How do children experience an X-ray examination?
Various factors influence how children experience a medical procedure: the preparation for the examination, the communication before and after, as well as dealing with fears and wishes. In radiology practice, where there tends to be little time for patient communication, taking these factors into account can be challenging. To help radiologists with this, a recent review1 examined the verbal and non-verbal communication that takes place during an X-ray examination with children and asked how children experience an X-ray examination.
Inadequate communication with children before and during a medical procedure can promote anxiety and other negative experiences and psychological stress. As a possible consequence, children can no longer or only insufficiently participate in the examination, in some cases even requiring fixation or immobilization.2 In other cases, agreed appointments cannot be kept and important examinations have to be postponed.3
Therefore, it is important to know the factors that influence a child's experience during an X-ray examination in order to optimize procedures in radiology practice on the one hand, but also to protect children's rights.4 For this purpose, the authors Saron et al.1 evaluated peer-reviewed publications in English (1999-2022) for their review. From 2,212 screened titles and abstracts, duplicates (570) and non-relevant articles (1499) were first excluded. Of the remaining 143 full-text articles, 8 publications were finally analyzed.
How do radiologists communicate with children?
X-ray personnel dominate communication during an examination. Observations during 32 X-ray examinations showed that the X-ray staff were responsible for up to 75% of the communication (children: 17%). The verbal statements were mostly task-oriented (“Could you pull your pants over your knee?”) or instructive (“You have to sit down here”). Open communication (“What does... mean?”) or even a social or personal conversation only took place in a few cases.5
In contrast, another study showed how children can be encouraged to participate with simple means. The comparison of patient data (name, date of birth, place of residence) at the beginning of the examination can be used for this purpose if it is carried out in child-friendly language (“Where is your home?”).6
Studies have also reported that although the examination is often explained to the children in a child-friendly way (“It's like having your picture taken”), this is only done immediately before the examination.6 This means that the children hardly had any opportunity to understand and process the upcoming examination. In a qualitative study with 45 children (aged 7-14), children therefore reported basic knowledge (“pictures of the bones”) on the one hand, but also misconceptions that the device could “come down on them” and “crush” them.7
Painful and threatening or quick and smooth - how do children experience the examination?
In some articles, children described undergoing an X-ray procedure as “scary” and “painful”,8 “uncomfortable” or “threatening”.9 Many children reported feeling pain during the X-ray procedure.9, 10 Negative experiences also included long waiting times with no activities or distractions.10
However, in other articles7, 9, 10 children also reported quick and smooth X-ray examinations. The factors that played a role here were, on the one hand, the technical staff, who were described as competent, empathetic, friendly and sympathetic. Secondly, for younger children, the presence of their parents provided reassurance and distraction.5, 6
Conclusion
In summary, the study by Saron et al.1 showed that preparatory discussions for an X-ray examination should take place at an early stage and that children should be actively encouraged in a child-friendly language to join the conversation. In this way, children's information needs can be identified and met in the run-up to an examination. This need for information often concerns relatively simple questions, such as the appearance of the X-ray room, whether the examination is painful or whether the parents stay with their children during the examination.11 In addition, distraction options in the waiting room and sensitive and attentive X-ray staff can have a positive influence on a child's experience of an X-ray examination.
Sources
1Saron H, et al. Communication during children's X-ray procedures and children's experiences of the procedure: A scoping review. Radiography (Lond) 2023,29 Suppl 1, S87-s95.
2Ng JHS, et al. Keeping Children Still in Medical Imaging Examinations- Immobilisation or Restraint: A Literature Review. J Med Imaging Radiat Sci 2019,50, 179-87.
3Davison G, et al. Children's and adolescents' experiences of healthcare professionals: scoping review protocol. Syst Rev 2020,9, 51.
4Dalley JS, et al. Teddy and I Get a Check-Up: A Pilot Educational Intervention Teaching Children Coping Strategies for Managing Procedure-Related Pain and Fear. Pain Res Manag 2016,2016, 4383967.
5Björkman B, et al. Will it hurt? Verbal interaction between child and radiographer during radiographic examination. J Pediatr Nurs 2013,28, e10-8.
6Harding J, et al. An observational study based on the interaction between the paediatric patient and radiographer. Radiography 2015,21, 258-63.
7Chesson RA, et al. Will it hurt? Patients' experience of X-ray examinations: a pilot study. Pediatr Radiol 2002,32, 67-73.
8Björkman B, et al. Children's Anxiety, Pain, and Distress Related to the Perception of Care While Undergoing an Acute Radiographic Examination. Journal of Radiology Nursing 2014,33, 69-78.
9Björkman B, et al. Children’s experience of going through an acute radiographic examination. Radiography 2012,18, 84-9.
10O' Shea C, et al. An exploration of adolescents' perceptions of X-ray examinations. Radiography 2015,21, 146-9.
11Bray L, et al. ‘We should have been told what would happen’: Children’s and parents’ procedural knowledge levels and information-seeking behaviours when coming to hospital for a planned procedure. Journal of Child Health Care 2021,26, 96-109.