everything). Does she need vitamins or minerals? - December

* Your child's diet has to be varied, balanced, and offered in appropriate amounts according to the 5 food groups, to avoid the risk of nutritional deficiencies.
* The appearance of your child cannot always tell us that her nutrition is well balanced.
* Some studies show that even in cases of good eaters, children do not consume enough calcium, iron, zinc, and vitamin E.