Dressing Changes-How to Cope!
“My 6 year old daughter really struggles with dressing changes. Any ideas to help her get through them?”
Dressing changes are one of those procedures that feel like they’re every day for patients. They typically have to happen weekly and are dreaded because of how sensitive the skin can become over time. For any reader who is new to all this information, children undergoing treatment for leukemia typically have a PORT (catheter that is underneath the skin) or a PICC (line that is peripherally inserted into a vein). Also, these dressing changes can be as quick as 15 minutes or as long as 30 minutes depending on how well the child is coping. Let’s talk about a few ways to advocate for your child and ensure they’re coping as well as possible.
Identify the Stressors
First, sit down with your daughter and discuss the hardest things about the dressing change. Is it when they take off the dressing itself? Is it the cleaning part that can sometimes feel like a burning sensation? Whatever it may be, it’s important to know what your child is struggling with before developing a plan. Next, discuss ways to help your child remain calm and distracted during the dressing change. Perhaps, you hold up an iPad so they can watch their favorite show or put on some music so they can zone out while holding your hand.
Create a Coping Plan
After the stressors have been identified and you have devised ways to handle them, talk with your nurse about your coping plan. Maybe it’s a matter of letting your nurse know that your child needs a 5 second break between the removal of the dressing and the cleaning of the skin. Or, maybe your child benefits from the nurse not announcing each step of the dressing change, as this can increase anxiety. Whatever it may be, make sure your coping plan is practical and attainable. Finally, keep in mind that some of your requests might not remembered in the moment so advocating in the moment is still required! Collaborative conversations before and after the dressing change are helpful so your nursing staff can understand your child’s needs.
Notify Your Child
I know it’s not easy to have to tell your child that they’re going to have to go through an uncomfortable procedure but you have to tell them ahead of time. And not just a few minutes before… because no one likes surprises!
Giving your child time to prepare themselves is so important. This allows them time to process what is going to happen, ask questions as needed, and confirm or adjust the coping plan. For example, maybe they decided that they want more control today and want to help the nurse in removing the dressing. Or, perhaps, they’re not feeling well and just want to close their eyes the whole time. Any decision they make is okay. When they are prepped ahead of time, this allows for an opportunity to “play out some experiences,” as we’ll discuss next.
Utilize Medical Play
To define medical play briefly, medical play is the act of taking part in medical themed play or using medical related supplies in a non-threatening way for the purpose of self expression. This type of play can help reduce a child’s anxiety and allow them to regain control over experiences they likely had little control over before. To learn more about the research behind medical play, check out this article.
Child engaging in a form of medical play.
At the beginning of this blog post, a parent asked how to support their 6 year old daughter. Hence, medical play sessions will look different for a child around 6 years old vs. 3 or 4 years old. At 6 years old, you’re likely to see a child who recalls their last dressing change in great detail; they likely will want to take this time to be the one in control. She may want to play the role of the doctor. And, she may insist on having all the “real medical supplies” (i.e. gauze, tegaderm dressing, etc.) to play out her experience properly! Then, she may request that Mom or Dad play the role of the patient so she can make it as realistic as possible.
A 6 year olds’ attention to detail is likely to be present in their play and that’s very helpful when they are trying to release some of the BIG emotions they’ve been having regarding dressing changes. Certainly, these are great opportunities to also play out or try out different coping plans to see what your child is most receptive to.