With the ever-evolving pandemic situation, public health policies in Singapore may require children to get tested for COVID-19. This means more children may be receiving nasopharyngeal swabs (also called “swab tests”) as part of the Government’s effort to identify and ringfence potential exposure to keep everyone safe. For many children, going for a swab test can be challenging. SPD’s occupational therapist, Genevieve Ng, shares some ways to help parents prepare their children for a swab test.
Challenges that children may face
In an unfamiliar situation such as undergoing a swab test, children with special needs may face the following challenges:
Environmental factors involved in going through a swab test include (but is not limited to):
- Being in a new environment with an unfamiliar crowd
- Having a stranger carry out the swab test, which is a new, unfamiliar and intrusive procedure for the child
Children with special needs may face challenges in the following areas:
- May not understand why they need a swab test, what it consists of and what is expected of them
- Difficulty coping in a new environment that is unstructured, unfamiliar and unpredictable for them
- Poorer ability in understanding standardised verbal or written explanations and instructions
- Experience sensory challenges such as heightened sensitivity to certain senses like touch, smell, sound, sight, or taste
How to prepare your child for a swab test?
Parents can minimise the child’s anxiety by understanding and addressing the causes of your child’s anxiety, and by following the below strategies.
1. Educate and explain to your child in a child-friendly way
Depending on what your child already knows or would like to know, parents can explain key information in bite-sized chunks, at your child’s pace based on their learning needs.
What should I explain to my child?
Use the 5Ws (what, why, who, when, where) and 1H (how) technique to explain the following:
- Overview of what COVID-19 is
- Overview of what a swab test is
- Purpose of it
- Why they need it
- Steps and duration of process
- When and where they will complete it
- How it will feel like
- Who will be doing it
How to explain to them?
- For older children, have a casual chat with them about it
- Use child-friendly terms (e.g. ‘long cotton bud’ for swab, ‘freeze’ for stay still)
- Use social story or picture cards to aid in your explanation
- Visual schedule
- Child-friendly videos that educate and illustrate the procedure
- Medical play: Role-play using medical toys or home items that can represent medical equipment (as close to the actual procedure as possible).
- Let your child be the doctor and carry out the swab test on you or on their soft toys. Parents can enact the procedure through play with your child when he/she is ready
- Use a calendar to show your child when it will happen – countdown day by day
- Bring your child to the venue or show your child a picture of the venue
- Give your child ample time to process the information. You may spend a few hours or days to slowly help your child understand.
- Keep talking about it and going through the procedure and resources as the day draws nearer.
- Provide your child with opportunities to ask questions.
- Ask your child how they feel about it, acknowledge their emotions and reassure them.
- Reward them after the procedure so that they have something to look forward to during the process.
2. Develop a procedural coping plan with your child
What is a coping plan?
A coping plan consists of the specific and preferred ways that the child wants the procedure to be carried out. It outlines the things to prepare for the swab test before leaving home, your child’s preferred comfort toy or object to hold during the test, distraction methods he/she prefers and what he/she would like the nurse to do. Reward(s) could also be written or drawn for the child to remember what he/she can look forward to.
Benefits of a coping plan
- Helps parents and child to plan in detail and reach an agreement
- Reduces child’s anxiety as it creates predictability and structure for child
- Gives the child a sense of autonomy and control as they get to make small choices in the process
- Serves as a visual tool to support child to cope during the procedure
- Clearly outlines how the nurse/doctor and parents can support the child through the procedure
Using the coping plan
After your child understands that he/she has to do a swab test, you can print the Coping Plan template and fill it up together with your child.
3. Support your child during the procedure
For children who are anxious or find it difficult to wait:
- Make sure to plan what your child can do while waiting at the clinic.
- You may consider engaging your child during waiting time by using sensory poppers, fidget spinners, stress ball, bubble wrap, Rubik’s cube, soft toy, story book, or anything that your child typically enjoys playing with and is easy to bring along.
For children who experience sensory difficulties:
Sensitivity to sound:
- Arrange for the swab test to be done at a quieter swab location or clinic, or during non-peak hours
- Put on earmuffs for your child if he/she finds it difficult to cope with the sound
Sensitivity to touch or textures:
- Find out if alternative swab types are available (e.g. Dacron Swab) if your child is able to tolerate the texture of it better.
- Expose your child to the sensation of the cotton swab on his or her body at your child’s pace, moving slowly from his/her hand, to the arm, and eventually to the area around outside of the nose such as the tip of nose. Here are some ideas on how you can do this:
- Incorporate the cotton swab in your child’s play activities. For example, use the cotton swab as a painting tool, play object or face painting.
- If your child is unwilling to have the cotton swab touch his/her face, allow your child to use it to lightly tap or stroke parents or siblings’ face and to explore and familiarise with how it feels on his/her hands and arms first.
- Eventually, tell the child that it is his/her turn. When your child is ready, parents can lightly tap or stroke the cotton swab on his arms, cheeks or outside of his/her nose.
- The overall objective is for your child to be able to tolerate the sensation of having the cotton swab in his nostril for up to 10 seconds (swab test duration).
If you suspect possible exposure, the Antigen Rapid Test kit (ART) is widely available at retail pharmacies and you can get your child tested at home. However, do note that children would have to follow COVID-19 testing requirements at a Swab and Send Home (SASH) clinic if they have been requested to do testing by the Ministry of Health. Nevertheless, using the ART at home as a trial run or for medical play would still be helpful for your child to familiarise with the procedure and feel more comfortable with the medical swab toolkit before the actual testing.
You can receive templates of the above-mentioned Social Story, Visual Schedule and Coping Plan by simply completing this form.
Here are some additional resources to support your child during the COVID-19 situation.
Caregivers (children resources included)
· Nose swab test
· Blood test
· Relaxation exercise
· Hospital admission
· Hospital stay
· Social story
· Visual schedules
· Communication board
· Child profile template form for caregivers to fill up) – pass to health professionals to understand child’s needs & preferences for procedures
Special Care Kit for COVID-19 (Credit: MOH, IMH, NUH, KKH)
(2-7 years old)
Visit to the emergency department
· Video from child’s perspective
(Credit: MOH, IMH, NUH, KKH)
General COVID-19 information
· What is Coronavirus?
· How do I stay safe?
· Video narrative
(Credit: Saint Lucia Government)
· COVID Book in various languages (English, Mandarin, Bahasa Indonesia and more)
(Credit: Manuela Molina)
Child-appropriate education on COVID-19 (SG context)
· Changes to routines
· Self-care skills (hygiene)
· Comic strip conversations
· Photo slideshow
(Credit: Superhero Me)