Preparing for facial stitches: a parent asks

Dear Brooke,
I read your post on Medical Play for preparation today and wondered: Is there a way you would suggest using medical play to prepare a young child for stitches? My daughter, Charlotte (3 years old), has split her chin and although the cut has been treated with glue, it appears to be reopening. So we are preparing for the possibility of stitches and would really like to avoid sedation. Any tips? Thank you!
Rebecca
Hi Rebecca,
Thanks for getting in contact! As a matter of fact I do have some ideas that you could try before getting stitches for Charlotte.

Gather your ‘stitches’ play equipment

You can play games without any expensive equipment. Depending on the child’s age, they are usually very good at object substitution- using an object that is nothing like the intended object in the play.
By the way, I know Charlotte personally so I know that she is capable of object substitution!
You will need the following equipment:

• Her favourite teddy or doll
• Torch
• iPad/iPhone for distraction- you can also use a book if you are not keen to use technology
• something to be the ‘needle and thread’ but that is not sharp- a small blunt pencil might spark her imagination

Start by knowing the aim of your playful preparation

Getting stitches on the chin means she needs to stay very still. She will be able to see the doctor as they do it too- they will be right up in her face. This can be very confronting for any person if our personal space is invaded.
You will want to get the following message across in the play: ‘You need to lie very still’.
Try to avoid unintentional threats such as ‘or it will hurt’ & ‘or we will wrap you up to keep you still’ and try to avoid bribes, i.e. ‘if you lie still you can have x, y, z.’ If we can give a child the message that we have full confidence in them, they are most likely to find this courage and go with it. There is no need for bribes or threats.

How to set up a game with your aim in mind

I would start by setting up a game where teddy or dolly needs stitches on their chin. Charlotte could be the doctor or the caring Mummy, let her choose.
Here are some phrases you can try and throw in the play somewhere to get your main message across (as well as some to reassure her):

• When playing with Teddy, tell Teddy often, ‘You need to lie very still so the doctor can work quickly.’
• If Teddy moans or tries to wriggle: ‘I’m sorry it is uncomfortable for you. We will be as fast as we can!’
• ’You are safe. I’m right here. I am not leaving you.’
• You can also try: ‘As soon as you can get up, I will tell you. Would you like help to stay still?’
• ’I can hold your hands if you think you might try to touch or push the doctor away or I can help you hold your head still so it can be over faster. What would you like?’
• Keep reminding teddy that ‘Mummy is here. It’s hard to lie still sometimes but as soon as it is finished he can move.’

Each time you ask one of these questions, allow Charlotte to answer. This gives her the opportunity to process and play out different options to decide how she prefers it. You are giving her the chance to experience it before she gets there and to have the opportunity to decide what she does and doesn’t like. This will reduce the overwhelm she may feel in the actual moment.
Once you have tried it on Teddy, you could suggest that you are the patient. If she is keen, pretend you are a bit sore (but don’t overdo it because that could make her more anxious).
If you want to make suggestions during the play, whisper them to her. For example, whisper, ‘You have to tell me to lay still!’ Whispering is a technique that is used in play therapy to remain in the play while negotiating the direction of the play. Use your normal voice when in your role.
If you can, eventually try to put her in the patient role also. You can also suggest that she looks at her favourite TV show on your phone or iPad while it happens as a form of distraction. If you play this into the game, remember to have it ready at the hospital.
Something else that you may like to include in your play is a torch above the patient. They will most likely use a spot light to see the area more easily. A bright light in your face can be confronting so including this in the play may also help her with this.
So when and if you go for stitches, try to remain calm both inside and out. Charlotte will pick up on your body language and use it to gauge how she should feel/respond in the environment. This is part of the polyvagal response which I will be writing about in more detail in the near future. In a nutshell, science supports the saying ‘a calm parent encourages a calm child.’

Now for some tips on the actual procedure…

I suggest you ask if they could consider Laceraine or something similar. It is a local anaesthetic that can be applied topically by soaking a cotton ball with it and taping it to the area. It takes about 15 minutes to work but it is much better than getting a local anaesthetic needle which I consider to be one of the most painful injections to get. It really does make your eyes water. The Laceraine will be able to numb the area enough that the local injection (if she still needs one) won’t sting quite as bad.
Ask them to attempt the stitches without wrapping her up too. Hopefully the playful preparation helps her to remain calm enough to get the stitches without moving.
Well I hope you find this quick preparation helpful. Please keep us posted on how Charlotte goes with her stitches if she gets them.
Until next time…
P.S. If you have a question to ask, please contact me via the contact form below. I will be answering a parent (or nurse) question each week. Just remember to refer to the disclaimer before submitting your request. I cannot wait to hear from you!