Strange Terrain

      Imagine being taken against your will to a strange, scary place populated by giant people with strange, scary names who speak strange, scary languages where painfully strange terrors await you.
      It's a sensation that's not at all imaginary to kids coping with a visit to the doctor's or dentist's office. Keeping in mind that image of childhood terror can help parents in trying to ease their own kids' fears during those inevitable trips to family health care providers.
      Differences between kids' and grown-ups' doctors usually can be seen the moment parent and child step through the office door and find the usual utilitarian waiting room replaced by a play space filled with toys, games and bright colors.
      The furnishings in pediatric dentist Dr. Michael Saxe's office include murals and parrots. Dr. Grace Shin's office has what the pediatric ophthalmologist calls "lots of toys -- big ones, small ones."
      Dr. William Evans, a pediatric cardiologist, keeps a waiting room packed with toys, books and continually playing cartoons. "Each of our examination rooms is absolutely crowded with toys. It's almost like a preschool," he says.
      Such fun-filled environments are designed to keep kids from becoming bored, to offer them a welcoming environment and, Evans says, to provide "a lot of distraction."
      Parents can employ the same sort of tactic when packing for a trip to the doctor's office. For instance, says Dr. Sharon Schaffer, a pediatric gastroenterologist, "If you have a transition object like a stuffed animal or blanket -- something they like for comfort -- bring that."
      A stuffed animal is especially good, because it can serve as a teaching aid. "Pediatricians will listen to a stuffed animal (with a stethoscope) before they listen to the child," Schaffer says.
      To allay a child's apprehension, a pediatric dentist or doctor tries to gradually acquaint a child with his or her office, examination room and even instruments. "On the first visit, we never do any work. We do an exam, maybe take some X-rays, and get the child comfortable with that," Saxe says.
      A parent can do the same thing, paving the way for a painless doctor's visit by preparing the child as much as possible beforehand. Most parents have been to the dentist or eye doctor often enough to give a child a rundown of how a routine exam goes.
      "Explain to them the different things in an office. If a parent wanted to come in just to tour the office, we let them do that all the time," Saxe says.
      But a parent might be just as clueless as a child before a visit to other pediatric specialists. In those cases, the parent can help by offering encouragement and support to a child.
      "It's tough to prepare for coming to our office," cardiologist Evans says. "So what we do is send out a fairly extensive packet of information to families to let them know what we're going to be doing."
      Shin notes that some parents subscribe to the less-is-more philosophy, opting to deliberately not tell their children much before a visit.
      "I don't know what the best answer is," she continues. "I think it would probably be better to tell, but I've had parents who say (their children are) going to be too freaked out if they have time to think about it. But, probably, to walk them through the exam at least verbally is a good thing."
      Either way, Schaffer says, "the main thing is, you want to reassure them that nothing is going to happen without them knowing about it first."
      Violating that rule can ruin a doctor's relationship with a child, Schaffer says, adding that a corollary for both parent and doctor is to "never tell a child something is not going to hurt when it does."
      When a child must experience unavoidable pain or discomfort, Dr. Reynold Rimoldi, an orthopedic surgeon who often works with kids, suggests that a parent help to put the short-term negative and the long-term positive in perspective.
      For example, compare the pain associated with setting a broken bone to the experience of a brother, sister or friend who broke a bone and is now healed. "Try and make good associations to good outcomes, ... even though there may initially be some (pain)," Rimoldi says.
      Parents sometimes suffer from their own anxieties about visiting a doctor -- maybe because of their childhood experiences -- and are apt to be anxious when watching their own children undergo uncomfortable or painful procedures. However, parents should be careful to never transmit their anxieties to their kids.
      "Kids are very good at picking up that parents are scared," Evans says. "So we try to calm down both of them from the moment they get in there."
      "Certainly one of the things that drives me crazy is when parents threaten kids -- if they're not good, they're going to bring them to the doctor and get a shot. That really sets them up to be scared," Schaffer says.
      Doctors differ on whether they prefer a parent to be with the child during an examination.
      Saxe prefers that they not be, because parents tend to talk to the doctor, taking time away from the one-to-one relationship the dentist is trying to build, and because "the child is distracted" and will keep looking up at the parent during the procedure.
      Shin says some parents "do say, `I'm going to leave the room because my child can't concentrate when I'm sitting there.' But I'd say, for the most part, my kids do better when the parent is in there because they're comfortable."