5 year old refusing to allow treatment or medication

[sleepymum12]

We had a rushed trip to A&E last night because my 5 year old suddenly started, out of the blue, coughing, wheezing and struggling to breathe. On arrival we found his Spo2 levels were too low, and heart rate too high. Having high rates of asthma on both sides of ghe family, docs think this is the likely cause. He has been totally fit and healthy before this, never had more than a mild cold, so has little to no experience with doctors.

The problem we are having is that he is fighting against having the medication. Even having the oxygen mask or nebulizer near his face, causes him to scream and cry, throw himself about etc, in a way he never normally would. Even taking liquid paracetamol is sending him off on a huge meltdown, when obviously he has taken Calpol at home for years!! He even fights against having the sensor attached to his finger to check his vitals. The doctor really wants to get things under control and then have him able to use an inhalor with a spacer before he is discharged, but I don't know when or how we will acheive this. We are on a second night in hospital at the moment, and have scolded, bribed, phoned grandparents, tried every trick in the book and are at a loss. We are just about getting enough medication into him to keep him at safe levels for blood oxygen etc.......any body else experienced this? What did you do?? He just seems to be terrified of anything medical. The strange thing is, he will talk, joke, accept treats etc from the nurses etc just fine, he only has a problem when it comes time to take medicine etc

It's not helpful right at this moment but does the ward have a play specialist? This is just the sort of thing they can help with. We used to do lots of DC giving the inhaler to mummy/daddy/dolly/anything that would sit still long enough. Let him play with a spare spacer.

Paeds nurse here. Unfortunately you are just going to have to pin him down. Or sit. Him on your knee and hold tightly. It's non negotiable. He must have the treatment. If there is a play specialist, enlist them. (Our play team provision is currently appalling)

Then when you get home work on it in a more relaxed environment.

No play specialist I'm afraid, we are in a small town with a smallish hospital. But us taken some of his stuffed toys in to 'treat' does sound like a good option!

I would agree with getting him to try things out on you, have spare spacers hold and play with, use on toys etc etc. Try and see if he will do things for himself rather than have you do it to him. Big praise for any small steps. He sounds like it's all too much and overwhelming him, any element of control you can give him might help.

Can you offer him choices? E.g. you administer the inhaler or the nurse? Is these an option of nebuliser Vs inhaler? Or do it while watching YouTube on the phone? Honestly I would keep force to an absolute last resort... I was in a&e twice with a wheezing toddler in the past few months, the first time the nurses were very insistent on roughly forcing various things on DD with the result that when we got home and had to administer the inhaler ourselves it was completely impossible because she was so distress and we hardly got anything into her and had to go back 😭 The second time I was more confident in asserting that we would take our time, give choices and explanations etc and it went much better.

Good luck!

And as per pp if he can do it himself that's even better. Lots of praise! Lots of "we can tell daddy about this when we get home" (in a good way!!) Etc

Get him a toy medical set he can play with whilst in there - make him the dr and you the patient - let him give you 'treatment' and show him it isn't too bad.
Then failing that, hold him tightly and bribe him with everything and anything

My autistic son had his first asthma attack about age 3. Does he have a spacer and fake inhaler to play with to get used to it? It all must have been quite scary for him and depending on the inhaler they can have horrible strong taste, like clenil modulite tastes like off oranges to me, so we literally gave ds a mini pack of buttons after every dose! And obviously what people above have said, give him as much control back as possible.

Needs must. The child does not know what's best for them, and sometimes force is necessary for their good. No one is enjoying it, but clearly nothing else is working.

Keep the messaging very clear. 'We have to do this for you to get better and go home.'

You can empathise and reflect his distress 'I know you don't like it'

Focus on what you can do after it is done 'Once you've had your inhaler we can...' - he can then choose what he does after (within realistic limits)

Broken record round and round.

You can use choices such as 'you can sit on my lap or on the bed' or 'I can hold it or the nurse can hold it' but it is essential he does not think having the medicine is a choice.

We do tend to find that fannying around and giving choices doesn't always help. With some kids it's better to do the 'this is happening' approach. And next time it gets easier as the child knows what to expect. There is nothing worse from the nurses POV than a parent who panders to the child and bargains with them. It rarely works.

I agree with this. Sometimes needs must.

if it helps Ds has had many treatments since 6 weeks old. We have had to pin him down for oxygen/nebulisers/medication on many an occasion in hospital. He is now nearly 13 (and autistic with massive sensory problems) but is fine with all medical treatment (he is complex and has a lot) bexayse he has got used to it.

we did lots of play based things in between but when ill If he fought then pinning down was the only option.

Before pinning down or anything that drastic I'd do some role play.

We role played the inhaler spacer & mask on DD's teddies and on me, gave her time to process that before doing another role play session and then she wanted to have a try. She was younger than your DS but I still think there's massive value in doing this. You're trying to normalise a new, unknown thing for him.

That works in general but when a child is hospitalised with low oxygen that’s not the time for playing!

I can see that but I also know as an asthmatic myself that going through a fight to do this thing will further worsen the breathing.

The problem is that treatment like this is likely to be necessary a lot so he absolutely has to come round to it. Scaring him more by taking away the last bit of control and pinning him down isn't going to help that and then next time it's needed he's even less likely to cooperate.

Also it's physically impossible if you're the only adult present to pin down a five-year-old so even if there's enough people present today to do this, it's not viable once you're out of hospital.

If the medics become really concerned today perhaps they'll sedate him so they can get some good treatment going in?

My dd had a heart operation at 5 and was like your son - thrashing around crying making themselves almost sick trying g to bite etc. like a banshee!! We just forced her in the end we literally pinned her down. Was awful but it worked and she didn't put up a fight after that. I still remember the look in her eyes and the guilt I felt - still feel. However she has no memory of it at all . Sometimes you need to do what's best not always what you think is right

Medics aren’t going to sedate a child when they can pin them down with the parents. Sedation with breathing difficulties generally isn’t a good idea anyway as I understand it.

the key for now is speedy recovery. The long term acceptance of medication and treatment can be dealt with when they are healthier.

Ds 5 did this when he needed emergency treatment , we also tried every trick in the book without really having the time to do it. We ended up pinning him down and forcing it , it was just the way it had to be.

Fannying around just prolonged it and made him worse , like he could negotiate.

Sometimes things call for tough parenting

Another paeds nurse here.
lots of role play when it’s not needing to be done with counting up or down. Ideally up to 10 but increments are fine if they not tolerating. Take the mask of between puffs after the counting. Get them to do it on you teddy etc. Get them to shake the inhaler.
sounds terrible but we like that they are shouting and wriggling we worry about the ones that lie there passively without any resistance.

I had a kid last week who was being bribed with a toy costing £130. It was ridiculous. Antibiotics are a big problem though because they really do taste absolutely vile.

I can see that but I also know as an asthmatic myself that going through a fight to do this thing will further worsen the breathing.

As an adult you understand. A toddler unfortunately does not.

Absolutely no way would we sedate a child just so they take medication. Besides, they wouldn't take the sedation anyway!

@Anunusualfamily yep. A silent and still toddler is not a good thing!

Ds mastered the art of showering me (and any nurses near by!) with antibiotics and steroids from a young age!