Children with retinoblastoma have many eye drops during diagnosis, treatment and follow up care.
Dilating and fluorescein drops are given to allow a clearer view of the eye. Antibiotic help protect the eye, and analgesic drops keep the child comfortable during or after procedures.
Though a simple procedure, giving drops can create strong anxiety, and children need special supports to help them cope.
Advocate
If you have a successful family method for giving eye drops that your child prefers, mention this to the nurse and advocate its use. Many nurses will allow you to administer the drops yourself, if you and your child are comfortable with this.
Practice
If you and your child struggle with eye drops, practice repeatedly to find the method that works best for both of you. Take turns administering artificial tears and pretend eye drops to one another.
Allow your child to practice dropping plain water drops or artificial tears into your eyes or into a doll or stuffed animal’s eyes. This promotes a positive experience and helps him gain familiarity and mastery, confidence and a sense of control over his fear.
Older children can begin practice with water drops or artificial tears, and work their way up to administering eye drops on themselves whenever possible.
Comfort Positions
Many children do not feel comfortable lying on their back during medical procedures. This can cause them to feel exposed, vulnerable and upset.
Explore different comfort positions (see pictures). Allow your child to practice giving drops into a doll’s eyes in the different positions you practice. This will add to his sense of mastery and control over the experience.
Cradled – Baby
The baby is held securely in place by the parent’s comforting arm, while the free hand is used to apply the drops.
Cradled – Older Child
The child’s hands are crossed on the chest and can be restrained by the parent’s comforting arm, if needed.
Baby on Lap
Applying drops can be difficult in a young baby who is facing away from you. The baby is more secure on your lap in this position, and you can also easily do infant massage to calm your baby before applying eye drops. If you worry your baby may kick, you can place a cushion between yourself and your baby’s feet.
Stroller 1
This position is good for children who are more confident with eye drops. The child needs no restraint and is fully supported by the stroller. The parent has both hands free to apply the eye drops, if needed. Never approach a child from behind without warning or preparation to apply eye drops.
Stroller 2
This adaptation of the Stroller 1 position supports children who need a little reassurance to master their confidence with eye-drops. Both hands can be gently but firmly restrained on the child’s chest. Never approach a child from behind without warning or preparation to apply eye drops.
Positive Language
Practice a calm voice and supportive language. Encourage your child during delivery of the drops. Tell him how well he is doing. If the drops sting, remind him they hurt only for a few moments. If they don’t sting, tell him they will only feel cool and wet – like the practice drops.
Distraction
Encourage your child to choose a special song he would like to sing when the eye drops are given, or a nursery rhyme to say. Some drops can sting for up-to a minute, so try to pick a distraction song that will occupy your child for at least a minute or two.
Your child may want you to read a book. This can be a great distraction, but remember he will not be able to see pictures during delivery of the drops. So don’t base distraction on visual stimuli.
Eye Drops Session – One Retinoblastoma World 2021
This session on Eye Drops took place during the One Retinoblastoma World 2021 Conference, held virtually on October 2, 2021. An entire session dedicated to the experience around dilating eye drops, which are vital to fully examine the eyes, and remain the primary cause of distress for the child receiving care, the caregiver who supports the child, and the health professional who instils the drops.
This repeated, invasive part of any eye exam can set the infant or child up for a lifetime of distress related to medical procedures, or calm, confidence and self-advocacy. We examine eye drops from the perspective of the clinician, the child, the parent, and the Child Life specialist who works to mitigate distress.
0:00: Clinician – Sandra E. Staffieri PhD, BAppSc(orth), Retinoblastoma Care Coordinator, Royal Children’s Hospital, Victoria, Australia
16:38: Parent – Belinda Faure, Melbourne, Victoria, Australia.
23:28: Child Life – Olivia Larkens, Certified Child Life Therapist, Royal Children’s Hospital, Melbourne, Victoria, Australia.
32:12: Q & A – Moderator: Paula Dillon, BN, PostGradDip Mid, MMid Retinoblastoma Parent, Brisbane, Queensland, Australia.
