When The Doctor Says This Won’t Hurt A Bit — And Incredibly, It’s True

In May, my six-year-old daughter, Julia, smashed into our front door handle and got a deep, bloody gash in her forehead.

We rushed her, head wrapped like a tiny mummy, to the medical center at MIT, where we generally go for pediatric care. Julia wept while the nurse cleaned and examined her lacerated skin. After a short exam, she sent us to the emergency department at Children’s Hospital Boston for stitches. “How bad is that, generally?” I asked, having never experienced suturing either for myself or my cautious, risk-averse, older daughter.

“It can be traumatic,” the nurse said.

Julia cried, “I don’t want stitches.”

It’s a large needle, but Julia is too busy coloring to notice.

So I braced myself for the worst: an endless wait and nerve-wracking bustle; screaming, germ-laden children and brusque, end-of-shift staff. But more than anything, I dreaded the inevitable pain in store for my small child with the deep cut.

(I know, kids get banged up on the path to adulthood and some pain is unavoidable. Still, when bloody heads are involved, I tend to overreact.)

Indeed, I was in full Mama Bear mode when into our exam room strode Dr. Baruch Krauss, the attending physician that evening.

Dark, lean and intense, Dr. Krauss shook my hand and then went straight to Julia, complimenting her pink, sparkly shoes. She lit up and was eager to chat. They talked about exactly how old she was (nearly six-and-three-quarters) and what she likes to do (climb trees). Then he gently rubbed a bit of Novocaine gel on her cut and said he’d be back.

I hovered nervously around Julia, checking and rechecking the cut and generally exuding anxiety, while my husband sat quietly, telling me to calm down. Sure, that’ll work.

Five times over the next 40 minutes or so, Krauss came in and re-applied the anesthetic, gently squeezing the site with his thumb and forefinger. Why, I wasn’t sure. Was it a dosing thing? Was he just numbing the wound even more before the scary stitching began? With each visit, he engaged Julia to learn something new about her. For instance, she loves to draw.

And, she loves snacks. On my way back from the cafe with treats, Krauss stopped me in the hall and said something like, “I’m going to stitch her up; it really won’t be bad.” I rolled my eyes. But, he added, “I need you to work with me. I’m going to give you a task.” Fine, I said, though the whole thing sounded a little gimmicky.

Krauss returned with an oversized 101 Dalmations coloring book and a handful of Magic Markers. He opened to a page overflowing with dog outlines. “Julia,” he said. “I want you to color each dog’s ear a different color, OK? Which color do you want to start with?”

“Purple,” she said, grabbing the marker. Focused, driven and completely oblivious to the large needle now going into her head, Julia colored in dog ears for the next 30 minutes. (This is a kid who, when awaiting her first flu shot, sprinted down a hallway until cornered by three nurses.) Every once in a while, Julia checked with Krauss to see if he approved of the colors. Great, he said. “Now, their paws. Each a different color.”

My job was to hold the coloring book up straight.

My husband took video. (That was his stress-reducing task, I suspect.)

As Julia drew, Krauss stitched, about five or six tiny loops in her head. He continued to chat with Julia about the picture and her color scheme; then he’d return to stitching. Soon, it was over. Julia finished her picture and signed it: “To Baruch, Love Julia.”

As we left the hospital, hand in hand into the night, my daughter looked up at me and grinned. “Well, Mama, at least I didn’t have to get stitches.” I looked back at Julia, with her bandaged head and big eyes: “But honey, you did get stitches.” “Really?” she twirled. “Well it was fun.” And she jumped into the car.

The entire experience was so profoundly different from any other medical encounter I’ve ever had as a mother. I understand that in an emergency, the priority is to fix the damage as fast and efficiently as possible. But Krauss offered such a higher level of care that I wanted to know more.

So I Googled him, and my mouth dropped as I read his profile: “Baruch Krauss’ research focuses on pharmacological and non-pharmacological techniques for relieving acute anxiety and pain in children undergoing diagnostic and therapeutic procedures in the emergency department… (my bold).

We’d won the ER lottery with this guy. It was like going in for your regular, ho-hum therapy session and finding Freud. This doctor chose my priority as his priority: to spare my child from pain.

But the story isn’t over.

About a week later, our home phone rang at around 9 pm. It was Baruch Krauss. “Hi,” he said. “I’m just checking in to see how Julia is doing.” He was interested in how the wound was healing, but also about her experience in the ER — her memories and the language she used to describe the treatment. Honestly, I said, she loved it. She said she would go back to the hospital any time.

About a week later, our home phone rang at around 9 pm. It was Baruch Krauss. “Hi,” he said. “I’m just checking in to see how Julia is doing.”

After our conversation, I hung up thinking this guy is too good to be true. Sure, any decent doctor at any children’s hospital in the country might comment on a kid’s sparkly shoes, and try to engage on the child’s level. “But,” says Gary Fleisher, Pediatrician-in-Chief and Chair of the Department of Medicine at Children’s Hospital, “the more sophisticated techniques that Baruch practices are not widely used. I don’t think anyone is as good as Baruch.”

So, why aren’t all medical interactions this way? Why isn’t pain reduction, particularly for children, a priority for all doctors? When I told this story to a friend, she said her kid recently needed stitches at a public hospital in Mexico City where the staff put her son in a straitjacket and sutured him swiftly, without even a local anesthetic.

Again, Dr. Fleisher said: “You can only focus your energies in so many directions. Maybe at another hospital what they’ve done is put a lot more effort into brightly painting the ER or painting murals on the walls, and maybe in another place they worry about the noise levels and try to minimize that. There are hundreds of things that are not life and death aspects of medical care. You’ve got to focus and prioritize.”

It turns out Krauss has been focusing for more than 20 years on how to minimize acute pain and anxiety in children undergoing medical procedures. “I first became interested in it when I was working at Cambridge Hospital in the late 1980s,” he said in an interview. “At that time there really was no emphasis on managing pain in children. And I witnessed children going through procedures, and they were really suffering, not only from pain, but also, more so, from anxiety and stress. And at that point I became really committed to doing something about that.”

But the seed had been planted long before. Krauss grew up in Woonsocket, Rhode Island where his father was the rabbi of the Jewish community. “In his later years,” Krauss told me, “he became the Jewish chaplain at Memorial Sloan Kettering in New York City focusing on death and dying counseling. I learned compassion from him and an acute sense of identifying people who were suffering or in distress along with a desire to comfort them.”

That explains the post-stitches phone call. “I try to call most of my patients, especially those that I do procedures on, to find out how they are doing and to have a sense of what their experience was like,” he said. “I have had many patients return to the ER who I took care of years before and tell me that what they remember from their experience is the task that they became involved in. It is very gratifying to know that I can help children not only with their injuries but more importantly in shaping their experience and their memories of that experience as painless and non-traumatic. My father would be proud.”

Krauss, who trained as a clinical psychologist before turning to medicine (and also has a Masters degree from Harvard Graduate School of Education) is well-known at Children’s for his rather unorthodox techniques, among them hypnotizing children using a combination of relaxation and desensitization methods to shift kids’ attention away from their traumatic injury and pain. He’s an expert on both pharmacologic and non-pharmacologic techniques, and wrote the book on pediatric sedation and analgesia.

Krauss and I talked for about an hour at an office at Children’s last month. Here, edited, are the top pearls of wisdom he shared.

How Children Feel Pain: The Evolution

There was a lot of dogma that we had in medicine until about 25 years ago, 30 years ago, that… newborns didn’t have the neurophysiologic apparatus to experience pain. So procedures — and I’m speaking about major surgeries — were done on these newborns with sedation, but without pain medications because that was the dogma, that was the belief that they really didn’t experience pain. And then there was also the dogma that when young children — if they experience pain, they experienced it less intensely than adults, and they didn’t remember the pain. Now, any of us that are parents know that that’s really not the case. And it took us a while from the medical point of view to arrive at that awareness.

Treating Children Means Also Treating Parents

With pediatrics, we’re…not just dealing with a child, we’re dealing with a dyad. We’re dealing with a child and parent. And as we all know as parents, there is a broadband, wireless, emotional connection between the parent and the child, and it goes both ways. The child is sensing the parents emotional state in a particularily stressful situation, and the parent is sensing the child’s emotional state. And they kind of feed off each other…I’m always very tuned in to the emotional state of both the child and the parent because if the parent is very anxious, [the child may be] picking up from the parent through that emotional connection and it’s shifting their emotional state.

Adults Like To Know Exactly What’s Going To Happen; Children Not So Much, Or The Curious George Effect

Over many years of observing children and their response to fear and anxiety, particularly young children, I’ve come to the conclusion — and I think this has been quite validated in the neuropsychology literature — that young children have great difficulty processing preparatory information. What you would do with an adult is…Let’s say you had a cut and we needed to suture it, then obviously I would explain it to you, almost a variant on informed consent. I would explain to you what’s going to happen, what we’re going to do, etc., before I did it so you are prepared for the procedure. And the theory behind that is that calms adults. Not only is it ethically important to tell them, but it also has a calming effect because they know what’s going to happen, they have all the information, they can prepare.

Well, my experience has been that if you look carefully, many practitioners are still using that approach with young children. And my experience has been that that produces the opposite effect in young children. To tell them what’s going to happen, it makes them more anxious and less cooperative because if you’re talking about a young child…they can’t cognitively mediate their anxiety. Right? You go to the dentist, you may be concerned, you may have a little fear, but you can sit in the chair. Children under five can’t do that. As soon as they’re afraid, they can’t cooperate.

So everything I do is focused on a completely different approach. And that approach is, instead of preparing them by telling them what’s going to happen, I prepare them by shifting their awareness away from the source of their pain and anxiety.

(I call this “The Curious George Effect.” Remember the 1966 classic, Curious George Goes To The Hospital, in which the little monkey swallows a puzzle piece that must be surgically removed? The most memorable moment of the book is when “the pretty young nurse” approaches George with a large needle and says, “This is going to hurt George, but only for a moment,” and he screams before the needle even touches him. I think this is what Krauss means when he says young children, or monkeys, can’t “cognitively mediate their anxiety.”)

Needles And Stitches But No Pain

You must be able to establish rapport. I think before you do anything, you have to establish rapport with the child. And that’s a relationship of mutual trust and emotional affinity. That’s a Webster’s definition. Well, what does that look like in a…child? What that looks like is me tapping into that emotional connection between the parent and the child, and being able to accurately assess the parent’s level of anxiety and the child’s level of anxiety. Then I can go to work. So, that’s the first thing I do. And I can begin to gauge that right when I cross the threshold into the room.

So if the child is sitting on the stretcher and the parent is sitting a chair reading a magazine, then that tells me a lot about the level of anxiety, as opposed to, I walk into the room and the child is clinging to the parent. Yeah? That’s a different level of anxiety. So I’m already making an assessment of the level of the anxiety of the dyad as I cross the threshold.

Treating Julia

Here’s where Krauss talked about my specific situation:

Krauss: So, when I walked into the room, one of the first things that I did was to assess the situation, and it seemed like there was a fair amount of parental anxiety, and that Julia was sort of in a funny state. On the one hand, she in her own experience was not particularly upset, yet she was getting a message down this emotional connection that something very anxious was going on, and something might happen. So, the first thing I had to do was work with that.

Rachel: My apologies.

No, you were acting normally as a parent. That comes from your protective mechanism. You want to protect your child, you want the best for your child. You’re concerned in a certain way. Sometimes with the parents there’s a little guilt mixed into that because they turn around for a second, they turn back and something happened to the child, and then they’re in this situation where they feel helpless because they don’t know the system. So all that has to be taken into account.

Now, as you noticed, the first thing that I did with Julia was I said, “Hi, I’m Dr Krauss.” Then I immediately started talking about how nice her shoes were…and they seemed to match her shirt, maybe that’s a color she seems to like. All that is about establishing rapport, and shifting her awareness. Because now, it creates a sort of confusion for her. She’s expecting me to go right for [her head] yet why am I talking about her shoes? Well, confusion is sort of the beginning of a hyper-suggestable state. So this is a beginning of a way to begin to make contact.

Then you notice that what I did was, instead of placing the topical anesthetic on and just leaving it and coming back in 30 minutes, I came back every 5 minutes and I applied it.

What was that about?

It was just Novocaine jelly; that’s all it was. And the reason I did that was because it’s important for me to desensitize her. I’m a stranger, I wanted to desensitize her to my touch and my presence. So every 5 minutes I came in, and you notice the first time that I did that, the first couple times, she’d look up, and she’d be concerned about it. And then by the 4th or 5th time, she really wasn’t paying any attention to that.

At the same time, I was gauging what she was interested in. Now for her, it was relatively straightforward because I recall she was drawing. And so I sort of validated, is that what she’s interested in? And then I used that to focus her attention. So here I am desensitizing her to my touch because that’s where I’m going to be spending my time. So by the time I got back in there, after about 30 minutes, the other thing was that she was not particularily concerned with what I was about to do, she was more focused on the coloring. Then I gave her some tasks to work on —

You brought her a coloring book.

I brought her a new coloring book, and I very specifically said to her, can you color that color in this way, so I’m focusing her attention, and drawing on certain developmental tasks she’s already working on herself to master. Can she color just around the eyes? The fine motor coordination. Can she do these kinds of things. So these are all going on, and at the same time a very interesting thing is happening, which is that as I’m working with her, her anxiety is decreasing. That gets transmitted up the emotional connection, and then you and your husband begin to relax, that gets transmitted back to her.

Julia is now fine; her wound is healing nicely. (Photo: R. Zimmerman)

The Anxious Parent

The thing I have found with parents is that sometimes at the beginning, parents want information: ‘What are you going to do to my child, what’s gonna happen,’ etc. And I find that addressing that first thing is counter-productive because if I’m talking to the parents, there’s almost nothing I can say, particularly if I’m doing a procedure on the child, that’s going to calm them down. They get more anxious, that gets communicated down the emotional connection, and that makes it harder for me to establish an emotional connection with a more anxious child.

But what happens is, I always wonder, where does the notion of competence come in? In other words, we are strangers. I’m coming into a room, you don’t know how competent I am, and I’m going to do something to your child. And I think some of the granting of competence is the change in your child’s emotional state…I’ve never had a parent where I’m working with the child, the child’s anxiety comes down, they’re being very cooperative, we’re in a rapport, and that gets transmitted up the emotional connection. At the end, the parents never tell me, “Well what are you going to do? Why didn’t you tell me this or that?” It’s self evident. They experience it.

I was outside the room getting her something to eat, and you told me that you were going to give her a coloring book and you asked me to just go with it. So you got me on board a little bit beforehand.

Yes because I really needed you to collaborate, mainly I needed you to collaborate in terms of controlling your emotional state so that she could have a positive experience and didn’t have a countervailing influence.

But you also wanted her fairly still while you stitched her up, right?

Yeah, I can hit a moving target — in the emergency department we hit moving targets. It wasn’t essential for her to be absolutely still to do the wound repair, she had to be relatively still, which she was. There were times I had the stitch in and she was sort of looking around, but that was fine. And I think, once you’re in rapport, you’re in the environment where you can influence the emotional state of the diad, then you can spend the rest of the time trying to focus the child’s attention away from the source of the anxiety on something they’re very interested in. So that sort of becomes the primary thing they’re focused on.

Seems So Simple, How Does It Work?

It’s almost as if the consciousness has two components. You can imagine it as the central component and the peripheral component. The peripheral is like your hard drive. So in your peripheral at the moment is perhaps the sound of the fan in the room, or the sensation of your pen against your fingers, the ambient room temperatures. In the central would be the sound of my voice, certain body sensations that you have. Now, my job is to move all the sensations of that laceration from the central compartment to the periphery. So for Julia, what I’m doing there may be no different from the sensation she has in her left great toe. She has it, but she’s not paying much attention to it. It has no emotional valence for her.

Once I’m able to successfully move or shift her awareness, then what’s in the central compartment is an empty file, which I can fill, in this case, with coloring and the developmental tasks she’s trying to do, etc. So that her experience at the end is that she doesn’t remember what happened here because for her it was no different than the sensation in her left great toe. What she does remember is what she was focused on.”

You put a big needle in her head and gave her 5, 6 stitches. She didn’t feel that?

That’s another piece. That piece is also technique. There are the very small gauge needles, there’s a way of injecting Novocaine so it doesn’t hurt. There are actually practical techniques you can do to minimize the pain of injecting, the pain of the needle.

But you’re saying that if you hadn’t done this psychological prep work —-

That’s right, she would have been very focused on this, and it would have heightened those sensations. She would have been anticipating feeling something.

Studying The Video

When I was a fellow…still in training, I was noticing that I was able to do things with children, to get children to cooperate, to have children have a painless, non-traumatic experience on a more consistent basis than some of the more senior faculty. And I didn’t think this was something more personal to me. There were clearly some skills that I brought to bear that I wanted to be able to identify, articulate, and teach.

So, at that time we didn’t have the stringent informed consent where we had to get permission for every picture. So I took a video camera and I put it in the procedure room. And I just let it roll while I was doing procedures…

And I would go home at night, and I would watch it and I would try to understand what I was doing. From that I was able to develop this whole philosophical framework that I talked to you about originally, about preparing the patient, and the techniques. That all came from watching what I was doing intuitively.

I teach this all over the world, the non-pharmacological management of acute pain and anxiety along with pharmacologic.

Do you carry this technique over to your own children?

I’ve actually sewn up my youngest, and he didn’t pay any attention to what I was doing.

So you’ve psychologically primed your kids to never pay attention to you?

Exactly, now they’re teenagers and they never pay attention to me.

The End Of The Story

Julia is fine now, and her wound is hardly visible. A couple of weeks ago, we received the bill from Children’s: a $100 co-pay. Best money we ever spent.

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  • Tawnya Jarvis

    What a nice experience for this little girl and her parents. I wish everyone could have such a good and positive interaction with the entire health care system. However, look closer at this story. I have been a physician for over 30 years, and can tell you that Dr. Krauss’ approach works well. And from the story, he spent approximately 1.5 hours or 90 minutes treating the laceration with 6 stitches. While working on this patient in a typical busy hospital Emergency Room, another person has had a seizure that was avoidable, one waited too long time with a broken leg that may cost him his leg without treatment, an older woman extended her brain stroke making her eventual recovery much less likely, and another person died of an acute heart attack. These bad things happened because Dr Krauss spent 90 minutes treating the nice little girl for her laceration, and her parents for their mental disorder, and did not have enough time for the rest of the patients. This is the reality in this story.
    You can tell things about Dr. Krauss from this story. He is a caring physician and he on a salary. His pay is not related to his productivity in the ER. This means that he can make his co-workers work harder while he takes 90 minutes with a small laceration. His co-workers are fully aware of his beliefs and approach to pain relief, but they have to work extra hours to treat more patients and save more lives while he plays nice. All of his co-workers like him, and they all wish he worked someplace else.
    You can tell things about the parents. They are loving and concerned parents, and totally bonkers. They wish to control the treatment of their little girl, and look for ways to prolong the entire process. They have the time and plan ahead to take a video recording of the placement of the sutures. Perhaps they wish to replay these fond moments to their daughter later at her wedding or some family get together. Or perhaps they are looking for problems so that they can sue the doctors and hospital later if there is a scar on their daughters face. And they are thrilled about their $100 co-pay, as if their insurance money and their co-pay was a suitable reimbursement for the extended care they received. It is likely that each of these parents make more money per hour than they paid this doctor for his 90 minutes.
    You can tell things about the little girl. She is a nice girl playing her part to her parents. She cries and carries on to her parents, not to the doctor. Once she is given something to do, she no longer plays for the attention of her parents, and things go smoothly.
    Here is the reality. Once a procedure for a minor has been explained to the parent, their questions have been answered, and they agree to the therapy, then they have to go sit in the waiting room. No standing around and making it difficult on the medical staff and NO videos. Actually, the video was illegal if it recorded any other person or voices, and the Hospital was taking a very real risk by allowing this. Up to $10,000 fine for each privacy violation. I am sure these parents scared the entire staff with these antics. Once the parents are gone, most children stop crying and listen to instructions, since their role in the play has changed, and the parents are not around to impress anymore. No special tricks are needed, and Dr. Krauss can get his work done, and go on to the next patient. It takes less than 15 minutes to place 6 sutures without severe pain.
    These kinds of stories about nice adventures in the real world are not really helpful. Dr Krauss needs to go into private practice, and these parent need some parenting therapy. Otherwise, the cost for health care for the rest of us goes up, and the quality of care goes down.

  • Deborah G. Walker

    This is light years away from what I experienced in hospitals as a child during the dark ages of the 1960s. Those early experiences are with me still and cause me great anxiety when I am in a hospital. I remember the traumatic experience I had getting my finger stitched up when I was Julia’s age. Then being tricked by an anethesiologist before my tonsilectomy. He seemed a kindly man and asked if I was afraid and would like him to hold my hand. I nodded and offered my hands. He pinned me down and I screamed while the mask to knock me out closed in on my face. It was like a horror film. I wish I had sought out that doctor as an adult to confront him about what he did to me.

  • http://www.ancathach.com/ GreenOfEye

    Great article and wonderful doctor. Having had a traumatic experience as a kid getting facial stitches where i was held down without anesthetic, i can only hope more medical professionals can take a leaf out of Dr Krauss’ book.

  • Laura Perry

    What an amazing gift! A Dr. who is insightful enough to realize that putting a child at ease will also calm the parent. This man is a pioneer. I hope that his ideas will become a standard of practice for the care of children. I have two boys ages 7&8 who have undergone and will continue to undergo multiple bone surgeries at Boston Children’s Hospital. The staff there is amazing in the level of care they give, from the security and cleaning staff to the doctors and nurses, each person is focused on giving children and their families the help and support they need.

  • Lynne

    Brilliant! I’m a hypnotherapist (and mind/body practitioner) in the DC area; this is a beautiful example of how to blend hypnotic techniques with conventional medicine. Thank you for sharing this powerful example, and for sharing both of the videos with all of us.

    Lynne Shaner, MA, CHT

    Washington DC

  • http://sunkcostsareirrelevant.com/ Slug @ SunkCostsAreIrrelevant

    Simply excellent. Keep spreading the word!

  • Tom Cloyd

    Wow. This has to be one of the most exceptional accounts of anxiety management I’ve ever read – from many points of view: superb subjects (Dr. Krauss, your daughter, and you), very intelligently written about, with a wonderful outcome. As a psychotherapist, I treat anxiety in its worst forms, and absolutely everything you reported Krauss saying and doing rang true. Rapport, then calm and low-emotional-valence activity, then focused misdirection…so I can do my job. It just works, and it all starts with one’s really caring about the individual in distress.

    I will be referring lots of people to this, for which I offer you my profound thanks.

  • Paula Braman-Duarte

    Brilliant, thanks for sharing, wish this method (and the ideas surrounding it) was employed generally. The doctor “had me” at the shoe query, and, does he have a brother who’s a dentist?

  • http://www.facebook.com/butta57 Margo Rubenstein

    you are the ER WHISPERER…..
    kudos…when i practiced dentistry i applied many of the same techniques…it always worked best with the parent out of the room…..

  • tonbo0422

    What is a “dyad?”

  • helentroy4

    Very interesting. My son forwarded this to me and asked “does this sound familiar?” Yes it did.
    Twenty two years ago, my son fell against a door frame and received a deep gash to his forehead right between his eyes. We took him to the emergency room where the doctor started applying an anesthetic gel to his wound. The doctor wanted a plastic surgeon to suture the wound. We waited over an hour for the plastic surgeon to arrive. The ER doctor applied anesthetic gel several times while we were waiting. Finally he said, “I don’t think he’s coming. Would it be all right with you if I just suture it?” I agreed that waiting was more stressful than getting sutures. The ER doc proceeded to suture the wound (ten stitches) without injecting anesthetic. My son didn’t have a coloring book but the doctor distracted him by using a suture drape cut into a “superhero” design.
    Not one “ouch!” was sounded. And he told us to drop in in a few days to have the sutures removed by him. For free. He taped the wound afterwards and now 22 years later there is hardly any scarring to be seen. Thank goodness for that nameless ER doctor and for doctors like Dr. Baruch Krauss who are patient, skilled, and tuned in to a child’s psyche.

  • http://www.facebook.com/damian.hamill.7 Damian Hamill

    Dr Krauss appears to do incredibly well what all other doctors SHOULD be doing – not just with children but with adults. As a hypnotherapist and trainer in the field I have introduced these ideas to many students and also used them with clients from as young as 4, through 17, and with adults as well.

  • http://www.facebook.com/jackLaustin Jack Austin

    Very impressive and enjoyable article to read. I love the multiple modality telling with video and audio, and of course the brilliant insights of Dr. Krauss. I love children and remember some pretty scary procedures when I was a young person. Fortunately I generally had great care. However the story of medical practices not even using anesthetics for young children because of the belief about not having pain memory caused me to decry the practice to the board meeting at University Hospital San Diego on my discharge interview. The sounds of the screaming young burn patients would haunt me for years, as they wailed in the ward next to mine because of their extreme pain and this absurd belief carried to the point of debreeding their wounds without the type of pain management applied to adults.

    Thank you for publishing this more evolved and humane experience.

  • Cathy

    Wonderful article….. yes, you hit the lottery with Dr. Krauss and that is the tragedy of it. More doctors who go into pediatric specialties should aim their care at the child and the child’s family, not at the child’s diagnosis. Thanks for publicizing his accomplishments in this arena with your article. I hope that others take his wonderful example and run with it.

  • http://cranquis.tumblr.com Dr. Cranquis

    WOW. This is a fantastic article/interview/videos compilation! It affirms a lot of what I’ve learned (totally on my own — nobody trains you in this art in med school/residency!) in dealing with children in pain — but it also expands my mind with further ideas to improve my therapeutic connection with frightened children. Thanks so much!

    • http://www.facebook.com/jackLaustin Jack Austin

      Patch Adams was persecuted for this originally, wasn’t he?

      • http://cranquis.tumblr.com Dr. Cranquis

        I’m no Patch expert, but yeah, I think part of the reason he was considered such a rebel among traditional medicine was because he believed children had feelings and emotions and a sense of pain.

  • Suz

    Dr. Milton Erickson would be very proud.

    • bubba

      this story is exactly something one would read in milton erickson/jay haley chronicles.

  • Whittney

    One of my biggest complaints about medicine and dentistry is addressed here. He doesn’t blow off the children’s feelings like so many professionals do. ( I had one tell me, well, you 3 year old (who is afraid of the dentist) brings the anxiety on herself.

  • http://www.facebook.com/hypnotictherapeutics David A. Blender

    Excellent share, Rachel! I’ve been in practice as a clinical and medical hypnotist assisting adults and children with acute and chronic pain for some time. Hypnosis and hynotic language patterns and distraction techiques work extremely well. Of course, there are many more ways to achieve hypnotic pain control and management. It never ceases to amaze me, when someone’s facial expression changes from being in pain, to the realization that they are no longer conscious of any pain. Good on Dr. Krauss!

  • http://www.facebook.com/aiton.birnbaum Aiton Birnbaum

    Terrific! Interesting that in psychotherapy using EMDR we also use “dual attention stimulation” to help clients process traumatic or other distressing life events.

  • Steven Tromans

    Wonderful story. For those with an interest in how to communicate more effectively to promote healing I heartily recommend the book Magic In Practice by Garner Thomson

  • disqus_BEzmvGxAjT

    New England Child Life Professionals, Inc. applauds Dr. Krauss’ sensitivity to the anxiety and stress that medical treatment can bring for children and parents. He clearly took the whole family’s well-being into account during their visit to the emergency department. His approach incorporates many of the tenets of family-centered care and techniques that child life specialists use in their daily practice.

    Child life specialists are professionals in the medical field trained to coach and support families through the challenges of hospitalization and health care. Like Dr. Krauss, child life specialists work to build relationships with children and families, involve parents and patients, and ease stress and fears about medical procedures. However, child life specialists also believe that knowledge and trust are important tools in helping children cope with health care experiences. For some children, not having information prior to getting stitches or some other medical treatment can lead them to worry they aren’t being told about other procedures. This can undermine their trust and increase fears related to health care. Child life specialists assess their patients’ ability and desire to understand medical procedures and provide information that fits those needs, as well as tools for coping with anxiety.

    • R

      Thank you for clarifying the important role of child life specialists and how their approach is both similar to and different from Dr. Krauss’. I only wish child life had beeb mentioned or discussed in the original article.

  • http://www.facebook.com/kris.bruneau.52 Kris Bruneau

    New England Child Life Professionals, Inc. applauds Dr. Krauss’ sensitivity to the anxiety and stress that medical treatment can bring for children and parents. He clearly took the whole family’s well-being into account during their visit to the emergency department. His approach incorporates many of the tenets of family-centered care and techniques that child life specialists use in their daily practice.

    Child life specialists are professionals in the medical field trained to coach and support families through the challenges of hospitalization and health care. Like Dr. Krauss, child life specialists work to build relationships with children and families, involve parents and patients, and ease stress and fears about medical procedures. However, child life specialists also believe that knowledge and trust are important tools in helping children cope with health care experiences. For some children, not having information prior to getting stitches or some other medical treatment can lead them to worry they aren’t being told about other procedures. This can undermine their trust and increase fears related to health care. Child life specialists assess their patients’ ability and desire to understand medical procedures and provide information that fits those needs, as well as tools for coping with anxiety.

  • yankeetransferred

    I had a similarly fabulous experience at Children’s when my daughter slammed her finger in the car door and we had to go to have the pressure relieved from under the nail. I wish I could remember the doctor’s name. He was fabulous, he put her at ease, he did what he had to do, and she never flinched. He drew on the sheet that was on the gurney with a pen! She was fascinated. He illustrated how a geyser of blood my spurt from under her nail, but explained how it would not hurt…and it didn’t. It was a really great ER trip.

  • Valerie Wycoff

    Most fascinating blog I’ve read in weeks! Thanks for sharing this greatly skilled practitioners methods and your personal experiences.

  • http://www.facebook.com/dgnreid Donna Reid

    When our daughter was 5 she had to have her tonsills out. We were fairly relaxed about it because my husband is an RN and the surgeon was/is a friend of ours. The unkown factor was the anesthesiologist. He came in to the room quietly and spoke to our daughter and then to us and then asked the adults to leave the room while he spoke quietly to her alone. He made a trusting relationship with her and explained things to her at a level she could understand. They laughed quite a bit! We were then invited back in and our daughter never revealed the contents of their conversation but she was very confident after that and had a good surgical experience.The Dr. went that extra step and made sure she was comfortable ,relaxed and trusting when she went in. She is 33 now and still remembers that as a very good experience.

  • http://www.facebook.com/richard.watt.330 Richard Watt

    When I was 8 I got a cut on my hand. The school nurse cleaned is and before she put Mercurochrome on it, she said this is going to sting. I thought she said stink, so aftewards I smelled my hand, and said, “It sure does.”

    • Raymond

      Ha Ha Ha ! Q.E.D.

  • Polly

    I only realised how good my dentist is when my ten-year-old had a filling done. He’d had such a good experience previously with the dentist that he didn’t know he was supposed to be frightened. I sat and watched and listened to that horrible whining sound of the drill, everything that usually sets people off – and was a bit startled to see that my kid’s hands were completely open the whole time, never once clenched onto the armrests, even during the worst of the drilling. He’s been to the same dentist all his life for checkups, and because the dentist is so calm and kind, he’d never learned that “going to the dentist” is a synonym for a bad thing.

    Same when he had an op. He was having minor surgery on his back, with some stitches under local anaesthetic, and the surgeon encouraged him to lie on his stomach to play his DS while the op was going ahead. A few rounds of Pokemon, and the op was over. The surgeon showed my kid the excised bit of flesh floating in the jar (to be sent off for analysis) and my kid thought the whole thing was pretty cool.

    What both of these had in common, I think, was that the dentist and the surgeon were very calm and relaxed – no drama at all. I’m the *worst* kind of overprotective parent, but I really downplayed both events (indeed, worried that I was downplaying them too much), and I made each hospital trip in the run-up to the surgery into a nice thing – went to a cafe afterwards as a treat, and so on. But it was the drama-free relaxed kindness of the two professionals, over an extended period of time, which I suspect made the most difference.

  • David Stuart Thalenberg

    “Exactly, now they’re teenagers and they never pay attention to me.” Excellent punch line!

    • http://www.facebook.com/jackLaustin Jack Austin

      Were the both of you speaking how desensitization to parental domination can be a preparation for adolescence?

  • Tammy

    What a great surprise and delight! I am a pediactric nurse practitioner and have worked with children in many different situations where pain was involved. How great to know that there are people out there who not only care deeply about children but also share their knowledge by teaching. Great work Dr. Krauss!!!

  • PL

    As a long time critical care nurse, I have always found it useful to engage my patient (if possible) in a discussion of anything…as long as it was not about their illness or pain. At least for awhile it removes their attention away from their current condition (and discomfort). Without fail however, in the middle of a nice calm conversation, the family will walk in, and the absolute FIRST thing they say is “Are you in pain?” HELLO! I have just spent 30-40 minutes moving their attention away from this! Frustrating!

  • Tamidon

    I had to take my daughter, than 8y.o., to an ER 5 years ago that was awful.Nice hospital, but the Dr.swanned in,intro’d himself to me, never addressed her, poked at the bad wound on her knee(peeled back the skin) and then left. He came back 5 minutes later with a tray, looked at me and said “Mom, you need to hold her knee down for me” and then shot up her knee with a large needle 4 times.She had been calm and accepting until that, and then totally lost it, so she was hysterical while he ignored her totally and stitched her up.He also didnt wait to see if the shots had taken effect and ignored her crying in pain. I wish more dr.s were like Dr. Kraus

  • EtherDoc

    Dr Kraus understands that much of pain involves the emotional state of the patient. Parents often make things worse for their children by unwittingly increasing their anxiety. Children are very good at reading their parents’ emotional state. So much of the treatment of children’s anxiety involves getting the parents to help decrease anxiety by being cool rather than uptight. We do the same thing when we anesthetize children.
    EtherDoc

  • judyp

    Great story, great doctor! Thanks.

  • Marie

    Julia, great verbal description of your experience! And Rachel, I could feel your experience the entire way through your writing. I am in LOVE with your doctor, and I also love the way he has tapped into something huge and uses it for good. Fabulous article – thank you.

  • rdev

    How lucky to encounter a gifted doctor with a humane, insightful approach at a crucial moment in your life. You conveyed everything I would want to know about your experience, as well as giving a concise account of the clinical observations of the good doctor, leading him to his unique method. In all, an inspiring read.

  • diesel

    Of course this works with adults too! What I learn from physicians who are actually concerned about the pain experience of their patients, is that they convey such a familiar and comfortable presence that their patients sometimes even “enjoy” a painful procedure. This is what I call “the spiritual approach” to medicine. The two-four licks of a popsicle can be translated to many other creative tasks for any person suffering pain.

  • Dave Holzman

    delightful story.

  • Klara

    I also wonder if these techniques could help adults with chronic pain?

    • Valerie Wycoff

      Kiara – there are techniques for changing chronic pain by teaching the spread of attention to areas that are comfortable and pleasurable and differentiating other sensations such as temperature, pressure, etc. The Feldenkrais® Method is something that offers chronic pain sufferers some paths of moving out of pain, and many other advances are being made using neuroplasticity to change the experience of pain sufferers.

    • http://www.facebook.com/miriam.breslauer Miriam Breslauer

      I am a chronic pain sufferer and I use techniques like this often to ignore the problem. Eventually the pain load gets high enough that I fall to the floor paralyzed until the pain trigger is dealt with, usually by someone else stretching my muscles.

    • Kelley T. Woods

      Absolutely! My colleague, Michael Ellner, and I even wrote a book for physician’s to utilize these approaches: Hope is Realistic – A Physician’s Guide to Helping Patients Take the Suffering out of Pain. We also have an ebook version for pain clients on our Hope is Realistic website. (We’re certified hypnotists who have helped thousands of people reduce chronic pain…)

  • Ash

    “…
    because if you’re talking about a young child…they can’t cognitively mediate their anxiety. Right?” This is also true of adults, prompting the question: Could these techniques help adults, especially those who have experienced serious traumas?

  • Yoshi

    Dr. Krauss sounds like the kind of practitioner we’d all want for the children in our lives, or for ourselves when we were children. I still vividly remember needing stitches in my forehead when I was six; I was terrified, and cried throughout and couldn’t stay still. The nurse was lovely and good at calming me, but the doctor stitching me got so fed up that he actually yelled at me to ‘stop acting like such a child’. I… was six years old.

    While I understand now that my doctor was probably exhausted from a too-long day full of dozens of other children being just as frightened and difficult as I had been, I think it’s telling that I remember his words so clearly almost 30 years later. Had he been able to try an approach like Dr. Krauss’s, I suspect that I would have had a very different experience of medical care. I hope that more pediatricians adopt these techniques.

    Also, Rachel: I struggled with getting shots as a child too, until I heard a doctor say that it can help to listen to a Walkman (as it was at the time) as a distraction. I told my parents, and at my next appointment we tried this. It was like night and day. I did this for a few years after, and eventually I became so comfortable with getting shots that I didn’t need it anymore and now have no problems at all with shots, IVs, giving blood, etc. This might be a trick worth trying with Julia.