Confused-Need Advice

[BWest]

After reading several posts and answers, I've decided to post here because your knowledge and expertise through experience is evident.

My son turned 3 two two weeks ago. At his three year old check up, he had a tantrum/meltdown that caused his pediatrician to want to refer him to a counselor. I was shocked and dismayed. His doctor used the words oppositional defiance which I'm familiar with. I've taught 4th and 5th grade for 8 years and have taught many children with this diagnosis in conjunction with ADHD.

Let me describe the situation at the doctor's office and then I will describe my son's general behavior.

Office Visit: To begin, my son has always had a strong fear of the pediatrician, especially when they pull out any "gadgets" (cuff that goes on finger or heel to measure oxygen levels, finger prick tools, etc.) He's fine with the stethoscope and the common tools that are used all the time. At this last visit, it was the blood pressure cuff that set him off. He had never had his blood pressure taken and when the nurse put it on his arm he immediately tried to undo the Velcro and said he didn't like it. She tried it again and couldn't get an accurate reading because he was screaming at this point and wouldn't sit still. She went on to check his height, weight, eyes and came back to it. He still refused and tried to kick at her. She started to get impatient and told him he would not be able to leave until he let her do it. She then immediately stuck his finger for blood without warning. He obviously cried and screamed louder. He did allow her to put a bandaide on and kept it on because I told him his blood would go all over the place. (In the past, this is what he would always do.) She then left the room and said that the doctor would not see him unless he would let her take if BiPolar (BP). I kept after him to allow the nurse to do this. He continued to scream until he was hoarse and wanted only to put on his shoes and leave. The doctor finally came in, without the BiPolar (BP). He put my boy back on the table. He had calmed down some was was still quietly sobbing. He let him look in ears, nose, but would not open mouth long enough to look in throat. Dr. immediately leaned him back and held him down and told me to hold arms...which I was used to because he often is not compliant at the doctors. Son began screaming again and kicking at doctor. This is when doctor suggested counseling because son had had tantrums at doctor in past. I was taken aback. He asked if son had tantrums at home. I said some, but he did not allow me to elaborate or anything. I left the office crying.

My son almost always is sweet and caring. He can get angry and when he does he will scream loudly and sometimes lightly push at myself or his father. This is not a daily occurrence. The most trouble we have with him is not listening. We often have to tell him to do things several times and eventually have to give him and either or like pick up your toys or you will sit time out. He picks the right thing to do 98% of the time. We give him time outs in his room. He always calms down within a few minutes and is able to tell us what he did and that he is sorry. He doesn't tell me no anymore after being put in timeout for it about 3 or 4 times. He also does not like to share and has a hard time when other kids come over and play with his toys. He will yell at them and sometimes push. This is getting better however because I consistently tell him to come tell me before he gets mad. This is still not perfect though. The only other place besides the doctor that he displays really bad behavior is getting his hair cut. He kicks screams, sometimes to the point of throwing up.

I think he is normal for three years old, but his pediatrician has me so worried and upset, I wanted the opinions of other non partial people. Thank you for your time in reading all that I've written.

 

[klmno]

Welcome!! Others with more experience in the "young child" department will be along- although it might be a little slow today, being a holiday.

Just my 2 cents- I can't say your child does or doesn't need a therapist or anything else, but I don't think I would cast a diagnosis of ODD on a 3 year old when it was made by a pediatrician who only saw one aspect, one time, in one situation. Again, there very well might be something going on with your child, but don't lose sleep over an ODD diagnosis just yet.

 

[Sara PA]

I would look for a new pediatrician. Not only did the doctor show no respect for your son as a person, neither did his staff. He sounds like a bully, simply put.

I am assuming that the nurse failled to discuss with your son what she was going to do and how it was going to feel before she attempted to take his blood pressure. Doing that is expected when dealing with children.

I roll my eyes at any doctor who would toss out a diagnosis of ODD for a three year old under the circumstances. He must have slept through early child development classes.

 

[SRL]

Welcome. Sorry you are having such a hard time.

I wouldn't be concerned about a 3 year old whose only significant issues were at the doctor's office and the barber. I had a younger brother who screamed to high heaven every time he got his hair cut. Now if it were to also extend to adults in most other settings (Sunday School, preschool, etc) I would be observing careful for signs of anxiety. If he doesn't start responding to discipline and his hitting of you and father doesn't taper off, that would also cause me to consider whether something might be up. Given time and consistent training neurotypical children will be developing appropriate levels of respect for parental authority.

ODD is rarely a standalone diagnosis so my first question would be is there anything else going on developmentally with him? Speech, motor skill delays, lining up toys, oversensitive to sounds/lights/foods, sleep problems--any problems in these areas or anything else you've observed?

You might search around amazon.com and see if you can find any children's books about doctor visits to ease the anxiety.

By the way, you didn't ask, but if I were in your shoes I'd be shopping for a new pediatric office. There are times when we've had to hold a child down for an exam or quick procedure but I never was uncomfortable with the doctor or nurse's mannerisms when it did occur.

 

[Andy]

I think it is very common for children to fear doctors and barbers. Most times I took my kids the pediatrician, I almost always heard a child in another room crying. I also thought it funny that it was the doctor the kids feared even though the nurse was the one who did the lab work and gave shots. Almost like the kid knew the orders came from the doctor.

Did the nurse work with your child at all? Did she suggest taking your BiPolar (BP) 1st so difficult child knew it wouldn't hurt? A BiPolar (BP) cuff could be scary. Of course your child was scared and overwhelmed - this is a new experience and here was this lady making him do scary things like wearing this cuff that squeezed your arm, that feels weird. And she seemed to just demand that you do these scary things without telling you why.

If you are able, whenever you take a difficult child to the doctor, try making an appointment 1st think in the morning early in the week (Monday would be best). If these doctors really do enjoy working with kids, they will be on their best patience and well rested on Mondays (unless they took a turn in ER on Sunday).

I can understand why doctors think they need to do whatever is needed to get the physical done - they only have so much time with each patient but I think there needs to be room to treat the child as a person. I would much rather have the doctor say, "I can not complete a physical when the child is behaving like this." than holding down the child which is very scary for the child.

The doctor should have spent time with you discussing the tantrum instead of jumping to the conclussion that there is a problem. He is just passing that part of his job onto a counselor who will evaluate and possibly ask why in the world you were referred.

Are you able to go to another pediatrician? Talk to the nurse ahead of time and explain that like many kids, your child is nervous about the doctor office. Ask the nurse if she can explain each procedure and tool to your child. The nurse does have a large role to play in how your child behaves when the doctor comes in - if your child is uncomfortable with the nurse, he will have put his defensive up for the doctor making it harder for the doctor to earn his trust.

 

[Marguerite]

I'll be tactful and discreet here - the doctor's a flamin' twerp. The nurse - does she REALLY work for a pediatrician?

I do wonder - does this pediatrician mainly deal with newborns? It would explain a great deal.

ANY health professional dealing with kids old enough to know what is going on (and to my mind, that is any child who is more tan a few weeks old) should show respect to the child and to the mother.

ODD as a diagnosis - on the basis of a child who is being disrespected and bullied like this? That is using diagnosis as a weapon. I wonder how many kids are given this diagnosis, and medicated, purely because of an incident like this.

OK, back to the child - if his phobia of doctors, barbers etc seem excessive to you (although after an experience like tis, it would be understandable) then get another opinion, preferably form someone with compassion.

difficult child 3 & difficult child 1 have had some phobias which really got in the way of medical interventions. difficult child 3 needed to be assessed for hearing when he was a toddler - but he screamed the place down when headphones were put on him by our GP. Now, this GP was a friendly, gentle person but even he couldn't get difficult child 3 to cooperate so we dropped the idea of doing the test that day. Instead, we were referred to a pediatric clinic that deals with difficult children.

I expected more of the same at the clinic but the technician showed difficult child 3 what was needed. She also plugged right in to another obsession of his - a marble rolling game. YOu drop a marble in the top of the box and it rolls down a chute to plop at the bottom.
difficult child 3 was permitted to drop a marble, if he would wear the headphones. It took some persuading, but the technician succeeded without my help.

Then we needed difficult child 3 to drop a marble every time he heard a sound. He had language delay so it took some pantomime and practice, with the technician giving difficult child 3 a high-five payoff when he got the idea.

He really tried hard for the test - the concentration on his face was amazing. He did well enough for the technician to be able to tell us that his hearing was good.

He did trow a tantrum at the clinic, though - he was desperate to use the toilet, but just as I opened the door someone was drying their hands with the hand blower, and difficult child 3 screamed, refusing to go in. But he was desperate to go, and home was an hour's drive away. From that time on, he refused to go into public toilets for multiple customers. He would only use a disabled toilet, and only after I had shown him that the hand blower was switched off. It was several years before we were able to persuade him to use a public toilet and a few years more before he would use a hand blower.

difficult child 3's behaviour was not ODD. It was typical of autism.

A kid with ODD seems deliberately defiant. But this still gives the wrong impression - you get the feeling (from the name as well as from medico's attitudes) that ODD is the child choosing to be defiant as a matter of principle. "You said X, therefore I will insist on Y."

It is far more complex than that. A kid who is disrespected as a matter of course, who is treated as if their fears, their opinions, their very existence is subject to the whim of a much larger and stronger individual, will crave the day when he is finally bigger, stronger and can shout louder than the person who is doing this to him.

Some kids seem to need more control over their world than others. There can also be a number of medical conditions where this is a huge problem despite the best efforts of the most conscientious parents.

We recommend "The Explosive Child" a lot on this site, with good reason. It has helped us a great deal with difficult child 3, who was developing some very difficult oppositional behaviours. An aspect of autism is that they see the world as truly equal. We are all equal, in their eyes. A good thing? Not in a world which discriminates between adults and children, teachers and students, parents and offspring. We don't realise just how much we encourage inequality, until we have to live with a child who treats others as they themselves are treated.

Think back to the last time you heard a teacher chastising a student. can you imagine what happens if/when that student turns around and chastises the teacher?

When I think about it, I first heard this when easy child 2/difficult child 2 was a toddler. She would talk to me in the same tone with which she was talked to. I would ask her to do something, and if she got it wrong or hadn't listened, I would repeat myself with, "I told you to do it THIS way!"
Then one day she had asked for a drink of juice and I was tired and poured a cup of milk for her. She slammed her tiny fist down onto the table and announced, "I said I wanted JUICE!"
And she couldn't be disciplined out of this, because the more I punished for tis rudeness, the worse she got.
So instead, I moderated my tone and modelled the behaviour I wanted from her. Almost miraculously, her behaviour to me improved.

difficult child 3, in his first year at school, was minding his own business in the school playground. A teacher (who should have known better, but we always had problems with this person) rang a handbell loudly, right behind difficult child 3. Now, this teacher had been warned to avoid sudden loud noises around difficult child 3, but clearly SHE knew better and went ahead and did what she wanted.
difficult child 3 turned round and said loudly, "Well, EXCUUUSE ME!"
The teacher's immediate response was a withering, "No, you're supposed to excuse me," but by then difficult child 3 had dismissively turned his back on her (halfway through her response) and walked away.
[Frankly, she deserved that - but she never did realise that she had just demonstrated utter disrespect not only for difficult child 3, but for anything she had been warned about him].

I was told this story by several different pathways, all via kids who were witnesses to the incident and highly amused by it. difficult child 3 had Sunday School classmates who watched out for him in the school playground, they reported to their parents as well as to easy child, who taught a special after-school class.

difficult child 3's behaviour was also not ODD. It was purely reactive, to a painful stimulus. difficult child kids can react like this. Autistic kids (and some ADHD kids) can react suddenly to a shock stimulus like this, and sometimes their first reaction is to lash out -verbally, or physically.

When a small kid, or a difficult child, reacts like this it is important to work out why and if possible, try to prevent in future. You do this before you think of punishing them. Do you feel your son should have been punished for his reaction to the nurse? Because I don't. I bet the doctor and the nurse thought so, though.

The purpose of punishment is to teach the child the difference between right and wrong, and to show them what is not acceptable. But if the child cannot control their reaction, or cannot learn the lesson, or even already knows the lesson but can't moderate their behaviour - then punishment is pointless. Worse - it's damaging.

You can talk about a problem, you can model the correct behaviour, so you don't have to simply ignore the wrong reaction. But you should always keep in mind the ultimate aim - to raise the child to behave properly.

Marg

 

[barbie]

Okay, Im sorry I work for a doctor, Internal Medicine, my patients are babies but most are over 80 and behave like babies. We can blame the nurse, and the doctor all we want to but what about the visit triggered this reaction for him.

Were you anxious and he is reflecting your fears and anxieties about visiting someplace where he mostly goes and someone gives him shots. About holding the kid down, I have to do that every single stinking time I take my kids for any exam, they arent hurting him by restraining him, but if youre restraining and he does need a shot and he's fighting and he/she is anxious becasue you are then let me tell you hun, its gonna hurt alot more, and be more traumatic.

When they are tense so is the muscle so to get deep enough for a vccine to be effective will be increasingly difficult and your anxieties and fears are feeding theirs so you have to be the adult and show them that it isnt such a big deal.

You would be surprised at how adults respond to "I'm going to get some blood from you now" I once had a girl who we warned about the Herpes rate in Miami, came back to the office a month later had active open lesions, didnt cry at that but boo-hooed when I had to get her blood to diagnose which form of herpes she had.

Noone likes going to the doctor when you go youre usually sick and miserable and they stick, poke and prode you. Take him with you to one of your visits, that is if you dont have white coat syndrome. Let him see how you handle things and then when he goes back tell him to remember that moment.

 

[Sara PA]

barbiealonso -- Perhaps you should reread the post. Bwest had taken her son for a 3 year check up; he wasn't sick and miserable. He was scared and anxious. And you can blame the parent all you want for his being scared and anxious (whether that's true or not) but it doesn't matter. A good pediatrician and a good nurse would work with -- not against -- an anxious patient -- or anxious mother (if that were the case).

 

[flutterbee]

Yep, I'd be finding a new doctor, too.

As far as the medical staff being busy and patients being 'babies' (and this child is a baby still, at 3 years old), we live in a free society. If we don't like the service, we go somewhere else. I wouldn't see a doctor who worked that way and I certainly wouldn't force my children to endure it.

And as mom was surprised by this reaction and, therefore, not expecting it, I'm not sure what anxieties or fears mom had that could possibly be triggering this. That's a pretty big assumption to make.

My daughter did wonderfully at the doctor's office until she was 5 and the nurse came in and surprised her with the vaccinations. A look of shock instantly came over my daughter's face and she sobbed off and on the entire day. It took her years to overcome that and she still has to muster up all her courage to go to the doctor. And, no, we don't see the same one.

I'm with SRL. This in and of itself would not be enough to concern me. It doesn't seem to be out of the realm of age appropriate behavior. And nothing in the post sounded like ODD to me. It doesn't read like a child being willfully disobedient just because. I did wonder about some possible sensory issues, but if he had never had his blood pressure taken before it could have just been the unknown that bothered him.

A suggestion I have is to pick up a blood pressure monitor, or borrow one, and show him how it works. Show him by using it on yourself first. Also, go over the various things that will happen at a doctor visit. Show him how the doctor will look in his ears and will look in his mouth so he can be reassured that these things won't hurt him.

I'm sorry you and your son had this experience.

 

[Marguerite]

Barbiealonso, I hear you that some patients can't be handled any better than you already can manage. But I don't think this was one such case. I've seen good blood draws and bad blood draws; I've seen some well-managed situations and some atrociously-managed ones.

I'm well-versed in blood draws on both myself and my kids. easy child 2/difficult child 2 had to have her tonsils out and a vital requirement was a blood cross-match done beforehand. They tried to do this in the doctor's rooms but even though easy child 2/difficult child 2 was cooperating (she was 6) the doctor just couldn't get any blood. He messed around, stuck holes in her, she sat there with tears pouring down her face but she was not moving, because she knew she had to cooperate. Finally the doctor gave up and organised for a blood draw to be done at our home, from a visiting pathology nurse.
The day the nurse arrived easy child 2/difficult child 2 had been getting increasingly anxious. She was in tears before the nurse even began, so the nurse sat down next to her, showed her the needle and said, "This is a smaller needle than doctors usually use. And I'm an expert. I will do this and get it right first time, because I am really good at my job. I can't promise it won't hurt, but I can promise I'll hurt a lot less than those tonsils are hurting you."
The nurse only needed to take a few minutes but in that time she heard easy child 2/difficult child 2's fears (very real, given her experience) and reassured them. The blood draw WAS painless, easy child 2/difficult child 2 didn't even feel it. The nurse told her, "See? I TOLD you I'm good!"

And now difficult child 3, 11 years old, also heading for surgery and needing cross-match. Also cooperative, but very, very anxious. He had asked me before we went in to the pathology clinic, "Can I have a local anaesthetic?"
I said, "I don't know, but we will ask."
We asked - and the nurse was very officious, said, "Good heavens, what nonsense! It's only a simple blood draw! We don't do locals here! We haven't got time for that sort of nonsense!"
I had previously reassured difficult child 3 (remembering easy child's second, positive experience) that nurses really are good at their job, they do blood draws all day.
difficult child 3 said, "Okay then," nervously, sat in the chair - and began to feel nauseous (as he does, when his anxiety gets out of control). The nurse ignored his claim of feeling like he was about to be sick, so I grabbed a rubbish bin (couldn't see a kidney bowl anywhere). The nurse was struggling to find a vein, difficult child 3 was dry-retching into the bin, then began to faint. He was a ghastly colour and kept saying, "I'm sorry, I'm sorry..."

We got him lying down, the nurse insistent that he had to pull himself together. She had already made a few holes in one arm and although he'd been still for her, she had to give up and go for the other arm. Again, she couldn't get a drop of blood out of him - his anxiety was so high that adrenalin had closed off his superficial veins. She finally had a small needle in (she was good - she knew it was in, despite the vein being closed) and together we coached difficult child 3 to breathe slowly, in and out. On each breath out, a few more drops trickled into the tube. As he breathed in, the flow stopped.

Once the nurse had a couple of mls of blood, we still had to keep difficult child 3 lying down for a while until he could stand up again without fainting.

Remember, he WAS trying to cooperate!

He's three years older now, we make a point of having him watch when we have blood taken. A couple of times he almost fainted watching his dad have a blood draw, but he knows he has to overcome his anxiety so he really tries hard to be good.
I've had to get injections of antibiotic in my rear at times; the local nurse does it for me and difficult child 3 asked if he could watch "because I have to harden my heart to this sort of thing".

Barbiealonso, this is what you suggested, isn't it, when you said, "Noone likes going to the doctor when you go youre usually sick and miserable and they stick, poke and prode you. Take him with you to one of your visits, that is if you dont have white coat syndrome. Let him see how you handle things and then when he goes back tell him to remember that moment."

It's a really good idea if you can do this, it is what we have been trying to do, and I think it has helped a little with difficult child 3. However, our son IS 14 years old now (with 14 year sized veins too) and I do think this is also making a difference. But to have to get blood from a much smaller child - it's not easy, even for a seasoned expert. An anxious child has smaller veins that are VERY responsive to the level of adrenalin coursing through their system. Even very young easy child kids who are cooperating, can have very traumatic experiences because of their tiny veins. If the doctor or nurse is at all unsympathetic, it often only wastes more time and makes it worse for the next poor sap who has to draw blood from these kids! And all it takes for a doctor or nurse to be unsympathetic, is a busy schedule. Ironically, that's when their schedule is most likely to blow out!

It is for such kids that EMLA cream was invented.

We don't currently have any EMLA, but we have promised difficult child 3 that if he EVER has to have a blood draw done, we will INSIST on EMLA, even if we have to find a doctor to write the prescription for us. The only exception will be if the blood draw is an emergency, his life depending on haste. I suspect difficult child 3 will cope better next time, he's made amazing progress. However, we need to hear his fears and take them into account, if we're ever to have a chance of helping him overcome them. Nobody ever got over their fears by being told to "pull themselves together".

After the incident with difficult child 3 at the local pathologist (whose time got even more wasted than if she had permitted EMLA - at least with EMLA she could have put us back in the waiting room while she dealt with a few more patients while waiting for the cream to work its magic) we spoke to a friend who is also a GP. Her daughter is about the same age as difficult child 3 (and is a easy child). The doctor said to us that SHE insists on EMLA being used for her daughter - they put it on her themselves when going for a blood draw, it makes sure that there won't be any problems.

Marg