A four-year old boy is wheezing and barely able to get a breath. He looks to you to help him while you race him to the hospital. Having been trained in Verbal First Aid, you breathe with him, slowing down until he breathes more calmly.
Your five-year old daughter cuts her hand while playing. You say, "I see the cut and I'm going to help you. After I put this bandage on it, hold it down and stop the bleeding." The bleeding stops.
Children Think Magically
Words have power. As adults we've been conditioned to deny and modify the way our bodies respond to words. But children haven't yet acquired those defenses and haven't yet been taught to hide their emotions or physical responses. So, the effects of our words on them are often instantaneous and palpable.
This is why Verbal First Aid works so well with them.
The principle of Verbal First Aid is that we all slip into altered states during a traumatic event -- some more than others. In these moments, we're highly focused, most often on some internal process, and are often more suggestible and more sensitive to what is being said around or to us.
Observations made at the University of Michigan Department of Education indicate that children are already in a state of self-hypnosis when they play imaginary games.(1) Because they're in these states more than adults, they're more inclined to soak up whatever is said to them. Children naturally look to adults for concrete and emotional direction, and in a traumatic situation this is heightened. This is especially true when the person speaking is a parent or authority figure, such as an EMT or paramedic.
We cannot underestimate the importance of rapport, whether with an adult or child. One of the most effective ways to develop and build rapport with a child is to pace them. If they're scared, acknowledge their fear. If they're hurt, let them know, in their language, that you see the injury. Always let them know you're there to help them.
A child in distress will have fear, and they will either recoil or cling when someone approaches. Those natural responses are signs that they need help. Regardless of which response they exhibit, always introduce yourself by name, let them know what you do and ask if they will help you help them.
We not only need to be understanding in our approach, but also literally stretch our senses to understand exactly what is upsetting the child besides their obvious physical trauma. For example, a young girl was calm when she had to receive stitches for a laceration but panicked when the time came to take them out. Her mother realized her daughter's reaction stemmed from a time when she sewed the arm of the girl's doll back on after it had fallen off. The girl knew that if they removed the stitches, the doll's arm would fall off and feared the same with hers.
When possible, offer reassurances, such as, "I remember a time when I did this for a little boy, and he was better in no time."
Magic & Imagination
In a child's mind, almost anything is possible. We can utilize that in an ethical way to gain compliance and begin to facilitate physiologic responses that increase healing.
It's important to understand that we're not facilitating a negative or pathological state of make-believe. Children often will fear the worst. Fear is the one thing that can make a bad situation worse, so we should utilize their gift for imagination in a positive direction.
Solicit Super Help
Sometimes ordinary humans aren't enough. When working with young children, it can help to bring in their favorite superheroes or cartoon characters. Every child has his or her own favorite, so it's best to ask who that might be. Always choose a hero or cartoon character appropriate for the age group.
Say it's Spiderman. Here's a potential conversation you could have, using Spiderman to help the healing process.
"You like Spiderman? Me, too!"
"What do you think he'd do right now to help you get all better if he were here?"
"I think he'd use his spider hand and make it all wrap up. Imagine that happening right now, like Spiderman is wrapping up the boo-boo and making it feel better."
And as their imaginations spin super-tales, you can also turn them into your little super-helper, such as in the following scenario:
"So, I'm going to put this machine right here where I can read it and then I'm going to ask you to hold out your arm for me. Can you be my helper, like you're Robin and I'm Batman?"
If the child isn't conscious, you can still solicit their help. Hearing is the last sense to go, and everything we say can still have some impact, such as this:
"I'm going to put these little tubes right here, and as I do, I want you to think of your favorite superhero and all the ways they can make you better."
Remember, the body knows how to heal itself. Sutures can only push the edges of the skin together. Surgery can only cut around parts we don't want and put in parts we do. How we heal is up to us. How things mend and merge and knit back together is our doing, not someone else's. Even when the technology is extraordinary and helpful, something happens in medicine that is beyond the technology we use. The place to keep your eye and your heart, like a child, is still on the magic.
1. Olness K & Gardner GG. Some guidelines for uses of hypnotherapy in pediatrics. Pediatrics. 1978;62:228 233.