Interventions for Pediatric Procedural Anxiety

Procedural Anxiety

A doctor’s visit can feel like stepping into the unknown for both children and parents. Whether it’s a routine outpatient procedure (e.g., vaccines) or a more invasive hospital-based procedure (e.g., surgeries), these visits can cause stress and anxiety for both children and their caregivers before and during the procedure (perioperative), as well as afterward (postoperative).  

Perioperative anxiety can lead to adverse outcomes during the procedure, including:

• Increased oxygen and glucose demand (Hosseini et al., 2025)
• Increased sensitivity to pain
• Greater need for analgesics or anesthesia (Chow et al., 2016)
• Longer procedure duration
• Increased burden on both the family and healthcare professionals 

Anxiety can also contribute to postoperative outcomes that may inhibit recovery, such as:

• Separation anxiety
• Sleep disturbances
• Delirium (Chow et al., 2016)
• Avoidance of future medical care (Chrisler et al., 2021)

Factors That Can Impact Anxiety

Children who are more anxious and less sociable are more likely to experience fear and anxiety around medical procedures (Chow et al., 2016), as well as children with past traumatic experiences. Age does not appear to significantly affect anxiety levels, although younger children may be less responsive to pharmacological interventions (Martin et al., 2025). Neurodivergence is another factor, as neurodivergent children may experience greater anxiety, be less adaptable, and be more prone to overstimulation during procedures (Wickramasinghe & McLean, 2025). Additionally, caregiver anxiety can increase a child’s anxiety, making it important for caregivers to manage their own reactions to help reduce stress for their children. 

Types of Interventions

Supportive Interventions

The first and most fundamental approach to helping children manage procedural anxiety is empathetic listening. Validating a child’s emotions and reactions—rather than minimizing them or immediately offering solutions—helps the child feel understood. For example, instead of saying, “It’ll be over soon,” a caregiver might say, “It’s scary, but you’re being really brave.” For children with differing communication needs, using visual aids—such as the one below—can also help to assess the child’s comfort level. 

Behavioral Interventions

Preparing a child for a procedure can help reduce anxiety and address any preoperative concerns. Strategies may include:

• Family-delivered education through literature and videos
• Visual aids, social stories, or demonstrations using puppets
• Familiarizing the child with the equipment that will be used
• Rehearsing each step of the procedure 

Distraction is another commonly used strategy, but the type of distraction matters. Active distractions, such as blowing bubbles or engaging in a virtual reality game, are generally more effective than passive distractions, like watching a video. In addition, offering the child choices in how they want to cope—such as through a coping menu—can provide a sense of autonomy and control over the process. 

For children who are particularly resistant to undergoing a procedure, the use of praise, sticker charts, or other rewards can increase motivation and help create positive associations with doctor’s visits.

Physical Interventions

Several physical interventions can help reduce procedural anxiety in children. Devices such as the ShotBlocker and Buzzy provide targeted physical stimulation to distract from injection pain. Acupressure has also been shown to be effective for reducing nausea and alleviating muscle tension. Additionally, simple comfort measures, such as heated pillows or the use of calming scents like lavender oil, can promote relaxation during procedures. 

Conclusion

Overall, effective management of procedural anxiety in children typically involves a combination of the following strategies (Hu et al., 2024; Kain et al., 2007): 

• Preparing the child for the procedure through education, familiarization, and rehearsal 
• Involving caregivers who can provide emotional support and model calm behavior 
• Providing options for distraction tailored to the child’s age, preferences, and communication needs 
• Maintaining communication and rapport to ensure the child feels heard, understood, and supported throughout the procedure 
• Offering praise and reinforcement, when appropriate, to encourage positive coping and association with medical procedures

By integrating these strategies, healthcare professionals can help minimize anxiety and provide comprehensive support to both children and their caregivers during medical procedures. 

Resource

Several organizations and programs provide support and resources to help children cope with procedural anxiety, one of which is Matio – Kids Kicking Cancer. This program uses martial arts-based programs to empower children facing medical procedures and chronic illness. Through guided breathing techniques, visualization, and movement, the program helps children manage pain, reduce stress, and build confidence during hospital visits. Programs like this not only provide practical coping strategies, but also foster emotional resilience, giving children and their families tools to navigate medical procedures more positively. 

References

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