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Care of sick children: what nurses need to know when calming anxious parents

Parental anxiety can transfer to a sick child, so parents need to feel supported and calm

Parental anxiety can transfer to a sick child, so parents need to feel supported and calm, but what is the best way for nurses to do that?

  • Emergency department attendances of children up to the age of 5 has increased by 24% in England over the past six years
  • Parents concerns about childrens well-being is increasing and nurses can be a key source of reassurance and advice
  • Parental anxiety can often stem from a lack of information, but it is also advisable not to overload

Caring for sick children often means managing their parents as well. Seeing their child unwell or injured can create degrees of anxiety in parents, frequently made worse by

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Parental anxiety can transfer to a sick child, so parents need to feel supported and calm, but what is the best way for nurses to do that?

  • Emergency department attendances of children up to the age of 5 has increased by 24% in England over the past six years
  • Parents’ concerns about children’s well-being is increasing and nurses can be a key source of reassurance and advice
  • Parental anxiety can often stem from a lack of information, but it is also advisable not to overload
Parental anxiety can transfer to a sick child, so parents need to feel supported and calm
Picture: iStock

Caring for sick children often means managing their parents as well. Seeing their child unwell or injured can create degrees of anxiety in parents, frequently made worse by the child’s inability to articulate symptoms or the locus of any pain.

For nursing staff, calming the situation may be a necessary first step to assessing and addressing the child’s needs. But how is that best done? What can you do to support and calm an anxious parent?

‘Every single emotion that can possibly come through tends to raise its head’

Nicola Doherty, consultant lead clinical psychologist

Parental anxiety over a sick child is normal and can manifest in many ways including guilt, fear or anger.

‘Every single emotion that can possibly come through tends to raise its head,’ says Western Health and Social Care Trust consultant lead clinical psychologist Nicola Doherty.

As a result, parents may go into ‘lion or tiger mode’, says Dr Doherty, who is also visiting professor at Ulster University and chair of a British Psychological Society paediatric psychology network.

‘They don’t want to see their child experiencing pain and will do everything to protect them.’

Parents’ concerns about their children’s well-being may be increasing

The parent’s own experiences from childhood may also come into play, and needle phobia, for example, may be common to parent and child.

Whatever their source, parents’ concerns about their children’s well-being may be increasing, evidence suggests. The Institute of Health Visiting says the number of emergency department attendances of children up to the age of five has increased by 24% in England over the past six years, despite a falling birth rate and overall improvements in child health.

Alison Morton, acting executive director of the Institute of Health Visiting
Alison Morton

Acting executive director Alison Morton says reasons for the increase are complex but may include changes in parental expectations and lack of confidence in managing minor illness.

‘But most importantly these visits tell us that parents are worried and are either unable or unsure how to access the reassurance or advice they need in other ways.’

Becoming a parent brings obvious happiness, but the sense of responsibility for the child’s health and well-being can also be daunting.

‘These feelings of worry and anxiety are particularly heightened when their baby is unwell, and it can be confusing to know what to do, who to ask and when to seek urgent medical help,’ Ms Morton says.

Children are adept at reading signals and can often blame themselves

Parental anxiety can transfer to the child, although Ms Morton says there are often many factors involved in a sick’s child’s anxiety and not all will relate to the parent’s emotions. ‘It is in no way deterministic,’ she argues.

That said, even very young children are adept at reading signals, Dr Doherty says. They will pick up on parental emotions and, although they may not necessarily mirror the parent’s response, in situations where emotions are heightened, developing a connection between nurse and family can be difficult.

Children may also feel a sense of blame if, for example, the parent is expressing anger towards health professionals. ‘Children are fabulous at blaming themselves,’ Dr Doherty says. ‘They might not become angry themselves but might develop a script where health professionals are bad and make mummy angry.’

Lower the level of emotion in the room by acknowledging anxiety

A useful step towards calming the situation and lowering the level of emotion in the room is to acknowledge the parent’s anxiety, says Western Health and Social Care Trust consultant lead clinical psychologist Nicola Doherty.

Try saying: ‘Sometimes in these situations parents can be really anxious,’ or ‘Some parents can be worried’.

Avoid saying: ‘You seem anxious,’ as it risks labelling the parent.

Lower the level of emotion in the room by acknowledging parental anxiety
Picture: iStock

You might also open by asking what the parent needs to know about the impending procedure or treatment, or saying: ‘What do you understand about what’s going to happen?’

Using open-ended questions, you should aim to listen, notice and feed back, Dr Doherty suggests. Your aim is to connect with the parent so they feel able to express their anxieties.

She often adopts the ‘regulate, relate, reason’ model devised by neuroscientist Bruce Perry with anxious parents, although it was designed for children.

Children may also feel shame as a result of blaming themselves. ‘In a lot of situations, staff go straight for reasoning and giving information,’ Dr Doherty says.

‘But you can’t reason if someone is dysregulated, so you need to go way back down to the bottom of the pyramid and regulate first – which is helping someone come back into themselves, ground themselves, be in charge of their emotions.

‘And when you’ve done that you can relate to them and when you’ve related or connected to them, then you can reason.’

Regulate, relate, reason – how the model works

Regulate Help the person regulate and calm their flight/fight/freeze responses by using soothing language, stepping back and allowing them time to process

Relate Develop a calm, sensitive dialogue, acknowledging how they feel and how that is hard for them

Reason Support the person to reflect, articulate and self-regulate their emotions.

Adapted from: The 3 Rs: Reaching the Learning Brain

If you model coping and calming behaviour it can also help contain the situation. Dr Doherty says: ‘If a nurse or other staff member sees a parent is worried and then matches that worry, it’s all going to escalate. Whereas a calm, contained approach can help things go in a different direction.’

‘There is good evidence to suggest that parents receiving consistent, clear safety-netting advice… are more likely to successfully self-manage illness in the future’

Alison Morton, acting executive director of the Institute of Health Visiting

Anxiety can often stem from lack of information and ,Ms Morton says, efforts to extend health literacy will improve parental confidence and reduce anxiety.

‘There is good evidence to suggest that parents receiving consistent, clear safety-netting advice – what to do now and symptoms to look out for if the child deteriorates, with clear information on what to do then – are more likely to successfully self-manage illness in the future and feel more confident.’

Important not to overload parents with information

She says parents value education about common illnesses as well as advice on trustworthy sources of information from quality assured websites and apps.

Listen to anxious parents' concerns
Picture: iStock

While many anxious parents welcome information about their child’s condition, it is important to avoid overload, Dr Doherty suggests. Breaking down treatment into a series of steps, with small chunks of information relating to each, is likely to be better absorbed than a torrent of facts, advice and instructions.

It is also important to highlight stages where choices are possible, even if the choice is over something seemingly insignificant such as cannula sites. Choices help give the individual a sense of control.

If a parent is anxious, avoid minimising their concerns

Information only has value if it is understood. ‘Never assume a family has heard what you said,’ Dr Doherty advises. ‘If they’ve been told something when they were feeling anxious, they won’t have been able to process it.’

If a parent is anxious, avoid minimising their concerns by saying things like ‘Don’t be silly’ or ‘Don’t worry’.

‘It negates the very real experience they are having,’ Dr Doherty says. Instead try: ‘I can see you’re worried – and that’s perfectly normal and natural.’

And however the anxiety manifests itself, even if it causes the parent to become angry, don’t personalise it. ‘Try to stand back and see the context in the room and remember that usually everyone has the same goal, the same motivation – they want the best for the child.’

Healthier Together: a valuable source of information for worried parents

Alison Morton of the Institute of Health Visiting endorses the NHS-backed Healthier Together website as a source of information for worried parents on conditions common in children. The site also includes resources for children’s nurses and health visitors.

Developed with paediatricians, health visitors, general practice nurses and parents in the Wessex region, the website covers a range of presenting symptoms, with red, amber or green ratings indicating whether urgent medical help is necessary. Parents are signposted to appropriate healthcare services as required.

NHS-backed Healthier Together website is a good source source of information for worried parents on conditions common in children
Picture: iStock

Ms Morton says Healthier Together is recommended for practitioners and parents.

She quotes a health visitor who was contacted by a new mother worried about her baby’s rash. Using a video link and Healthier Together’s symptom-checker, the health visitor was able to reassure the mother that the rash was not serious.

The health visitor said: ‘I then texted her the link to the Healthier Together factsheet on rashes in babies under three months for her to refer to and for further reassurance. The mum was happy and it avoided an unnecessary trip to the doctor or emergency department.’


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