Desperately needing help with cannulating DD

[123Holly]

DD who is 4 has had dental issues due to severe milk allergy and being on neocate as a baby.
There is a lot of decay and recently she has had horrible abscesses in the gum and it has been agony.
DD is not very trusting of strangers especially docs and nurses as she broke her arm and remembers being held down etc and needed to be canulated just a couple months ago which was a nightmare. They blew the vein and she had to be restrained to get it in the other hand.
After months on the waiting list for a general anaesthetic for abstraction of 7 teeth and our appointment was Wednesday. We met the dentist and anaesthetist, and waited to go down. The anaesthetist was pretty straight to the point checking name and DOB. No chit chat but that was ok.
And no trick in the book was keeping her distracted and still. She was kicking about and crying. And the anaesthetist said to her she was being too naughty and now she would have to go and wait for the other boys and girls to be done. So another couple hours in the waiting room with a thirsty and hungry child and I was practicing the mask it’s her, and showing her how her hands were numb and I thought she would do it. But same thing again kicking and screaming and the anaesthetist said she was being really naughty and upsetting everyone. And that she could just go home and keep on having a sore mouth and that the waiting list is long enough with boys and girls that want help. DD then cried and said ok she would do it, but the anaesthetist said no she didn’t get to be naughty kicking up a fuss then have her own way.
As soon as we were out I just cried all afternoon about the whole thing. Embarrassment that I couldn’t control my child (who is usually really good). Made to feel bad by the anaesthetist.
I just don’t know what to do. We will get sent another appointment. I tried to prepare her before this one. I’ve spoken to the health visitor who said she wasn’t sure what to do in this situation.
Please any advice would be greatly appreciated.

I'd be making a complaint about that. I've done 3 GAs with my kids and the staff have been wonderful at working with them, comforting them and distracting them as necessary. My severely disabled brother has the anaethetist throwing toys round the room or blowing bubbles to help relax him before he goes under. Different approaches are discussed and agreed- he usually doesn't have sedation in advance as he actually doesnt mind needles (he just likes to pull canulas out and have a look at them) but it definitely has been an option. There so much that can and should be done to help those who are nervous and are too young/ill to respond to a logical arguement. They should not be threatened or lectured in that way.

I wonder whether the anaesthetist or another member of the team was pregnant? I can’t think of any other reason why they didn’t just use a mask induction and get on with it. The last thing a frightened 4 year old needs is hours of waiting to build up their anxiety levels and then to be told they are naughty for feeling frightened. If you haven’t already made a complaint you really should. Your problem sounds like an incompetent anaesthetist not a naughty child.

it’s not helpful to deal with fear by meeting it with force in a medical situation, it just compounds the problem. It sounds like she had long term health needs if she’s having major extractions at four, so dealing with this is crucial. It’s up to the hospital to make this part of her treatment rather than just ask you to deal with it.
You can ask what the terms of the meeting are, you don’t just have to go along with no information.

How dare the anaesthetist treat a child like that? They should be very experienced working with children with needle phobias, it’s not uncommon. My son has needed lots of cannulation and one GA and I have never experienced anything other than complete compassion (he’s 3 now).

A few things I’d recommend:

1. Get a Buzzy - this vibrates and cools above the site and makes it less painful / distracts from the pain

2. Get Emla cream and the dressings at home. Apply it yourself before you go so there’s less waiting around. If your DD has good understanding, you could do a trial run with the cream a week or so beforehand and show her that it numbs her skin.

3. Someone here explained a hold that really helped me. You sit on a chair facing forwards. DD sits on your knee at a right angle (so facing 9 o clock or 3 o clock). The hand being cannulated goes under your arm and the nurse sits behind you. Give DD an iPad.

4. speak to them in advance. Explain the serious phobia and what happened last time. Your DD needs calm professionals offering support, not discipline.

Please make a complaint - that person is in the wrong job!

Not a very child friendly anaesthetist that's a bad attitude to a small scared child. Ours are much better these days. They use Bubbles/distraction and lots of encouragement.

Ask for play support if there is that available.
Ask for sedation prior (we use oral midazolam but not buccal, it doesn't always work but it's worth a try. Tastes bad though)

Sticker chart maybe for the day: step by step stickers if she like that kind of thing.

Unfortunately no matter what you do some children just hate every second. Lots will not respond to any prep before hand and just a big cuddle from mum or dad as they go to sleep. Lots of praise and support post op.
Does she vocalise what upset her?

DT2 would not tolerate the mask either. He was absolutely terrified when he had his GA. we had to hold him down in the end. It was awful for me but he bounced right back afterwards as if it never happened.

Hang in there x

I am speechless. That’s the most outrageous thing I have ever heard. I take it this was a kids hospital?

Kids will be kids and this sort of stuff happens and dealing with it should be standard practice. The only issue occurs when parents make the situation untenable which does occur and has become more frequent over the years. They don’t tend to grasp that having a 3yo scared, hysterical and completely cracking it for 90mins while they try and reason with them and ‘gain permission’ for someone to touch them let alone get further than that is far more traumatising for the child than a grab, pin and jab which would be over in 30sec or bear hold and mask on and them out within a min (the more and harder they scream the more they take in, the faster they go). The reality is no one has time for a continuing 3-ring circus but as long as parents are willing to be reasonable you can get the job done and the quicker the better for the child.

How someone could not do their job and send you away is mind boggling. As for cannulating a problematic child without knocking them out, any idiot knows that won’t work. Younger kids cannulated after mask and older kids with issues sedated and then mask if necessary, then cannulate. I would definitely make a written complaint.

Chasing she screams and says anything she thinks that will get them to stop.
Liking the bubble idea. She loves bubbles and I wonder if a play therapist would help with this.

Kids need cajoled into medical things I suggest a pre med and doing it while she’s sleepy , give her a teddy that gets ‘ cannulated’ at the same time , make sure they use Emla cream etc
Hopefully the next person has a better bedside manner .

Hopping yes I said I was willing to do anything to get the job done. I had her sit sideways on me with her hand behind my back and I tried to hold it in place with my elbow. They tried distracting with the iPad but she was only worrying about what they were doing to her.

He sounds awful. I am sorry this has happened to you and your lovely dd. The two of you did nothing wrong and he did everything wrong by the sound of it.

What a horrible experience. I hope you get someone else next time and she gets the treatment she needs.

Your poor dd. And you. Like a pp said, how dare he speak to her like that? I hope somebody has reported him, because I find it astonishing that another member of staff would witness that and not intervene or say something. Unless of course, that's how he always is, and with other members of staff are afraid of him, which is totally unacceptable too.

Please contact PALS. Take someone with you to that meeting too.

You've had great practical ideas to help with your dd, but I'll put money on it being a very different experience with a different member of staff. One with some sympathy, empathy and decency.

Definitely contact PALS about the anaesthetist. So unprofessional and uncalled for.

I've taken lots of children down for surgery in my last placement at uni, I didn't once see any health care professional speak to an upset child like that.
One child was trying to kick and punch everyone, screaming the place down and all they did was explain that he was going back up to the ward and they'd try another time when he had calmed down. He had a sedative and all went smoothly.

If distraction doesn't work, and the surgery is essential (which it sounds like) then ask about midazolam.

Your poor daughter, and you!

The anaesthetist was a prick. And I say that as a doctor myself. There was no excuse for that attitude towards a very young, frightened child.
I would guess the hospital is arranging a meeting because another staff member has reported their behaviour and they want to be proactive in dealing with it.

Agree with the others that this is dreadful. We used the hold described above with ours. DS2 is well into double figures with surgeries & I have never had the misfortune to come across such an attitude.
Apart from anything else children don’t have surgeries because they behaved! She’s four, very frightened & distressed. Surely nothing they won’t have seen before. Definitely follow it up OP. A decent play specialist in the room & an experienced team will be able to get a child into theatre. Good luck.

I’m still upset after reading this earlier. Stuff like this can cause lifelong needle phobias, it’s just not okay. I have a terrible phobia of needles and during my spinal for my emcs they had to attempt it seven times - I was like a cornered animal, swearing, growling and then crying and apologising for swearing at them (I was honestly absolutely terrified - I would never ever ever swear at an HCP, or anyone, under any other circumstances). I also had to have my arm reconstructed while awake many years ago and I was hysterical. All of those staff treated me with a great deal of understanding because their job is sticking needles in people and they understand that some people are genuinely terrified. If I can access that sort of care as an adult, a child shouldn’t be treated this way.

Please contact them and ask if there’s any support available - play therapist, being first on the list etc etc.

Thank you everyone genuinely. I am going to be able to go into this meeting next week more confident knowing that the anaesthetist was definitely being unreasonable. And will be able to ask for specific help like the play specialist and an oral sedative. And definitely a different doctor!