There is no shortage of doctor visits and wellness checks during your child’s first few years. And that can cause some apprehension and anxiety for both parents and children.
I am so excited to welcome my family’s own pediatrician, Dr. Rachel Geronemus, onto the podcast to fill us all in on what pediatricians want parents to know! This conversation is chalk full of helpful tips, like what you can expect at your child’s next doctor’s appointment, developmentally appropriate expectations to set, and strategies you can implement weeks and days ahead of their next visit to make for a more calm and enjoyable experience for you both.
Dr. Rachel (00:00):
A lot of times I hear parents telling the kids that it won’t hurt at all. And I don’t think it hurts much, but I do like to tell them that it will hurt a little bit, just so that they’re not then shocked and that, you know, because if they are prepared for it, maybe it does bring down the fear level a little bit. And they often notice it less.
Dr. Sarah (00:21):
The first few years of our child’s life are filled with many doctor’s visits and wellness checks. It’s common for children to feel anything from a little apprehensive to quite fearful of these appointments. And as a parent, knowing what you can expect at each of these visits helps you to be able to prepare your child and support them through any anxiety they might feel. Joining me this week to discuss how we can do this as parents is pediatrician Dr. Rachel Geronemus, Dr. Geronemus is board certified by the American Board of Pediatrics and is a fellow of the American Academy of Pediatrics. And beyond that, she’s my own kid’s pediatrician. So sit back and enjoy. As we share some specific strategies that you can use. Some mindset shifts that you can make, and a few personal mom stories of our own.
Do you sometimes find yourself questioning whether you’re doing this whole parenting thing, right? Second guessing yourself, losing your cool and falling prey to mom, guilt. You are not alone. And that is why I will be hosting a free live masterclass to help you genuinely feel confident in parenthood. I’ll be teaching what I like to call my confidence recipe with the specific things you need to know. And some very important things we all need to let go of that can really get in the way of confident parenting. We won’t be just talking theory. You’ll walk away from this masterclass with tools that you can put into practice right away to challenge that self- doubt to stop panic-Googling and find the ease in early parenthood. So head to my website, drsarahbren.com and click the workshops tab to sign up for my free masterclass, Confident Parenting From The Start. It’s gonna be on July 6th and July 7th, or if you’ve got your phone in your hand, just click the link in my Instagram bio to sign up, see you there.
Hi, I’m Dr. Sarah Bren, a clinical psychologist and mom of two in this podcast. I’ve taken all of my clinical experience, current research on brain science and child psychology and the insights I’ve gained on my own parenting journey and distilled everything down into easy to understand and actionable parenting insights. So you can tune out the noise and tune into your own authentic parenting voice with confidence and calm. This is Securely Attached.
Welcome to the podcast. I’m really, really excited to introduce you guys to my family pediatrician and a friend of mine, Dr. Rachel Geronimus and Dr. Geronimus has a special interest. In addition to being a pediatrician within that realm. She’s a special interest in postpartum mental health and breastfeeding support, and also the management of acute illnesses and infant kidney disease. So you’re like a wealth of knowledge, and I’m really grateful to have you here.
Dr. Rachel (03:19):
It’s great to be here. Thank you so much. You are not only a patient of mine, but also a great inspiration to me and a colleague as well. So thank you for having me on the show.
Dr. Sarah (03:28):
Oh, that means so much. And you’re also a mom of two.
Dr. Rachel (03:32):
I am also a mom of two. I have an almost six year old and a two year old. So I’m also a working mom and just in the thick of parenting two young wild children.
Dr. Sarah (03:45):
Yes. Oh, me too. So, we have that very much in common. Well, one of the reasons I was really hoping to have you on today was, you know, I get asked a lot and I imagine you do too about, like, how do we help kids prepare for doctor’s visits, especially, you know, in the current climate, but like in general, like there’s a lot of visits in the first year of a child’s life and beyond to the doctor. And it can cause kids to feel a little anxious. And you know, I’m a big proponent myself of helping kids helping fill in the blanks for kids, helping kids know what’s gonna happen next and prepare, and practice and play as a means of kind of reducing anxiety. And I’m just curious, like, what are some of the things that you see in the families that you work with as far as like child anxiety for doctor’s appointments and how they respond to that.
Dr. Rachel (04:45):
So there’s definitely a lot of anxiety surrounding doctor visits, have you, as you’ve pointed out as we’ve, I think we’ve discussed before kids are very routine driven and any interruption of their routine is sort of destabilizing and surprising and can cause sort of anxiety and agitation for them. So going to the doctor can be a break in routine because usually, you know, they’ll come home from school. They’re not necessarily expected to go to the doctor. So anytime they go, it definitely can be stressful for them. So I think preparing is a great way to give them comfort. And also, I just like to so much of what I do in general pediatrics in, you know, is normalizing things for parents. And so even, I wanna help them prepare and reduce the anxiety, but I also wanna normalize the anxiety for them as well.
I would, I’m almost surprised if a child isn’t anxious or at least uneasy or looking around wondering what’s going on. Because I mean, that can be a sign of great preparation, but again, it’s more the norm to be worried about it than to be comfortable with it. So I wanna tell the parents that it’s okay if they’re nervous, it’s okay. If they’re screaming in my face the whole time I’m used to it. And I try to remain calm during the visit when we’re already at the point of the visit and they are nervous. So we start to see separation anxiety, you know, at all ages, but particularly around the nine month visit. And that usually continues for the 12 month, the 15 month, the 18 month visit. So during the nine month visit, I’ll often start the visit by telling the parent if they’re already anxious fine, or if they’re not, they may become anxious when I go near them.
So I do try to tell the parent during the time, this is totally normal. They may scream in my face. I’m not worried about it. You shouldn’t be worried about it. And often that happens. So I think during the visit, preparing the parent to tell them it’s okay, if they’re screaming at me, they’re not having a behavioral problem. Or, you know, because a lot of times I find that the parent is apologizing for them right off the bat. I’m so sorry. They screamed at the nurse. I’m so sorry. It’s at, they walked in here, the moment they walked in here, they were nervous. You know, they feel uneasy about that. And so I try to reduce the parents’ anxiety by just telling them it’s really normal and it’s okay. And I expect it and it’s fine. And they, you know, they’re not gonna wanna open their mouth and say, ah, and they’re not gonna wanna tell me all the letters and the numbers they know, you know, it’s okay.
You know, and I tell them, it will get better by the time they’re two or three, they may be excited to actually come and see me and they wanna show off for me and, you know, we’re their cutest outfit. But until then, don’t be surprised if that’s not the case, you know, and don’t be, I believe you, that they are very verbal, you know, and I believe you, that they’re very cute and say P Cabo, you know, and do Peek-a-boo and things like that. But that it it’s okay. You know, it’s okay if they don’t love me, you know, that’s all right. So that’s something that we do while they’re in the room, but then I think maybe we should talk to about sort of preparing for the visit as well.
Dr. Sarah (07:47):
Yeah. Yeah. And even just going back to one thing you said that makes me think about like, yes, we should talk about preparing. And I love this idea of normalizing, not just the anxiety that the kid and the parent might be feeling in this session or this visit, but also that they, the child might freeze up. Cuz I actually think there’s a lot of like, you discuss a lot of milestone achievements in these sessions. And I feel like even I have had this experience where I’m like, you’ll be like, do they do this? Do they do this? Do they do this? And I’m like, I know that they do that, but I cannot get them to do that for you. And then I, as a parent, feel like this flood of like my own performance anxiety yes. That I need to get. So to also normalize this idea that like our kids, aren’t like able to just perform on demand, right. And when they are in an uncomfortable or new or anxiety provoking situation, they’re not gonna have access to the same set of skills they do when they’re calm and playing at home and feeling really safe and secure.
Dr. Rachel (08:44):
Right. So I actually, before the two year visit, I don’t direct developmental questions to the patient that often, because I just expect that they won’t perform for me and that they won’t answer what their name is. Even if they know their name so starting at two, I try to direct it to the patient because oftentimes they will, the, the anxiety level will be lower for that age group. Not always, but I try to start the two year visit by asking them, what is your name and how old are you and what do you like to do? And who’s your best friend, because sometimes they will answer me and then we can start a little banter back and forth. If it doesn’t work, then I’ll direct my questions to the parent. And then sometimes the kid will fill in. But before that, that visit, you know, for the 18 month visit.
And before then, I really don’t ask the child questions because I expect that they won’t perform it for me because it’s really rare that a kid will answer. Even if they know the answer to what is your name or how old are you? You know, most kids won’t, you know, we wanna say, how old are you? One? You know, most kids won’t do that because they’re scared of me, even if they’ve seen me many times before. So I just, you know, I, and I’ll tell the parent as such that, you know, it’s okay. I believe you, you know, and I felt that for my own children as well, I wanna show off, you know, how many words they know and how smart they are, but they never show off the visit. So, you know, I tell the parents, you know, I believe you, I get they’re. So they’re the smartest kid ever. You know, you can answer those questions, you know, I’ll ask the developmental questions to you and maybe sometimes the kid will pipe in and give me a wave or say a word, and then I’ll really, you know, play that up. Oh my goodness. That’s amazing. You know, but I don’t necessarily expect that
Dr. Sarah (10:25):
To happen. Yes. And also, but I do think, you know, it’s, I think asking sort of putting the child on the spot to perform in those moments, it makes sense that you are kind of redirecting that attention onto the parent as a way of like almost shielding the child from the, that direct expectation of performance. But one of the things you do do that I’ve always like really loved from the beginning was that you talked to my kids from the beginning of the session, like maybe not asking them to perform for you. Those questions will direct to me. But you will tell my kids what is gonna happen next versus telling me what’s gonna happen next. Like most of the sort of dialogue of the session is directed at either both of us or to my kid, which I have always appreciated because I think it helps them feel like they’re in the room with two people who are with them.
Dr. Rachel (11:16):
Right? Yeah. I like to make it about them cuz I’ll, you know, even though I feel that as a general pediatrician, I’m sort of, you know, the doctor for the whole family in a way, and a family therapist, to some extent that my true number one patient is the patient, you know, is the, is the kid there. So I like to put them center stage that they feel included. And also sometimes if you don’t include them from the beginning, they become disinterested and then they start, you know, touching everything or, you know, destroying the exam room and things like that. So some of it is also logistical, but it’s a way to, for me to assess their development. Even though, again, they’re not gonna show me everything they know, you know, I am getting some developmental information from how they pay attention, how they answer questions, if, you know, if they’re attentive to me or if they have trouble sitting still, you know, all of that is part of the job of the general pediatrician to assess. So that’s, that’s part of why, you know, we obviously take everything the parent says as into that, but I also like to look to the, the kid to give me a lot of information about themselves, you know, both by report and the way they’re interacting with me.
Dr. Sarah (12:23):
Yeah. And I think one of the effects of that is that it helps them feel included. And I think when kids feel included and engaged then they, they, that, that connection reduces that physiological arousal of anxiety like that sort of connectedness to other human beings that feel kind and safe and attuned reduces anxiety.
Dr. Rachel (12:47):
Yes. I do find that if I can start off, you know, again, I can’t always get the trial to be engaged with me, but if I can get them engaged, then that it sets the tone for the visit to be a little bit calmer, you know, maybe less screaming, maybe less anxiety provoking. Not always again, but you know, oftentimes it can just bring down sort of the, the temperature in the room and make everybody feel a little bit more at ease. If we start off with a nice rapport or at least some acknowledgement of the, of the, from the beginning that they sort of feel, you know, and then they’re more receptive to when you’re telling them, okay, I’m gonna touch your tummy right now. You know, they’re maybe listening a little bit more than if you haven’t directed some of the visit to them already, you know, they’re sort, they feel a part of it.
Yeah. And I think they also feel proud of themselves when they do answer a question or you are talking to them, they’re sort of like, okay, I’ve got this. I’m, I’m the patient here. This is about me rather than feeling sort of sidelined. I think they, yeah. You know, I even do that with sick visits sometimes. You know, why are you here today? And you know, they may stare back at me blankly, and then I ask the parent, oh, do you, or I ask the child, would you like me to ask your mom or dad, what brings you in today? You know? But just again, so that they feel engaged and maybe bring down the, the temperature a little bit and feel, feel a part of things. So,
Dr. Sarah (13:59):
Yeah. And I think if you’re a parent who maybe has a pediatrician, that’s not doing that, like just maybe they’re have a different style and they’re less engaging with the child. You as the parent can still sort of serve as an inter intermediary. I think like you can sort of, if the parent is, if the doctor’s directing their, all of their conversation to you, you can then relay it to your child in front of the doctor. And then usually that’ll help the doctor kind of get the hint that you want them to be kind of directing the conversation to their kid or including them in the conversation or at the very least, it just helps keep your child kind of actively informed of what’s happening, cuz not every doctor’s gonna do it this the way that you do. Totally.
Dr. Rachel (14:41):
Yeah. And this is just my personal sort of style and something I’ve learned from other pediatricians and from taking my own, you know, my own children to pediatricians and developing, you know, my style over time. But there’s so many different ways to be a physician, you know, and we all do it differently and I’m not saying mine is the right way.
Dr. Sarah (14:57):
Dr. Rachel (14:59):
Dr. Sarah (15:01):
But I, but I, but I did, I think listen, like it’s, I don’t think anyone who’s like sitting here being like, oh my gosh, my doctor doesn’t do this. Do I need to go get a new doctor? Like, no, but there are ways that you can sort of shape the way that you and your doctor and your child interact in the visit to, to sort of clue the doctor into the kind of conversation you would like them to be having with your child. And also you can have a conversation. I would imagine outside of the session or outside of the visit, if you’re feeling like, you know what, my doctor really isn’t talking to my child and including them in this conversation, like maybe that’s something I can bring up with them, not in front of my kid, but outside of the, of the visit.
But I’m thinking too, like, okay, so we talked a little bit about like the, the value of preparing a child to reduce anxiety, to help them know what’s coming next. It might be helpful for parents to have kind of like a, a cheat sheet almost of like, what does the first year of wellness visits even look like? Like what can parents, like, maybe they can even reference back to this episode. You know, every time they have an appointment coming up to be like, okay, wait, I’m going to the six month visit. What am I gonna be facing here so I can help my kid prepare?
Dr. Rachel (16:06):
Sure I’m happy to go through that. There’s also, there’s a great website. I think they have this information. I hope I’m saying it correctly off the top of my head, but they’re the American Academy of Pediatrics has a website called healthychildren.org, which is a great repository of information of all kinds, but I believe they have guides for different wellness visits and what you might go over, what are the developmental milestones, what vaccines we, you may have to look at different different references on that site, but there it’s a really big wealth of knowledge. So they may also besides referencing this episode, I think you could also use that as a source for some more information. So in the first year kids come to the doctor a lot and that’s so we can track their growth and their development and pick up on any subtle medical conditions and also, and intervene on things that require earlier diagnosis.
And also just sort of to make sure that everything’s going well and help support the parents with parenting, which may be new to them, or even if they’ve done it before, you know, parenting each child can be different. So typically after the newborn visit, you’ll come in for a one week follow up visit and wait check. And then there are wellness visits at one month, two months, four months, six months, nine months and a year. And each of those visits will have vaccines. So in addition to, you know, height and weight and head circumference, and then talking to the doctor about development and feeding and toileting and sleep and all of the sort of usual things there will be vaccines. So you can expect that as a part of the visit and, you know, the kids are aware very early on. So I think it can be helpful.
You wanna give them some preparation, but maybe not too much, but at least at the beginning of the visit or just before the visit telling them, you know, there will be a little pinch as part of this it’ll hurt for a second and then it’ll be done. You know, I, a lot of times I hear parents telling the kids that it won’t hurt at all. And I don’t think it hurts much, but I do like to tell them that it will hurt a little bit just so that they’re not then shocked and that, you know, because if they are prepared for it, maybe it does bring down the fear level a little bit and they often notice it less. If they, if they know they’re gonna be a little bit hurt, you know, but it’s, yeah, it’ll be a little pinch and then you’ll move on with your life and then you’ll be fine.
So that’s the first year. And then maybe it helps too to go the second year I feel like is when they’re more aware too. And so at again at the one year, and then at 15 months and 18 months, they come in for wellness visits, again, height, weight, head circumference, general questions, and there are also vaccines at those visits. At two, that visit is nice because there are often not vaccines if you’ve gone, if you’ve completed the primary series on time. And unless you, your birthday happens to line up with flu season. So you might be, some kids will be getting their flu vaccine at the two year visit or other visits from six months on. But if you’re lucky enough to not have a birthday in flu season, then usually the two year visit does not have vaccines, which is nice because that’s a, one of the often sort of the turning point with the doctor where the kid starts feeling a little bit more comfortable, a little bit less anxious.
So it is nice. I think that they’re not vaccines of that visit because that can create a little bit of a rift with the depending on the kid with the, with the parent, with the, with the patient and the, the doctor, if they’re not so pleased about the vaccines, we do also though, do blood work at one and two. And that’s mandated by most states, but certainly in New York state to check for anemia and lead poisoning. And that is done depending on the doctor’s office, either with a finger prick or with a venipuncture, you know, in the vein. And so that also can be a little bit painful so that, you know, I would be prepared as a parent for that, to know that, there are at, at least at the, the one year visit, there are a lot of needles between the vaccines and then at two, you know, at least at least the blood draw.
So those are sort of the big sort of pinches. And so I think it can be helpful as a parent to know, especially in the first two years, there are a lot of them, you know, and to prepare the child. Yeah. What’s nice about the three year visit. I think that’s sort of the turning point is, you know, even more so than the two, I think that’s when the child, certainly in most cases feels very comfortable with the doctor. And again, if you’re not, if it’s not during flu season, you probably get no needles at three. So that’s a really nice visit. So that’s one of my favorite visits of childhood because it’s like, it’s a lot of chatting with the PA, you know, I really direct a lot to the kid and ask them, you know, when I’m talking about nutrition, I ask them about their favorite foods and they’re, you know, they’re more likely to engage with me at that visit and there’s no needles most of the time. So it’s a, that’s a nice visit.
Dr. Sarah (21:04):
Yeah. And I mean, I’ll just talk about needles makes me, in general, you know, like, listen, we’re, this is very culturally relevant right now because we’re talking about vaccines in a time when we’re in a pandemic. And right now kids under five are getting vaccinations and you know, how do we help a child prepare to get a shot, to get a vaccine, to get their blood drawn? You know, you, you, I think you, I think your point that telling a child that it does hurt, you know, is really valuable actually. Like I think as parents, sometimes we have this, this myth that we hold, that if we, if we say something to a kid that’s negative, it will plant a seed that will make it worse. Like if I tell a kid there’s gonna be pain, then they’re gonna be more anxious. Whereas if I tell a kid there isn’t gonna be pain, and then there is pain, what does that do in like the long term ability for them to trust me when I’m helping them feel less anxiety?
Dr. Rachel (22:02):
Yeah, it actually, it makes me uncomfortable sometimes when a parent really tells me, don’t tell them, you know, sort of surprise them. So once in a while I’m giving a vaccine to a child that isn’t expecting it and that that can be really shocking. You know, one safety, we just have to make sure that we’re no one is getting stuck by a needle, but, but I also, it makes me feel uncomfortable and, you know, and I will, I wanna keep the parents’ wishes, you know, intact, you know, I they’re my patient as well, but I also wanna be comforting to the patient. So I think it, it can be tricky to, to surprise them with a needle, you know? And, and to your point about trust, you know, I think it sort of undermines the kids’ trust in everybody. You know, if we, if we sugarcoat it too much, but there’s a balance there too, cuz I think sometimes over preparation for some kids can be really difficult.
So sometimes telling them too far in advance of the visit that there’s a shot or sometimes at the beginning of the visit that there’s a shot, you know, can be really anxiety provoking to some children. And so sometimes too much preparation can be tricky, but it it’s a lot of times it’s kid dependent. So a lot of times parents will know their child, you know, at some point during the visit will introduce the idea that they will be getting a shot. It will hurt a sec for a second and then we’ll move on, you know, for others, it’s okay to tell them, you know, weeks in advance, oh, you’re gonna go get your flu shot. You know, so it’s definitely child dependent. My own daughter is afraid of needles. And so it’s a little bit tricky when she got her COVID vaccine.
The first one was okay for some reason, I think I talked to her so much about the meaning of this vaccine and how special it is and everything like that, which maybe helped a little bit. But then for the second dose, three weeks later, she knew what it was and you know, she’s intelligent enough to know that she was there for her second shot. She’s almost six. And she tried to run away so we actually had to run and, and end up holding her down. So there, yeah. You know, it’s, it’s kid dependent, but yeah.
Dr. Sarah (24:05):
And then again, like their big feelings and their big reaction is not necessarily a, a, a problem in and of itself. I mean, logistically it can be difficult, but I think from like a, you know, I don’t think we, we need to catastrophize the presence of that kind of anxiety. It doesn’t mean that we’re doing a bad job as parents and helping them prepare or just cuz they feel anxious. In fact, you know, you not preparing her, if she’s prone to anxiety around needles and she had that big of a reaction with the preparation. Right. I would imagine that what, even though she had a big reaction interpreting that to mean I failed preparing her well enough versus saying, had I not prepared her, it might have been even worse and had longer and a longer effect.
Dr. Rachel (24:53):
Dr. Sarah (24:54):
And her recovery from that.
Dr. Rachel (24:55):
Yeah. And, and I even again, yeah, as you’re saying with preparation, there still can be anxiety, but I think we can sort of in the exam room model, good behavior too, from for all of us, if we can tell the parent, if we can tell ourselves it’s okay that my own child or the patient is screaming and they’re scared and telling them during it it’s okay. I know you’re scared. It’s gonna hurt for a second and then it’ll be done. And talking to them about, okay, this is the worst part. So oftentimes that there’s that, you know, couple minutes when they know they’re getting a shot, it’s about to happen. And I tell the patient and themselves, this is the worst part, this fear that you’re experiencing right now, it’s gonna be over soon and then you get to move on and trying. And oftentimes I try to get it over with, you know, a lot of times parents, I think that are feeling, I dunno if it’s embarrassed about how their child’s reacting or worried that it’s a sign that either they didn’t do well enough preparing or there’s something wrong with their child.
They’re sometimes wanting to, they’re telling me like, okay, let’s not do it yet. Let’s take a little time. The kid needs some water. You know, they they’re sort of delaying it because I’m not sure exactly why, but for a variety of reasons, but I tell them actually, no, let’s just get it over with because that sort of, you know, preparatory
Dr. Sarah (26:11):
Dr. Rachel (26:12):
I guess what anticipatory anxiety is the, is often the hardest part. So I try to normalize that as well. Okay. I know you’re really scared right now. This is the worst part it’s gonna be over soon, you know? And then they realize, and then they look, oh, that wasn’t that bad, you know? Right.
Dr. Sarah (26:27):
And I think what I mean from a, from an anxiety perspective, from like my psychology hat, I’m like, okay, as parents or doctors, we’re always trying to kind of balance our response to a child’s anxiety in this kind of like in between space of, on the one hand, we wanna validate that this is happening and that they’re scared. And not like dismiss it. Like this is not a big deal. You’re not gonna feel anything it’s gonna be fine. But instead saying things like this is scary, you’re feeling scared. It’s okay to feel scared. This is gonna hurt for a moment. And then it’s gonna be over. I’ll be here the whole time. Right. There’s that little like maybe not all those words, but like pick one of those data.
Dr. Rachel (27:07):
Yes. You know, I agree.
Dr. Sarah (27:09):
Give some type of validation and acknowledgement, but then on the other side of that scale, we wanna communicate and embody confidence that our kid can handle this. So if we’re waffling on when to do the shot or we’re really like breathing heavy and panicking, or we’re talking our kids ear off because that’s how we’re managing our anxiety or, you know, whatever it is that we’re doing, that’s kind of undermining our confidence in our kids’ ability to deal with this, to say, this is hard. And I know that you can handle this I’m right here and I’m gonna be here the whole time.
Dr. Rachel (27:43):
I mean, I think so much of what I try to do in my job is sort of validate how everyone’s feeling, you know, whether it’s the patient or the parent, you know, I hear you, I hear your anxiety, I hear your concern, you know, and this, you know, sort of, you’re scared and we’ll do it anyway. You know, I, for the parent as well, you know, I totally understand your child is upset. I hear that they’re anxious about the shot and we’re gonna do it anyway. You know, so sort, you know, hearing them and validating their concerns and then proceeding, you know, as we need to, I think is shows the child too, that everything’s okay.
Dr. Sarah (28:21):
Yeah, yeah. It’s containing, I think to have the grownups kind of continue to move through this because if, if we felt it wasn’t safe, we wouldn’t keep going. So if our, like our steady movement forward towards the goal kind of embodies this sense of safety too.
Dr. Rachel (28:38):
Dr. Sarah (28:38):
And like one of the things that like a little, like thing that I have done with my kids, like before our doctor’s visit, where I know they’re getting a shot, and again, this goes back to this idea of like, how early do you prepare and what kind of preparation, like when, what are the optimal windows for? Like what ki type of preparation? Like I agree that I wouldn’t necessarily like three weeks out. And then every day afterwards up until the doctor visit being like, you’re getting a shot in three weeks, you’re getting a shot in three weeks and six days. But our, you know, the idea that I might also start about three weeks out introducing doctor’s kit to the play space and introducing play around doctors’ visits and books around doctors’ visits and helping them experiment and explore and play with these ideas of what a shot might be or what a COVID test might feel like.
Like I brought out Q-tips for my kids to put in my nose, put in their dolls, nose, put in their nose so that they could just kind of play with this idea, experiment with what it feels like and see the materials a little bit. Like I have a doctor’s kit that literally is from like 1985 cause I had it for it’s like a play school doctor’s kit that I used to play with and I have it and my kids love it. And it has a blood pressure thing and a stethoscope and they like play around with it. And that came out right around the time that they were going to doctor’s visits regularly and needed to like play with these ideas. And then closer to the actual visit was when I might say, we’re gonna go to the doctor tomorrow. These are the things you can expect.
This is what’s gonna happen. I’m gonna be with you the whole time. Even asking them a few questions of like, how do you think it might feel if they’re older? You know, I explore more open ended questions and like offer them opportunities to like share with me when they’re a bit older and they have that expressive language. But when they’re even when they’re babies, I did this, like even when my kids were like in before the first year, you know, in that first year visit window, I would tell them everything that was gonna happen. Even though I knew that they didn’t understand every word I was saying. But I think using just using that strategy in general, as a parent, like with parenting, like always kind of telling my kid what’s happening next and what they can expect, there’s a there’s even if they can’t understand like linguistically or verbally what I’m communicating, they understand tone, they understand facial expressions, they understand affect there’s a way in which my narrating something is a communication of safety that they can sort of embody, even if they don’t know what the words mean.
Dr. Rachel (31:28):
Yeah. I love that approach. And as I’ve told you, your children are the most well prepared for the doctor’s visit and have the least anxiety surrounding it. I would say, you know, I said, I think at the beginning that I’m surprised when children aren’t anxious of the doctor, although not your children, because I know that it’s coming from a place of great preparedness rather than one of, you know, not knowing at all what’s happening. So that’s always been sort of remarkable to me that they they’re very much aware they know what’s happening. They are less scared because they’re so prepared. So I think it’s great to start that early on and having toys from the beginning, the doctor sets and just having it sort of around with all the other toys is awesome and reading books. I mean, I’m a big proponent of, you know, early literacy and reading to children from the time they’re a day old.
So I talk about that often at the newborn visit, you know, sort of this idea of like playtime, which is you narrating your day, reading them a book, even though if you feel silly about it and talking about the weather and just telling them what’s going on and talking to them as if they know what you’re talking about. So I think that’s great early on in telling them, oh, we’re going to the doctor today. You know, I sort of will sort of say these things during the visit sometimes. Oh, tell them what you’re doing, tell them we’re going there. Well, this is what’s gonna happen. So I’m a big proponent of that. So I think you can start reading books about going from, to the doctor from, you know, day one, literally. So I think that all really helps and sort of just, and, and playing and experimenting with the stethoscope and knowing what things are called, helps them when they get there.
And then they’re looking at things, all the tools more from a curiosity standpoint than a fear and sort of, oh, I saw this before we have one of these at my house. So a lot of times kids will get excited when I take out the stethoscope, if they know, oh, it just looks just like the one I have at home. So I think that could be really helpful from very early on, you know, to play with those things and practice giving a shot. And of course the one at home doesn’t hurt at all. So that can be, you know and, but you could say something when you’re playing with a shot, like, oh, it just hurts for a second, you know, or something you don’t have to say doesn’t hurt at all. You know, you could frame it that, oh, quick pinch, ouch. You know, and, and then move on, oh, that wasn’t too bad. Or, you know, sort of to yeah. To frame it in a positive way. Oh, it does hurt, but it’s not that, you know, and then it’s fine. Right. And we,
Dr. Sarah (33:49):
And model realistic coping. Right. Realistic coping is saying, ouch. Ooh, that was tough. I’m gonna be okay. I’m gonna take a deep breath. All right. That was okay. And I’m okay. Versus saying, oh, dad didn’t hurt at all. I’m so fine. Right. Like, so when your kid gives you, these shots have a realistic response that also models appropriate, realistic coping and effective way like effective coping.
Dr. Rachel (34:14):
Yeah. I think the same is true for the, the COVID swab to your point. We’re doing that a lot. There are many kids who have been COVID swabbed, you know, numerous times too many to count. And so I often when I’m doing it, I think it’s nice to prepare at home. But also when I’m doing the swab, I’ll tell them, oh, this is gonna be uncomfortable. It’s gonna feel like, what are you doing to me? You know, I’ll sort of say something silly like that. And it makes some kids laugh. It makes some kids wanna kick me, you know, maybe say, I dunno, on a, this podcast, but you know, it might make you a little angry, you know, that it, I just tell them it’s kind of annoying and it’ll be fine, you know? So I think you could play with that at home as well, sort of swabbing your stuffed animals nostrils or, you know, yeah. Something like that to just sort of play around with it. Hopefully we’ll be done with that. And not too long.
Dr. Sarah (35:01):
I know this was really helpful cuz I think, you know, I, I think we talked a lot about kids’ anxiety and this episode, but I think we also talked a lot about parent’s anxiety and it can be anxiety provoking to one, anticipate your child being in pain or distress or discomfort. It can also be anxiety provoking to go to the doctor as grownups. Like it can be anxiety provoking to feel like your child needs to perform or that, you know, maybe they haven’t hit certain milestones and am I gonna feel worried or, or ashamed or guilty. And I think, you know, your approach to normalizing just how much range there is in how children show up in the actual visit, but also how they develop and how much range there is and where kid’s gonna be at any point in these wellness visits is very reassuring to parents.
Dr. Rachel (35:52):
Yeah. And I know I, you know, I’m a parent as well, so it can, I know how it can feel even with all that preparation too. I know as a parent, sometimes it can still feel embarrassing. I recently took my two year old to the eye doctor and he was doing great at first and he was participating and then he, we had to wait for a while because he needed a dilated eye exam. And by the end he just totally lost it. And he actually couldn’t cooperate. We, and we’re gonna have to go back because she really couldn’t examine his eyes. So we need to go back. And I found it embarrassing because it’s a colleague of mine and you know, it’s so even with, you know, I know that these things are okay it’s he was very tired. He didn’t want anyone looking in his eyes. He felt destabilized by the eye drops probably. And he couldn’t see well, but even then with all that ation, you know, I know as a parent it can feel still sort of embarrassing or annoying, you know? So I really wanted normalized things for the parent, you know, as well as the child. Yeah. Cause I I’ve been there.
Dr. Sarah (36:51):
Me too. And as much as like, you know, I I’ve my kids and I can’t take full credit for the fact that my kids are so chill at the doctor’s office. Frankly, I’m like shocked at it myself. Cause some of it is just their temperament. I got sort of lucky. My kids are low on the anxiety spectrum in general. But I also think that I’ve been in, I’ve been in situations where my kids are having a really hard time. They’re just maybe they were too hungry before the visit or maybe they just were, you know, there’s a million reasons why a kid might be having a hard time, but a, a strategy. I tend to kind of remind parents to explore when they’re in these moments is as much as we want to apologize for our kids’ behavior to another adult, whether it’s a teacher or a doctor or somebody that we’re like feeling compelled another parent like compelled to apologize for our kids’ behavior.
I tend to suggest, instead of like, if you have that compulsion, like if you have that, that wave wash, that that feeling wash over you where like, I really wanna apologize for this behavior to just check in for a second first and check how anxious you are feeling and like take a breath and see if you can just check in and see, is am, is this urge to apologize because my child’s doing something wrong or bad or is it because I’m holding an expectation of them. That’s not in this moment developmentally appropriate. And to then kind of reconnect with my kid and, and narrate for them instead of talking to the other adult, to narrate for my child, what I’m seeing like that you are having a hard time. This is hard, you know, and to use that opportunity to just sort of connect with them because when we apologize for them in front of them, we’re, we’re sort of alienating them a bit from this process of staying connected and staying regulated.
So sometimes we have to tolerate our, our fear that the other person might be judging us and align with the child in that moment and just kind of sit by their side and narrate for them. What’s going on instead of siding with the sort of aligning with the other adults and managing our own discomfort or anxiety, which is super hard to do like very hard to do it’s we have to unlearn a lot of sort of societal norms. Yeah. And like misinformation, I think to do that. But it’s, if you can do that in the moment, I think it’s very helpful for our kids.
Dr. Rachel (39:14):
I always learn so much from me. I’m gonna try it. I’m gonna, next time I bring Henry to the eye doctor. I’ll try to align with him if he’s having a hard time.
Dr. Sarah (39:24):
It’s hard because, because we are so we’re so conditioned to be paying attention to how other people are perceiving our parenting. So we have to, it’s like hard to unlearn that.
Dr. Rachel (39:34):
Yeah. That’s I think that’s why I try to make the, the parent feel, not judged in that sort of scenario when the child is totally freaking out. I preempt the whole thing by saying, oh, this is totally normal. You know, to that to, I think I talked about that in the beginning, even from the nine month visit telling them they probably are gonna scream at me when I come near them. Or maybe even if I’m just sitting all the way over here, they’re worried, you know? So I try to sort of preface that to really make the fam the parent feel okay from the beginning.
Dr. Sarah (40:02):
Yeah. And if you’re the parent in that room, receiving your reassurance and having that urge to apologize. Your child’s screaming in, you know, your pediatrician’s face, I would go to the kid and say, you’re really upset right now. You’re screaming. This is not this. You don’t like this I’m here. I get it. Instead of I’m so sorry, they’re screaming. Because when we do that, we leave our kid. Even if we’re physically standing right next to them, we’ve, we’ve left them in that moment. And what they really need is for us to just kind of narrate what’s happening for them and let them know that we’re seeing them, we’re hearing them and we’re there with them. And that alone can be really calming for a kid. It might not stop them from screaming, but it’s gonna help their insides calm down.
Dr. Rachel (40:42):
I like that.
Dr. Sarah (40:44):
Yeah. Thank you so much for being here. This was really helpful. And I think this is a great resource too, for parents, like kind of whenever they’re gonna be bringing their kids to the doctors, which you know, happen so much in early childhood, there’s lots of opportunities to practice these strategies.
Dr. Rachel (41:00):
Yep. Yes. I, and yeah, if you have any more questions, you can, you know where to find me.
Dr. Sarah (41:07):
Yeah. Yeah. I’ll probably see you at my kids’ next wellness visit.
Dr. Rachel (41:10):
Perfect. Can’t wait.
Dr. Sarah (41:12):
Dr. Rachel (41:12):
Thank you so much for having me. This is really fun.
Dr. Sarah (41:19):
So much of combating anxiety is knowing what to expect and feeling confident in our ability to cope. And that applies for adults just as much as it does for kids. That’s why I’m hosting a free live masterclass and Q&A session all about parenting confidence. Because when we are confident, we start to relax. We connect with our kids and we can actually enjoy the journey a whole lot more. In this masterclass, I’ll be teaching you what I like to call my confidence recipe with three key elements to pay attention, to plus what you can give yourself permission to let go of to help you feel more confident in parenting. By the end, you will have specific strategies and tools that you can put into place right away to challenge your self-doubt, to stop that endless panic-Googling, and actually find the ease in parenthood. So head to my website, drsarahbren.com and click the workshops tab to sign up for my free masterclass, Confident Parenting From The Start. There will be two dates I’m offering it, July 6th and 7th. And make sure to bring your questions, I’ll be saving plenty of time at the end to get to talk directly with you. Hope to see you there. And don’t be a stranger.
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