The Problem with ‘Be Brave’
Sophie (5 years old) screamed in pain and tried desperately to get away. She couldn’t move! Someone was holding her down! She began to perspire and tried frantically to make them stop.
Everyone was talking loudly and sternly at her.
‘BE BRAVE!’ ‘Come on! Stop this now. It doesn’t even hurt!’
‘If you don’t stop moving, we will have to do it again!’ ‘BE BRAVE!’
‘I thought you were a big girl! I didn’t realise you were a baby!’
This scenario is something I saw daily in my nursing practice.
All of us (nurses, doctors and parents) want to provide medical care for the child with the least amount of protesting. In fact we are so uncomfortable with the child’s discomfort that we will do anything, say anything, to make their protests stop. Instead of comforting them in their scariest hour, we send the child the message that it is not OK to cry or be unhappy with what we are doing/are about to do.
We do this by telling them to be brave. In other words, if you are scared, don’t be. That is unacceptable behaviour.
We also tell them it won’t hurt which is a lie. And by lying to them, we not only create distrust, we also tell teach them that what they are experiencing is not actually the truth. We teach them to distrust their own perceptions of what’s really going on and what their body is experiencing.
Other times we avoid telling them what will be happening because we want to avoid hearing their cries of protest before it has even started.
The reality is children do get upset.
Children do feel pain. Children feel fear when they don’t know what is happening to them and when they understand what’s happening to them and are frightened by this.
Asking them to deny their fear is asking them to deny their feelings for the sake of our own discomfort.
Our patients will be better able to cope with traumatic experiences when we adequately prepare them with 100% honesty and include them in decision making where possible. For example, when I knew a child was going to be getting a needle, I began the process by applying numbing gel at least half an hour before the procedure. While I put it on, I began to explain what we were preparing for to the child. Notice how I said ‘to the child’? That’s because the parents were listening in anyway and could understand what I was talking about — they didn’t need the explanation, the child did. So I spoke to the child in language they understood. In language that empowered them to face the challenge they had no choice but to face.
My explanation slightly differed depending on the child’s age but it sounded something like this…
‘Sophie, I am putting this gel on your hands and elbows because you need some medicine given to you that can only be given this way. Some kids can feel uncomfortable when we do it so this gel is supposed to help make you more comfortable…
This gel takes some time to work so I will come back to answer any questions you might have in a little bit. I’ve also got some ideas on how you can help us make it even more comfortable for you.’
Usually, as soon as I have mentioned ‘poke’ or ‘pinch’, the child cries, turns away from me or becomes apprehensive.
It’s a critical time not to jump in and tell the child to ‘Be Brave’ although it’s usually the time when significant adults do.
I’ve also heard, ‘Look at the nurse when she is speaking to you!’ To be honest, I don’t need eye contact because I know the child is listening. The fact that they turned from me confirms to me that they understand what is going to happen and turning away is an attempt at self soothing their distress.
Let’s get some adult perspective here
Let’s take a step back for a second here and place some adult perspective on it all.
Think back to a time when you have received some distressing news. Now think about how that felt and what you really needed in that hour of need.
Imagine that you were crying about the situation and went to your closest friend for comfort. There are two ways your friend could respond:
A) ‘Oh. my. goodness! Be brave! Stop crying about it and just get on with it. It’s not really that bad!’
OR
B) ‘That’s tough news. Come here (hugs). I’ve got you. We’ll face this one together. I’ll be right here with you.’
Which one would help you feel more confident in facing the challenge?
Response ‘A’ would have me feeling unheard so I’d probably protest and scream louder, or just go on and on about it until the person acknowledged my hurt. (My husband is totally nodding his head right now!)
Response ‘B’ would have me feeling heard and supported. I’d be in a much better place to pull it together and face the music more quickly.
It’s important to listen
Okay, back to a child who has just been told they’re having a needle.
It’s a time to just listen and allow the feelings. It helps them to work through their fear and come to terms with it more quickly.
Be that emotional rock that helps them build resilience as they face their fear.
When the kids became upset under my care, I always acknowledged their emotions. I did this by demonstrating empathy.
‘I wonder if you’re feeling scared/worried/nervous about this? It’s okay to feel like this before you get a poke and it’s okay to cry about it if you need to. Your Mum/Dad and I will be here to help you. We don’t want it to be uncomfortable either.’
You see, it’s not about ‘being brave’
Being brave does not change anything for the child. It doesn’t make the procedure any less painful or any less stressful.
Demanding a child be brave by not showing their emotion about a scary experience risks denying them the chance to fully express themselves and naturally make peace with their situation.
Instead, parents and healthcare workers can use the experience to build trust by acknowledging the child’s feelings and being a reassuring and calming presence.
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