"Cynthia Jaeger was packing up the family minivan for the two-hour trip from her house in Richmond, Va., to Washington, D.C., when her 8-year-old daughter began having an anxiety attack. Zoey, Jaeger’s middle child, has a rare neurological condition, and she needed to go to Children’s National Hospital for chemotherapy and intensive cognitive testing.
A visit to the hospital didn’t freak Zoey out — she was a sturdy patient who was accustomed to medical procedures. But after Jaeger told her daughter she had to get a coronavirus nasal test when they got to the hospital, Zoey refused to get in the minivan. Jaeger coaxed her into going, and ultimately had to restrain her daughter in her lap while a nurse reached into the van and swabbed Zoey’s nose.
“It was such a nightmare. I was crying, Zoey was crying. It was just a mess, there’s got to be a better way,” Jaeger said. “She was traumatized.”
Testing children for coronavirus is becoming more prevalent as states reopen, posing challenges for parents, caregivers and medical providers in administering the test. Most hospitals now require patients to get a coronavirus nasal swab before any surgeries and procedures. Some summer camps and athletic programs are mandating children get tested. And day care centers and schools are considering imposing testing requirements for the fall.
“With more availability of testing, with schools looking at different models for opening, these tests are going to be a very common experience for children, like getting a vaccination,” said Kim Stephens, president of the Association of Child Life Professionals, an organization that represents workers who help kids handle the anxiety associated with hospital visits.
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While many medical procedures — like dental work, X-rays and annual vaccinations — often cause kids distress, experts say the coronavirus nasal swab test is a perfect tripwire for inducing anxiety in children. That is partly because of the novel coronavirus itself. Many kids recognize that the virus is formidable; it has upended the world around them for the past several months and unleashed a steady drumbeat of scary news. And the test is very uncomfortable. Nurses take a cotton swab and capture cells far inside the nose, which lasts a few seconds and often hurts. When children wiggle their bodies or shake their heads, they will likely experience more significant pain. Some facilities require the test to be done in a drive-up setting to minimize person-to-person contact. In those scenarios, the test is often done while a child is sitting in the back seat of a car, and conducted by a nurse who is not only cocooned in protective gear but also reaching through a half-open rear window.
“Nurses are rightly concerned with physical safety during tests and procedures, but we also have to worry about emotional safety,” Stephens said. “A lot of little minor insults can add up to long-term emotional harm that makes people afraid to go to the doctor, and affects overall medical compliance.”
Research shows that nerve-racking medical tests and interventions can affect children psychologically. For example, a study found that 10 percent of adults abstain from medical procedures involving needles, such as vaccinations, because of poor experiences they had as a child.
Even though the nasal exam is new — and scary — for some kids, parents and caregivers can help by telling kids exactly what to expect, and leveling with them that the test is unpleasant.
“It’s important to be open and honest and share the truth about the test,” Stephens said. “It’s normal for a child to feel anxious and worried. But in the end, it’s an opportunity to build trust.”
For younger kids, there are videos that can demystify the test, and Stephens said it helps to describe the process in familiar terms for kids.
“We talk to them about a soft cotton Q-tip that is going to grab some of their boogers,” she said. She also recommended using play time to act out the procedure.
Because keeping your body motionless makes the test more bearable, the Children’s Hospital of Philadelphia instructs parents to tell kids to “try to hold your head still like a soldier” or “let’s pretend we’ve been frozen like Elsa.” It also recommends validating a child’s feelings by saying, “It’s OK to feel upset about this.” And it endorses bringing a favorite comfort item to the testing site like a blanket or a stuffed animal.
“Even for kids who have excellent coping skills, they are having a very hard time with this test,” said Jennifer Rodemeyer, a child life specialist at the Mayo Clinic in Rochester, Minn. “We have found anything that comes in deeply through the nose is very challenging, and there is no topical anesthetic we can use to make it more comfortable.”
Karen Turner is a patient advocate who works with children with developmental disabilities at Massachusetts General Hospital in Boston. Many of the kids she sees visit the hospital regularly and must get the coronavirus test numerous times. She said some of the proven strategies that help kids with autism cope with fight-or-flight situations can also help kids cope with the test.
She suggests putting children in a weighted vest during a swab to provide deep pressure, which is shown to be calming. Another method often used to help autistic children deal with anxiety-producing events is to create a booklet known as a social story that illustrates the situation. Turner says showing a child a social story that depicts all the steps of the Covid-19 test can defuse some of the fear.
Meanwhile, at the Mayo Clinic, nurses have found that parents should keep children from lying on their backs when they get the test since it is natural to feel a loss of control in that position. “Sitting up is best,” Rodemeyer advised.
“Obviously, we would love it if there was a less invasive way to do this, but for now, the nasal swab is the best and most accurate way to do this testing,” said Rodemeyer. “Children are going to have to go out into the world, go to the hospital, and take this test. Covid-19 isn’t going away.”" -The New York Times