Book Review

Calming the waters of procedural anxiety in children: A primer for parents

Everybody stay calm: How to support your young child through medical tests and procedures

Mackenzie A (2014). Victoria, Australia: Global Publishing Group, 212 pp. ISBN 978-1-922-11835-6 (Paperback: $29.99 AUD). Link

Reviewed by F. Ralph Berberich

printable version (PDF)

This is a gem of a book, one that should be on the bookshelf and promoted by every pediatrician or pain specialist who deals with children’s medical needs. Pain, procedural discomfort and associated anxiety and distress accompany the pediatric medical journey from birth to adulthood and beyond. Too often, iatrogenic and condition-generated pain experiences are discounted, undertreated, or approached passively. What Dr. Mackenzie so eloquently emphasizes in this taut, beautifully assembled and eminently readable monograph is that parents are best suited and poised to play an active role in mitigating pain and anxiety while preparing their child for medical procedures. Parents need only be armed with knowledge, confidence and an armamentarium from which to draw helpful and meaningful contributions to bolster their child’s coping assets and self-regulatory resilience. Dr. Mackenzie conveys this information by combining her own vast knowledge and experience as a seasoned general pediatric clinician with long-standing interests in pain management and hypnosis-related phenomena.

Everybody stay calm is an affordable, exemplary primer for parents. In about 200 pages, 16 chapters and some additional website materials, Dr. Mackenzie covers the gamut of challenges posed by procedural pain and its attendant fear as she teaches parents how to respond, pitfalls to avoid, supportive proactive measures to take, and how to advocate for their child. Chapters are relatively short and to the point, written in an easy conversational style, suggesting the author is joining with—rather than lecturing at—the parent-reader. Dr. Mackenzie invites parents to read the book in its entirety first then use it as a topic-specific resource. This approach is quite feasible despite the book’s density, because of the manner in which subject material is presented. Chapters are generally organized into subheadings which progress from definitions and information, through what children and parents are apt to experience, then through suggested interventions and special circumstances. This structure is logical and very complete. Each chapter contains observations, factual material and practical advice, peppered and interspersed with anecdotes, parent- and patient-derived tips, applicable quotes, charts, and charming cartoons that break up material and provide space for its absorption. At the end of each chapter, there appears a boxed summary of key points, which reinforces content, provides a pause for reflection and offers a later-in-time quick need-based refresher.

Dr. Mackenzie’s book details many noteworthy tips and pearls of wisdom. Only a few can be highlighted here: She dispels myths such as the notion that a quick procedure—get it over with—is a better tolerated and less traumatic than one which takes the necessary time to instill a sense of safety and overarching protection. Or that supplying a comfort object or story or song creates a negative association and aversion to that object. The sections dealing with procedure definition, pain pathways, and medications are well thought out and presented in a straightforward and easily comprehended manner. The author often uses the substance and language of hypnosis in her first person descriptions and culled anecdotes, thus implicitly modeling the subtle but suggestive advantage of words and phrases such as “insert”, “soft tube”, “notice the chair”, or “use your breath as an anchor”. She cautions against using a single experience to measure success and rather favors a cumulative assessment as the parent continually helps the child achieve growth in self-mastery over time when facing subsequent challenges. Throughout the book, Dr. Mackenzie emphasizes child development as it relates to perceptions, responses and effective parental behaviors, leading to age and stage appropriate measures that promote confidence and resilience. In this context, she explores the origins, development and significance of fears, rigid belief patterns, attention shifts, areas of physical autonomy, or intimate zones for any individual and the invasion of those intimate zones, all interwoven with splendid advice. She instructs parents in the before, during and after of medical procedures. For example, when approached developmentally and with intimate knowledge of the individual, distraction becomes a fine and flexible art, a nondeceptive act volitionally shared between parent and child. Comfort positioning becomes an obvious tool of advocacy. The subjugation of parents’ own emotional states to their role in promoting calm becomes a necessity to be embraced. The importance of positive memory creation and the hazard of mixed or negative messages are highlighted. The thorough inclusiveness of what is addressed can only be hinted at here.

There may be some ways in which this high quality book could be strengthened further. The title of the book could be misinterpreted. “Everybody stay calm” includes the child, even though he actually may choose to cope by using intense crying negative trance to be “absent” from the procedure, and that should not necessarily be viewed as failure. “Stay Calm” is popularly associated with the response to someone yelling “fire” in a crowded theater and may provoke a rolling of the eyes: In a subsequent edition, perhaps a subtitle, “how parents can create or instill or induce a sense of control and safety for greater child comfort during medical procedures”. The importance and evolutionary necessity of pain and fear are underemphasized, which leaves intact the notion that negative child and parent reactions to well-intentioned medical procedures are abnormal or open to criticism or even to chastisement. The role of behavioral regression could find a home in the chapter on distress since the whimpering 16-year-old clutching a Teddy bear might need a parental approach that is neither demeaning and condescending nor overly solicitous. The glossary is a nice addition and a topic index might be even more useful.

These quibbles aside, this is an outstanding book unlike any other, one that sparkles with information and beautifully prepares parents to participate and guide children through medical procedures. The author deserves our appreciation and applause.

Cite as: Berberich FR. Calming the waters of procedural anxiety in children: A primer for parents. Book review: Everybody stay calm: how to support your young child through medical tests and procedures. Pediatric Pain Letter 2014;16(3):43-44. www.childpain.org/ppl