6 Ways to Help Older Children and Teens Cope With and Conquer Hospital Anxiety

Monday October 14, 2019

Many children and teenagers experience anxiety and distress with repeat and new medical interactions after retinoblastoma diagnosis.  Pediatric registered nurse and child life intern, Michelle Badejo, describes how hospital anxiety can manifest, and explores how parents can help them cope, be active participants in their ongoing care, and raise their quality of life.


A young girl wearing medical gloves, glasses and a stethascope prepares to practive a procedure on a medical play puppet.

After a diagnosis of retinoblastoma, eye exams and checkups become the new normal and a regular part of your child’s life. Eye drops, eye exams, and other medical procedures can go smoothly at times, and at other times be uncomfortable or stressful for your child.

Many older children and teens who receive routine eye exams and check ups for retinoblastoma can develop anxiety surrounding the hospital and medical procedures. There are many reasons that hospital visits and procedures might cause anxiety. Some things we can’t control, like a very busy clinic, emergencies, or short staffing. However, there are some things we can control, like hunger, fatigue, or boredom. When getting ready for a hospital visit, try to prepare by packing snacks and activities, and allowing for extra rest.

Anxiety can develop from repeated exposure to stressful events where your child might feel overwhelmed, unsuccessful, or unable to feel and be independent.

Hospital anxiety can present as a number of different behaviors such as:

  • Irritability
  • Stomach aches and headaches
  • Avoidance
  • Sleepiness
  • Insomnia
  • Obsessive behaviors
Image 1: Poster of 8 pictures with text below each image, encircling the central caption: “Childhood anxiety is sneaky. It doesn’t always look like worry”. Picture 1: Person lying in bed. Text reads: Physical complaints: Headaches, stomach aches, muscle aches, chest pain, racing heart, dizziness, hair pulling difficulty swallowing, lump in throat. Picture 2: Three question marks. Text reads: Seeking validation, asking the same questions over and over, clingy, concerned about safety. Picture 3: Sad emoji face. Text reads: Sadness, frequent crying, overwhelmed, lonely. Picture 4: Angry emoji face. Anger, irritability, low frustration tolerance, verbally aggressive. Picture 5: Chalkboard and teacher’s desk. Text reads: School refusal. Picture 6: Panda bear, crying. Text reads: Frequent meltdowns or tantrums. Picture 7: Yellow tent in front of a night sky with stars and a moon, and green grass in the background. Text reads: Social isolation, avoidance, procrastination. Picture 8: Sleeping emoji face. Text reads: Fatigue, “I’m just tired,” exhaustion.

So, how can you help your child cope with hospital anxiety? The first step is to encourage your child and promote appropriate independence with their care from a young age. Below, I describe six ways in which you can support your child in their coping during hospital visits.

1. Advocate for a Child Life Specialist

Call Child Life STAT!

Children of all ages can benefit from child life. Most hospitals in North America have a certified child life specialist on staff. In other countries, these professionals are usually called hospital play therapists or Hospital Play Specialists.

A child life specialist will use play and child friendly language to educate and prepare your child for medical procedures. Child life specialists will even support your child throughout the stressful examination or procedure if needed.

A child life specialist can also teach your older child or teen effective ways to cope with stressful medical procedures, and manage the anxiety that may come with that.

Additionally, child life specialists will work with you, the caregiver, and teach you ways to best support your child.

2. Normalize Medical Equipment

Get Playful

Medical equipment is a source of stress and anxiety for many children and teens. Child life specialists can help your child feel more comfortable and capable around medical equipment by giving them time to get comfortable with it in a non-stressful environment. Simply holding and exploring the equipment can take away some fears, especially for children with limited or no sight. Using video games, stories, and making art with medical equipment are great options to help older children and teens normalize the equipment.

The Simply Sayin’ app is a great resource for children who feel overwhelmed by hospital visits. The app uses pictures, sounds, and games to explain and prepare children for medical procedures.

Please Note: Presently, this app does not work with voiceover.

YouTube also has a wealth of information and fun, positive videos that can help your child prepare for a hospital visit. This great video from Cleveland Clinic shows you what you will see, hear and do during an MRI.

WE C Hope provides more information about the different types of medical play, the difference between medical play and preparation, and how to discreetly integrate medical play into everyday activities.

3. Offer Choices Where Possible

Let Your Child Be Picky

Another source of hospital anxiety for older children and teens is forced dependence. When a child is diagnosed with retinoblastoma, or enters follow-up care, there are a lot of things they must do. Between eye exams, MRIs, general health checkups, blood tests and more, a lot of independence and choice is taken from your child.

So, while your young one can’t choose to skip their eye drops, you can encourage them to make some choices. For example, you can ask your child if they would prefer to sit or lay down for their eye drops.

Other appropriate choices for older children and teens include:

  • Deciding which hand for an IV
  • Choosing which finger for bloodwork
  • Asking your child if they would like to watch the procedure or look away
  • Allowing your child to choose a distraction method
  • Asking your child if they would like a count down to eye drops or other procedures

In addition to offering choices, you can encourage independence for your child by having them practice administering their own eye drops. This can be done at home with artificial tears or lubricant.  WE C Hope offers some tips for practicing giving eye drops at home.

4. Create a Coping Plan

Don’t Forget Your Business Cards!

With the help of a child life specialist, or on your own as a family, you and your child can create a coping plan for hospital visits. After identifying coping methods and finding effective techniques to manage hospital anxiety, it is important that you and your child practice and use these methods.

Some children find music or stories help to distract them during medical procedures. Others practice deep breathing, and some like to squeeze a stress ball. Getting information is another way some children cope.

Consider writing down your child’s preferred coping methods on a business size card, and bringing it with you to hospital appointments. The card can serve as a great reminder for you and your child during stressful procedures. These cards can also be given to hospital staff, allowing the nurses, doctors, and technicians to understand how to best support your child too.

Making coping cards can be a fun, encouraging and empowering activity for older children and teens. Below is an example of a coping card, and a link to download a PDF template for your own use.

White cue card with a coping plan written out. Stickers of a hospital, a dog, sport balls, and a needle on the right side of the cue card. Text reads: My Hospital Visit Plan. Name: Billie Jameson. Age: 12 years old. Things that I like: Video games, Spiderman, Basketball, Drawing, Star Wars. A comfortable position for me: I like to sit upright whenever possible. A person who supports me is: My mom, my dad. How you can help me at my hospital visit: Please give me a countdown before my eyedrops. Please use my left hand for IVs and bloodwork.

Encourage Independence and Feelings of Mastery

55 Positive Things to Say to Your Child. 1. You are helpful. 2. You were right. 3. I know you did your best. 4. I’m grateful for you. 5. You have great ideas. 6. I love being your mom. 7. I believe in you. 8. You are important to me. 9. You make me proud. 10. You are loved. 11. You don’t have to be perfect to be amazing. 12. I believe you. 13. You are worth it. 14. Don’t be afraid to be yourself. 15. It’s good to be curious. 16. We all make mistakes, it’s OK. 17. I understand you. 18. You can say no. 19. This family would not be the same without you. 20. We can try it your way. 21. I appreciate you. 22. I know you did your best. 23. I forgive you. 24. I am so glad you’re here. 25. That was really brave what you did. 26. I admire you. 27. It’s your decision. 28. If you really believe in something, it’s important. 29. Don’t give up. 30. I could never stop loving you. 31. You can try again tomorrow. 32. Don’t compare yourself to anyone else. 33. You are enough. 34. It’s OK to be scared. 35. Eaven if you make a mistake, you can fix it. 36. Being kind does not make you weak. 37. Your ideas are great. 38. You don’t have to do what everyone else is doing. 39. Anything is possible. 40. You can make a difference. 41. I love how you said that. 42. I’m listening. 43. You did that so well. 44. You make my heart full. 45. Not everyone will like you and that is okay. 46. You have a choice. 47. That’s a great question. 48. I’m so excited to spend time with you. 49. That was a really good choice. 50. I trust you. 51. I hear you. 52. Your attitude can change any situation. 53. You are a great friend. 54. Never stop trying. 55. I’ll always love you.

Shower Them With PraiseTT

Older children and teens have an emerging sense of independence that must be nurtured. You can foster your child’s emerging independence, even when they are living with retinoblastoma or its effects. Anxiety happens when we feel like we have no control over our situation. By helping your child feel more in control, you ward off anxious feelings.

During and after medical procedures, you can offer your child words of encouragement, even if the procedure isn’t going as well as everyone hoped. By staying calm and using statements such as, “I can see how hard you are working to stay still”, you encourage feelings of mastery for your child.

6. Try, Try Again

Sometimes, It’s Just Not a Great Day

Sometimes, no matter how prepared we are, things don’t go as intended. If your planned coping skills don’t work one day, try them again. Or tweak them. Remember, coping skills take practice.

Keep in mind too that when things don’t go how we hoped, it’s no one’s fault. Be kind to yourself and your child and plan with a positive intention for the next medical interaction.

A boat on a wavy sea. There is a storm cloud in the background with a sad face and tears coming down. Text written in wavy lines reads: 10 Things to Say instead of Stop Crying. 1. It’s ok to be sad. 2. This is really hard for you. 3. I’m here with you. 4. Tell me about it. 5. I hear you. 6. That was really scary, sad, etc. 7. I will help you work it out. 8. I’m listening. 9. I hear that you need space. I want to be here for you. I’ll stay close so you can find me when you’re ready. 10. It doesn’t feel fair.

There’s Always Hope

One certainty with a retinoblastoma diagnosis is that your child will have many procedures, tests, and exams over many years that can be stressful and anxiety provoking. Child life specialists can help you and your child find ways to manage anxiety before, during, and after hospital visits – at all ages and stages of their care, making each visit a little less stressful. Together with the hospital team, you can help your child build resilience and conquer their hospital anxiety.

About the Author

Michelle Badejo is a pediatric registered nurse and a certified infant massage instructor from Toronto, Ontario. While working in pediatric medicine within the hospital setting, she found a passion for palliative care and community care. At the pediatric hospice, Emily’s House, she works with children living with a life limiting or terminal illness, and their family members.

Throughout her nursing career, Michelle has always had an interest in psychosocial care and global health. These interests inspired her to pursue a career in chid life. As a current child life student, she has traveled and studied with child health organizations such as Save a Child’s Heart Israel and the Sally Test Child Life Team in Kenya. Presently, Michelle is completing her child life internship and plans to become a certified child life specialist.

Michelle Badejo