Fighting Fear of Doctors : Parents can help ease children’s distress about health care. Pediatric Projects has toys and books to mitigate the dread.

“Mommy! Mommy! Don’t let them do this to me!”

Any parent who has been caught between a child and a doctor’s hypodermic needle has heard the cry. Unfortunately, while good medical care is essential to a healthy childhood, kids and doctors aren’t always a winning combination.

There are ways, however, for parents to ease their children’s fear of doctors--whether they’re facing a physical for camp or a hospital stay.

In fact, although a routine exam may seem worlds removed from brain surgery, the potential for distress can be as great in both cases. Pat Azarnoff, executive director of Tarzana-based Pediatric Projects, which distributes toys and books to help children understand health care, explains that “to a child, routine exams are not routine and minor surgery is not minor.”

To mitigate a youngster’s dread of an examination, parents can express confidence that a doctor knows how to make people feel better. If a child asks whether a certain procedure might hurt, Azarnoff advises parents to answer truthfully. “ ‘You will feel it, but I’ll be there and you’ll be able to manage,’ ” she suggests saying. She adds that children should always have information about what to expect during medical visits.

Doctors also play a role in paving the way for a more positive experience. Their waiting rooms set the tone for what’s to come. Children of all ages respond to waiting rooms that are bright, cheerful and packed with toys, games and books.

During the visit, Azarnoff says, the physician’s approach to the child is critical. “If doctors can give a gentle, sensitive exam,” she says, “a child will be more willing to have a doctor touch them later when they have a painful ear infection.”

Pediatrician Nan Zaitlen, who has practiced in Tarzana for 11 years, encourages kids to talk about themselves as she examines them. “I also try to get some rapport going by knowing what’s on TV for children of different ages,” she says.

If youngsters have persistent fears, Zaitlen may ask them to bring in a stuffed animal that she can perform the exam on first. “I also let them ‘blow out’ the light on my otoscope (an ear inspection device) and tell them I’m checking for rabbits in their ears,” she says. “That usually works until they’re about 6.”

The prospect of surgery and an overnight hospital stay, of course, can be especially stressful for children. Azarnoff says the active imaginations of preschoolers make them particularly fearful. “They’ll picture all sorts of terrible things that will happen to them,” she explains.

Here again, parents can offer reassurance, both by explaining what lies ahead and by remaining close to a hospitalized child. With preschoolers, Azarnoff suggests waiting until a few days before surgery to start talking about procedures.

She advises parents to explain terms simply. “ ‘The doctor will make a small opening, will make you well and then will close the opening,’ is usually what a younger child needs to know,” she says. “Don’t use the words cut or fix --what you do to a dog--and don’t forget to say the doctor will close the opening and that your child will come home from the hospital. Parents always seem to forget that.”

Some hospitals have preoperative programs and tours that familiarize young patients with the building. If no program exists, ask a nurse to schedule an informal tour. An increasing number of hospitals also allow parents to be present during anesthesiology.

Even for infants, experts say, parents should not overlook the stresses of hospitalization.

“Babies acquire a preference for a primary care giver in the first few weeks of life,” Zaitlen says. “My bias is that parents should stay overnight at the hospital and continue routines, like breast-feeding and changing diapers. It lessens the trauma for infants, who undoubtedly feel vulnerable surrounded by strange sounds and lights.”

Some hospitals employ play therapists to work with especially anxious children before or after procedures. Many use miniature hospital furniture and stuffed animals with removable organs marketed by Azarnoff’s nonprofit company.

“Children see adult-size hospital furniture as being very powerful and capable of capturing and hurting them,” Azarnoff says. “They can work out their fears through play by using a toy wheelchair, MRI machine or anesthesiologist’s cart.”

One of Zaitlen’s 5-year-old patients used a play therapist to handle fears about upcoming surgery to remove a brain tumor.

“He was able to play with a doll and see how the operation was going to go,” the patient’s mother says. “They explained everything carefully. His fear evolved into anger about everything that was happening to him, which we thought was a healthy sign.”

Older children, according to Zaitlen, have a greater need to participate in their medical care than do younger ones. “They can change their bandages,” she reports. “I’ve seen 10-year-old boys put in and take out their own catheters.”

Azarnoff adds that the issue of control is even more crucial for teen-agers, who might be faced with grave decisions--”like whether or not to have surgery. They need to know every last detail. They have worries about dating, about if they’ll graduate--all these need to be discussed.”

For all hospitalized school-age children, experts say, contact with friends is paramount to a speedy recovery. Visiting friends, get-well cards and phone calls relieve young patients’ isolation and help them return to the everyday world.

Some Helpfu Publications

These may help ease a child’s fears:

“Hospital Story,” by Sara Bonnett Stein (Walker, $8.95), part of the Open Family Series, uses pictures and an adult text to dramatize one girl’s hospital stay.

“The Hospital,” a free booklet about helping children cope with doctors and hospitals, is distributed by Pediatric Projects. Send a self-addressed, 52-cent stamped 9-by-12 envelope to Pediatric Projects, P.O. Box 571555, Tarzana 91357. Parents may also phone with questions about pediatricians and hospital stays: (800) 947-0947.