THE 4 YEAR OLD CHECK UP

Over the years as a pediatrician, I have come to dread the 4 year old check up as much as many parents do.  It’s the age when we give vaccine boosters, and at 4 years old, children know exactly what may happen at the doctor’s office.  As a pediatrician, I had noticed that the children whose parents had talked to them beforehand about vaccines seemed to do better than children who found out at the appointment that they would be getting shots.  I tucked away this mental note as I thought about my own daughter one day turning four.

A few months before my oldest daughter turned four, as planned, I informed her that she would be getting shots at her next check up.  We had a doctor kit at home, and we gave each other shots. She gave me shots in my leg, my arm, my face, wherever she could aim that toy needle (hopefully she doesn’t go into nursing in the future, considering her aim).  The shots “tickled”; it was a quick poke, and then it was “all done!”. Every once in awhile, I would mention her upcoming check up and the shots, and she would happily tell me how brave she would be.

The morning of her check up, we entered the waiting room of the office where I worked, as happy as can be.  I saw one of my good patients in the waiting room, and we said hi, laughing at the fact that now I was on the other side of the appointment, taking my own daughter in. We approached the front desk, and while I was chatting with the secretary, my daughter slowly looked up at me.  Her eyes grew increasingly wider and tears welled up. She had a moment of realization. “Mama, do I have to get shots today?” I responded, “M, we don’t have to worry about that right now”, and then the wails started. She cried and cried. Then I remembered, my patient is here in the waiting room, seeing my daughter crying uncontrollably–what am I supposed to do?!

I hugged M to comfort her, and, fortunately, the nurse brought us back to a room (maybe not to scare the other patients??), and M continued to cry, refusing to get her measurements, her vitals, refusing to do the hearing test, anything.  I felt so embarrassed that here I am a pediatrician, and I didn’t have my own daughter held together. But I had done everything I was supposed to do! We had prepared for months for this moment; no surprises here! I held her as she increased her crying volume, and we waited in the room. As it happened, my husband was able to get out of work and join us, and he suddenly appeared in the room where M was wailing, his own eyes wide, wondering what had happened to her.  Nothing yet, unfortunately. We couldn’t get anything done because she wouldn’t stop crying! M crawled into my husband’s lap, and our pediatrician entered the room. We could barely talk to each other, M was so loud, and I was at a loss as to what we could do to get her examined.

I was lucky because the pediatrician M saw is a seasoned pediatrician who is incredibly understanding and patient, and…I worked with her!  We decided in this case, M might do better if we got the shots out of the way first. I wasn’t very optimistic that M’s behavior would improve, but we weren’t getting anywhere with her, and M was not letting go of her father.  The nurse walked in, hiding the shots from M’s line of vision, and M’s father and I held her while the nurse gave her her shots. Suddenly…the crying completely stopped. M just stopped crying all together! M’s anxiety from the anticipation for the shots was gone, and she relaxed, and now I was able to relax too.  She suddenly decided to cooperate, and she allowed the pediatrician to examine her. We left the office, prizes in hand, which, my gosh, I felt like I deserved more after the stress she put me through!

I feel like this is the constant tug of parenthood.  Trying to decide what the right approach is for our own children, not always knowing how they will react.  But we have to try something! I thought I was doing what was right for my child by mentally preparing her in advance of shots, but in her case, it increased her anxiety due to the anticipation, just the mere thought of the shots and what it might feel like.  I would have felt guilty for not telling her beforehand, but then again, she wouldn’t have worried beforehand either. As parents, we are all doing the best we can to make the right decision for our children, and we really try to do it with their best interest in mind.

Months later, I took M in for her flu shot, but I did not tell her ahead of time.  We were at the doctor anyway for my other daughter, so M did not suspect anything. When the nurse came in to give M the flu shot, M definitely resisted, and I had to hold her tight, but it was so much quicker and less stressful not having her worry beforehand.  Lesson learned.

Medical Mommy Musings:

1. I still think for most children, it is helpful to prepare them beforehand for upcoming procedures and make them aware of changes to their daily routine.
2. That being said, what works for other children may not work for my own.
3. Pediatricians’ kids don’t like shots either. And when they come to the office you work at, they will remind everyone that at the end of the day, this pediatrician is just a mom at home, too.
4. We are all trying to do our best, when it comes to our kids. And our kids will realize that. That we are doing all of this with love.  Even if the stress of it may kill me in the process.