Pediatric and Teen CL Care

How to Calm an Upset, Frightened Child

BY CHRISTINE W. SINDT, OD, FAAO

Not all children are excited to get contact lenses. For many children, a contact lens is scary and unknown. In cases in which the lens is medically necessary, overcoming the child’s anxiety is paramount for success. There are several techniques that I use to build trust and to calm the situation.

Address Concerns

Using a calm but clear voice, ask the child if he knows why he is at the appointment. Discuss the events that led up to needing the contact lens and offer empathy for what has happened. Ask the child if he has concerns about wearing contact lenses and what they are. It’s important to repeat and paraphrase back to the child what he says, to make sure he knows you have been listening. Once you know what a child is afraid of, it is much easier to address his anxiety.

Parents pose an interesting, added level of tension in the exam room. Children will frequently mirror their parents’ emotional state. The parents have different, but equally valid concerns for their child such as: “What if this doesn’t work?” “Will my child be blind?” and more abstract things such as “What will be my child’s future?” They also have personal fears about applying and removing the lens, how this will fit into their daily routine, and cost.

After first addressing the child, I generally turn my attention to the parents and repeat my empathetic listening techniques. Once all of the concerns are out in the open, I begin to address them.

I give the parents additional resources including financial help, names and numbers of other parents who have been through similar situations, and how to reach the on-call practitioners after hours. However, the bulk of the visit is directed at communication between the child and me.

Child Involvement

I include children in the decision-making process of what will happen next. I always give a child two options (both acceptable to me) so he feels in control. I have the child wash his hands so he can touch the lens. We talk about how smooth the lens is, what it will feel like, and then we discuss how it will be placed on the eye. Of course, we’ll also include something from the treat drawer once the lens is applied.

I tell the child, specifically, what I want him to do, rather than what I don’t want him to do. For example, give him a toy to look at and say “look at the car,” rather than “don’t shut your eyes.” Oddly, when children are told not to do something, that’s all they seem to do.

Breathing Exercises

Breathe, loudly, in a slow and calm manner and have the child breathe with you. Breathing keeps everyone focused and calms the whole room. It also teaches the parents a technique for keeping calm at home. I make sure that my voice is steady and quiet, especially as tension mounts when I apply the lens; I remind the parents, if necessary, to do the same.

Of course, it is not always easy to maintain an air of calmness, but practice make perfect. By controlling my state of anxiety, I can generally help both the child and parents with theirs, which is necessary for successful contact lens wear. CLS

Dr. Sindt is a clinical associate professor of ophthalmology and director of the contact lens service at the University of Iowa Department of Ophthalmology and Visual Sciences. She is the past chair of the AOA Cornea and Contact Lens Council. She is a consultant or advisor to Alcon Vision Care and Vistakon and has received research funds from Alcon. You can reach her at christine-sindt@uiowa.edu.